New Predictal Precertification Tool Update

Important Notice!

Blue Cross Blue Shield of North Dakota (BCBSND) wants to thank providers for their continued support as we navigate through our first week of our go live with our new precertification tool, Predictal.

We are continuing to work through incoming requests and want to let providers know they may see a small delay in non-urgent cases as we get familiar with the new system.

Reminders to help our Utilization Management team and avoid delays:

• Procedure codes are not required on the following levels of care:
  • Medical Inpatient, Residential Treatment Centers, Skilled Nursing Facilities, Long Term Acute Care, Inpatient Rehab.
    • Adding the procedure line, adds an additional line for medical necessity review that can cause confusion and delays.
• Reminder that provider can access precertification requirements through our website.
  • For Commercial plans:
    https://www.bcbsnd.com/providers/policies-precertification.
  • For Medicaid Expansion plans:
    https://www.bcbsnd.com/providers/policies-precertification/Precertification-for-Medicaid-Expansion
    • BCBSND has canceled several requests as no precertification is required. This process slows down the review of services that do need precertification. Examples of cases that have been canceled include MRI, CT scans, Colonoscopy.
• After you complete and submit a case, please hit the button labeled Exit AAH. This instruction can be found on page 14 of the Predictal resource guide.

• We are aware that not all UM determination faxes are generating. We are working to resolve this issue. Providers will still get rationale letters in the mail, even if the fax does not go out.

Questions?
Email prov.partners@bcbsnd.com for questions or feedback regarding the Predictal resource guide.
For other questions pertaining to precertification requests, utilize the resource guide or contact the phone number on the back of the ID card.