Medicaid Expansion 1915(i) Precertification

Blue Cross Blue Shield of North Dakota (BCBSND) wants to inform providers who provide 1915(i) services of an update regarding precertification requirements.

To comply with the Center for Medicare and Medicaid Services (CMS) guidelines, providers will need to include three signature pages with each plan of care when submitting precertification requests. Going forward, please submit the below signature pages in addition to the current plan of care with SMART goals identified.

These forms can be found by going to

  • Individual right and responsibility page
  • Meeting attending signature page
  • Individual acknowledgement page with signature

If BCBSND receives a precertification request for 1915(i) services, without the three signature pages included, the request will not be approved.

For questions relating to the above information, please contact the Provider Service Center at 1-833-777-5779.