Curious Which Services Require Precertification?

Blue Cross Blue Shield of North Dakota (BCBSND) released a capability to aid providers in determining if precertification is required. By using the precertification search tool, available on the BCBSND provider website, providers can now search by code or keyword to determine precertification requirements. The enhanced tool, links providers directly to the corresponding medical policy and into Availity Essentials to complete the precertification request.

This information is available to providers 24/7 and eliminates the need to contact Provider Services to verify the requirements.

For Drugs, a list is available on the Rx Tools webpage. Towards the bottom of the page, under the “Restricted-Use Drugs” section, the listing can be found under the “Restricted-Use Prior Approval Drugs” link. When viewing the listing, pay attention to the far-righthand column. If the indicator is “MED” then the precertification request should be submitted to BCBSND. The Outpatient Authorization Request should be used. This form can be found at https://www.bcbsnd.com/web/providers/forms.

All other drugs on this list should be submitted to Prime Therapeutics for review. Providers are encouraged to go to the CoverMyMeds website or use the Prior Authorization link on the BCBSND retail pharmacy webpage. If using this option, after clicking on “Prior Authorization”, providers can continue without sign in and choose BCBS North Dakota as the health plan. Then select the appropriate form based on the drug or type of drug and follow the directions on the form to submit with the appropriate clinical documentation.

The BCBSND commercial line of business precertification tool can be found under the Policies & Approvals section of the BCBSND website.

The Medicaid Expansion line of business precertification tool can be found under the Policies & Approvals or Medicaid Expansion section on the BCBSND website.

This tool is not able to determine member benefits, for member benefit verification or questions regarding precertification contact the Provider Service department listed on the back of the member ID card.