New Medicaid Expansion Non-Emergency Medical Transportation, Meals and Lodging Billing Claim Form

Blue Cross Blue Shield of North Dakota (BCBSND) would like to inform Medicaid Expansion Non-Emergency Medical Transportation (NEMT), Meals and Lodging providers of a change to the paper form utilized to submit claims for Non-Emergency Medical Transportation, Meals and Lodging services.

Providers who previously utilized the NDDHS State SFN1731 form will now complete the new Medicaid Expansion Non-Emergency Transportation, Meals and Lodging Billing form when submitting claims for reimbursement. This new form requests additional service details, which will help claims process timelier and accurately.

Effective June 23, 2022, BCBSND will require the Non-Emergency Medical Transportation (NEMT), Meals and Lodging billing form to be used and will no longer accept the SFN1731 forms post marked after June 20, 2022.

The new form along with instructions can be found here Medicaid Expansion Non-Emergency Transportation, Meals, Lodging Billing Form under the Common Forms & Document section of the www.bcbsnd.com Provider’s page. Additional information on NEMT can be found at Medicaid Expansion Non-Emergency Medical Transportation.

For additional questions, contact the BCBSND Medicaid Expansion Provider Service Center at 1-833-777-5779.