Credentialing Notices: Incomplete Applications, Retroactive Requests and Lapsed Recredentialing Changes

Effective Nov. 1, 2021:

Incomplete Credentialing or Recredentialing Applications Will Not Be Processed

• Only applications containing all necessary information and attachments can be processed.
• Applications missing information will be rejected.
• If you receive a notification that something was missing from a credentialing or recredentialing application, please resubmit the application with the requested information at your earliest convenience.

Lapsed Recredentialing
Recredentialing occurs every three years. Three notifications are sent to request submission of recredentialing applications:

• 180 days prior to due date
• 120 days prior to due date
• 60 days prior to due date

If recredentialing paperwork is not received by the three-year recredentialing due date, claims will deny, and providers will be liable for services rendered on or after that date. Claims will not be adjusted to accommodate a lapsed recredentialing timeframe.

A full credentialing application will be required to reinstate provider eligibility/participation as well as directory display capabilities.

Effective Jan. 1, 2022:

Retroactive Providers
Providers have a responsibility to notify Blue Cross Blue Shield of North Dakota immediately when a new provider is joining a group/practice and when a provider is no longer on staff or taking appointments.

As of Jan. 1, 2022, BCBSND will not retroactively affiliate providers to a service location beyond 90 days. Credentialing/recredentialing must be current before any setup can occur. Services incurred more than 90 days prior to submission of any credentialing or affiliation request will be provider responsibility and adjustment requests will not be accommodated.

Directory Maintenance
This is a reminder that directory information must be reviewed and validated every 90 days starting Jan. 1, 2022, in accordance with the No Surprises Act. Our most recent provider demographic surveys have been timed to begin aligning with this new requirement.