Enhanced Ambulatory Patient Groups (EAPG) Implementation Update

Blue Cross Blue Shield of North Dakota (BCBSND) delayed the scheduled implementation of the EAPG system until July 1, 2021. Since the announcement of the delay, BCBSND has been working with providers that decided to stay on the EAPG reimbursement system to address any questions that have arisen on their expected reimbursement; reviewed additional options that would address concerns raised during the initial orientation sessions to this system; and have worked with 3M to develop revised impact reports using updated claims data.  It is anticipated that these new impact reports will be available for distribution by the end of March.

Additionally, reimbursement policies posted to BCBSND.com have been updated to reflect changes in regard to the EAPG system.  From a billing perspective, the only change will be how to bill bilateral services which is noted in the Bilateral Procedures reimbursement policy. 

Please see the additional reimbursement policies and reference materials that have information regarding reimbursement under the EAPG system:

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 extended implementation timeframe allowed additional time to ensure those goals are met.

If you have additional questions regarding implementation of the EAPG system, please contact us at feeschedules@bcbsnd.com.