March 2025 Quarterly Provider Insights

Message from Becky, Nicole and Ryan

We are gearing up to hit the road this April for our yearly Spring Provider in-person collaboration sessions. We look forward to the opportunity to connect with each of you in-person, provide updates, answer questions, and hear your thoughts.

We are excited to share this year’s sessions will have breakout sessions, allowing providers dedicated time for collaboration to ask questions related to the topics discussed.

We typically find these topics to be helpful for individuals in roles within the revenue cycle, leadership role, and/or administrative staff that process authorization, complete payer reviews or complete billing follow up. The topics do have some clinical perspectives and would be minimal in comparison to the practice management or revenue cycle. 

Listed below is a list of some of the topics which will be discussed.

Agenda topics include:

• Organizational update
• Arkos Health information
• Prior Authorizations updates
• Plan updates
• Modernization

Join us! Session options:

• April 15, 2025
  • Minot – In-person only 2:30 pm - 4:00 pm (Central Time)
• April 17, 2025
  • Bismarck – In-person only 8:30 am - 10:00 am (Central Time)
• April 22, 2025
  • Fargo- In-Person only 10:30 am - 12:00 noon (Central Time)
• April 23, 2025
  • Grand Forks- In-person only 9:30 am-11:00 am (Central Time)
• April 29, 2025
  • Virtual Meeting 11:00 am - 12:30 pm (Central Time)
  • Teams link will be provided upon registration.

Our continued connections are important to us, and we also look forward to making new connections. Our commitment and goal is always to continue collaboration.

Sincerely,
Becky, Nicole and Ryan

BCBSND.me launched on Jan. 1, 2025, and we are hearing great things from our member community on the new digital platform. Partnering with Apree Health to make it easier for members on our Commercial and individual insurance plans to understand and use their benefits is providing new member experience.

How will this impact providers?
Within BCBSND.me, members can view their medical claims, search for providers and specialists, and access an extensive library and wellness tools, programs, and services. This is a reminder on the importance of providers attesting their provider directory information every 90 days to make sure that the information is correct in your “find a doctor” tool. Incorrect information can lead to our members/your patients finding other providers outside of their primary care location.

In addition, members can connect with Care Guides for additional support. These health care experts can help members navigate care options including finding and scheduling appointments with providers like yourself on our member’s behalf.

Blue Cross Blue Shield of North Dakota (BCBSND) Caring foundation is proud to announce that again this year we are continuing to support the needs for mental health resources and services in our rural school.

In order to keep the mental health benefits and services available in North Dakota rural schools, the BCBSND Caring Foundation is partnering with FirstLink to Shut Out the Stigma. Clink on the link if you are wanting to learn more about Shut Out the Stigma .

Keep an eye on the “Saves Scoreboard” to stay up to date on how much we have donated to mental health resources for rural schools based on the Bismarck Bobcats, Fargo Force, University of North Dakota Fighting Hawks, and Minot Minotauros saves.

Together we can make a difference for our youth in the state of North Dakota who struggle with mental illness. 

We always encourage our providers to review our website and provider manuals when having questions or looking for guidance. If you are not locating an update, please refer to our HealthCare News section for the latest updates. 

Provider Website

The following updates have been made to our BCBSND Providers Webpage.

New:

• Medical Pharmacy Solutions Requirements
  • Medical Pharmacy Solutions
• Telehealth Services Provider Guidelines Webpage
  • Provider Guide to Telehealth Services

Revised:

• Medicaid Expansion
  • 1915(i)
    • Medicaid Expansion 1915(i) Providers
    • Added new guidelines, policies and forms
  • Medicaid Expansion Non-Emergency Medical Transportation (NEMT), Meals and Lodging Providers
    • Medicaid Expansion Non-Emergency Medical Transportation (NEMT), Meals and Lodging Providers
    • Added billing fleet vehicle definitions and multiple members transport guidance

Provider Manuals

The following updates have been made to the Commercial provider manual  and and will be made within the next 60 days to the Medicaid Expansion provider manual.

Revised sections include:

• Table of context- Commercial only
  • Removed the definition section
    • Definitions are still located at the end of the manual
• Updated grammar and language within manual
• Provider access and availability standards
  • Updates to access and availability standards
• Credentialing and Provider Data Management
  • Removal of the phone number
• Claim adjustments/correction process
  • Updated language
  • Updates made to align with claim correction change effective Nov. 1, 2024
    • Claim Correction Change
      

• Electronic Visit Verification (EVV)- applies to Medicaid Expansion only
  • Related to Home Health Providers providing in-home services

Is your provider's directory information up to date?

Our members (your patients) rely on the information listed in the provider directory to select in-network providers for health care services. Validating your information every 90 days ensures our provider directory displays accurate information.

Blue Cross Blue Shield of North Dakota (BCBSND) asks our provider community to validate their directory information through the Availity Essentials Provider Portal and continue to submit changes through the Availity Essentials directory maintenance form. Making these timely changes and validating information every 90 days allows for the directory to be the most accurate. This also assists BCBSND in meeting the No Suprise Act (NSA) Federal Mandate and Utilization Review Accreditation Commission (URAC) requirements.

Your provider information may be suppressed from the directory if validations are not attested at least once per year. Removal from the directory does not change participation status.

Questions?
For assistance follow the Provider Directory Validation process.

Need help with Availity Essentials or login?

• Call Availity Client Services at 800-282-4548.
  

For questions about the Provider Directory Validation process, email Provider Credentialing at prov.net@bcbsnd.com.