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Medicaid Expansion Precertification Changes Effective January 1, 2023

Precertification is the process by which the member or the member’s health care provider provides information to Blue Cross Blue Shield of North Dakota (BCBSND) to establish the medical appropriateness and necessity of specified services.
 
The list below is an update to the Medicaid Expansion precertification list for January 1, 2023.

Additions:

  • 1915(i) Service home and community services, e.g., peer support in lieu of services (ILOS), among other ILOS benefits and services (added peer support)
  • Medication Therapy Management Services (MTMS)

Deletions:

  • Behavioral modifications for the treatment of Autism Spectrum Disorder including ABA
  • Hospice
  • Negative pressure wound therapy in an outpatient setting
  • Chronic Pain Management Program
  • Total ankle replacement
  • Wireless capsule endoscopy

The member’s benefit plan describes the available covered services as well as the specific cost sharing amounts. Please contact Provider Services at the number listed on the back of the member’s ID card for additional information.
 
Please Note: These changes only affect Medicaid Expansion.