New Precertification Tools Coming by End of Year

Blue Cross Blue Shield of North Dakota (BCBSND) is excited to announce that we are implementing two new tools, Predictal and Itiliti Health to our precertification functionality within our Provider Portal, Availity Essentials later this year. BCBSND is excited to partner with these two vendors to streamline your provider experience with precertification's.

The Predictal tool will provide a faster pathway to submit a precertification's through the Provider Portal, Availity Essentials, as providers will access the Predictal Portal directly through a single sign on (SSO) to complete the online precertification. The request will be directly routed to a nurse for review thus skipping the manual set up needed for faxed submissions. Our NextBlue of North Dakota Medicare Advantage plan will not be part of this change.

The Itiliti Health tool checkpoint will provide real-time responses to providers who submit precertification's to assist in determining if the service requires precertification. It also will link providers directly to our medical policies, which should increase efficiency for providers. Itiliti Health will allow for faster determinations, with real-time response. All responses are tracked through Availity, and providers will receive a tracking number. This will also improve more timely patient care requests and reduce the administrative burden, which will lead to provider savings. Our NextBlue of North Dakota, Medicare Advantage plan and Federal Employee (FEP) lines of business will not be part of this change.

Our BCBSND Utilization Management (UM) team will be able to self-administer these new tools. It allows us to enhance our provider and member precertification search capabilities on the web and allow Utilization Management to control the coding changes and updates as they come out.

Watch our HealthCare News (HCN) weekly as we will keep you all updated with any educational opportunities for the tools we implement. If you are not registered for HCN weekly, please register here: HealthCare News.