Member Services Representatives unavailable May 27

Our member services representatives will not be available Monday, May 27, due to the holiday.

Show More
  • October 19, 2023

Medicaid Expansion Provider Manual Updates

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    • Language additions, revisions, and removal of outdated information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.