Blue Cross Blue Shield of North Dakota (BCBSND) wants to inform providers of updates made to the Medicaid Expansion (ME) provider manual over the past thirty days.
New:
- Section: Appeals, Grievances and Disputes
- Added Retrospective Review Claim for Benefits Inquiry details
- Added the new appeals form and dispute form links
Revised:
- Section: Disclaimer
- Added sentence: If information within the manual conflicts with your contractual Participation Agreement or a member’s benefit plan, the Participation Agreement or benefit plan information should be used.
- Section: Utilization Management Program
- Language additions, revisions, and removal of outdated information
- Added link to the ME precertification online tool
- Updated the process instructions under the Precertification & Concurrent Review/Discharge Planning sub section
- Section: Approval for Meals, Lodging and Transportation
- Removed information and added link to the direct webpage
- Section: Claim Corrections: Criteria
- Added information regarding claim correction exceptions must be filed within 365 days from the date of service
- Section: Inpatient Swing bed and Inpatient Transitional Care Unit– Hospital Billing
- These sections were combined due to a similar process. New section is called Inpatient Rehabilitation, Swing Bed and Transitional Care Unit Per-Diem services – Hospital Billing
Questions?
Contact our Medicaid Expansion Provider Service Center at 1-833-777-5779.
