Impacting our Medicaid Expansion line of business only
Blue Cross Blue Shield of North Dakota (BCBSND) Medicaid Expansion is informing providers about an important change regarding the inpatient admission reviews effective Oct. 14, 2024.
Providers will still be required to notify us of all inpatient admissions. However, starting on this date, for acute inpatient admissions paid based on diagnosis-related groups (DRGs), a medical necessity review will no longer be conducted at the time of submission. Instead, these reviews will occur retrospectively.
Providers will receive an approved status confirming the notification. Providers will still need to submit concurrent reviews and discharge plans as you do today. Details on discharge notification can be found in the Medicaid Expansion Provider Manual (bcbsnd.com) page 46.
Please note that claims will continue to deny if the admission notification process is not completed prior to claim submission.
Retrospective reviews will begin on Jan. 1, 2025, looking back to dates of admission on Nov. 1, 2024, and beyond.
Thank you for your attention to this important update.
Questions?
Contact our Medicaid Expansion Provider Service Center at 1-833-777-5779.