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New Precertification Search Tool Available

Blue Cross Blue Shield of North Dakota (BCBSND) recently released a new capability to aid providers in determining if precertification is required. Using the new precertification search tool, providers can now search by code or keyword to determine precertification requirements. The enhanced tool, links providers directly to the corresponding medical policy and into Availity to complete the precertification request.

Availity Provider Portal Precertification Request
Blue Cross Blue Shield of North Dakota (BCBSND) is providing monthly tips reminding providers of functionality in our Availity Provider Portal. This month’s Availity tip is submitting a precertification request. Availity is used to submit precertification requests for both inpatient and outpatient services. Precertification does not guarantee payment, this is determined based on member’s eligibility and benefits.

Using Availity to request Precertification
Determining whether a precertification is required first can save time and resources before starting the request in Availity. Some services, procedures, and equipment require precertification before the service is performed. The ordering provider is typically responsible for obtaining precertification.

Listed below are some Availity Provider Portal submission tips:

  • The Availity portal currently does not have the functionality to determine if a code requires precertification 
  • Precertification verification information can be located on our BCBSND website at https://www.bcbsnd.com/providers
    • Located on the BCBSND Provider webpage toolbar
      • Click Policies & Precertification
        • Select Precertification
        • Determine if the member is in network or out-of-area (network)
        • Search for the CPT/HCPCS code (in-network) or enter the three-alpha prefix (out-out-area) 
      • NOTE: The search results listed do not apply to the Federal Employee Program (FEP) or NextBlue of ND Medicare Advantage plans. Please refer to the FEP or NextBlue provider websites or contact the appropriate Provider Services.
  • The Availity portal does not give specific benefits but it will indicate if member is active
    • Contact Provider Service at 1-800-368-2312 for verification of benefits
  • Requests that do not require precertification and have a published BCBSND medical policy will be cancelled
    • Providers will be directed to contact Provider Service for benefits, or any questions related to your request 
  • Submit the required clinical documentation for any requests submitted via the Availity portal
    • Referencing our BCBSND medical policies can assist in determining what clinical documentation is required for the review
    • Once a determination is made the provider will receive a response back through Availity
    • Provider will also receive a request for additional information or clarification if needed via the Availity Portal
  • If all information required is received, providers may see the determination immediately in the Availity Portal
    • A fax will also be sent to the number which the request was submitted from
    • Determination letters will also be mailed to both the provider and member

Availity Provider Portal Registration
As a BCBSND Provider, you may be already registered with the Availity Provider Portal, if not we encourage you to register at Portal Registration.  Whether you are a current user or new to Availity, we encourage providers to take advantage of on-demand Availity Portal Training.

To access the Availity Training center as shown below:

  • Log in to your Availity Account and click on “Payer Spaces” located on the navigation bar
  • Access "Resources"
  • Enroll in the "Authorization and Referrals" on-demand training

For more information on how to register, and the variety of tools that are available to you, contact Availity.

  • Contact Client Services at 1-800-282-4548
    • Monday through Friday, 8 a.m. to 7:30 p.m. EST

Availity website: https://www.availity.com