Enhanced Ambulatory Patient Groups (EAPG) Implementation Delayed

Blue Cross Blue Shield of North Dakota (BCBSND) is delaying the scheduled implementation of the EAPG system to July 1, 2021, instead of January 1, 2021.

Over the past month, BCBSND has heard the concerns raised around the timing of the EAPG payment system implementation given the fact that providers are still battling the COVID outbreak. With all that providers have been dealing with, they have not had the opportunity to review and determine the financial impact that the implementation of EAPGs will have on their operations; provide the necessary training for the internal facility staff that will be working with the new outpatient reimbursement system; and to make any system adjustments that may be required to bill under this new system and to post the payments when the remittance advice is received.

BCBSND has long been committed to partnering with our participating providers in the development and implementation of payment models that are transparent and produce outcomes that are able to be replicated. The pilot project and the extended implementation timeframe will give the Plan additional time to ensure those goals are met. During the delay, BCBSND will be working with providers and potentially other third parties to ensure providers have a clear understanding of the impact to their operations and programming requirements that may need to be completed in order to bill correctly for the services provided. Thank you for your understanding.

The EAPG fee schedule was posted to the online fee schedule portal on Thursday, October 29. The fee schedule is effective November 1, 2020 through June 30, 2021 for providers continuing to participate in the EAPG pilot program. Contact our Provider Contact Center at 1-800-368-2312 with any questions.