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Payment Integrity Payment Policy Management (PPM) and Coding Validation (CV) Implementation

Blue Cross Blue Shield of North Dakota (BCBSND) has implemented the next phase of our enhanced Payment Integrity Program, Payment Policy Management (PPM) and Coding Validation (CV) for Fully Insured and BlueCard.
 
Claims will be reviewed on the following concepts:

  • Duplicate, including professional and technical components
  • Modifier usage
  • National Correct Coding Initiative (NCCI)
  • Daily and annual unit limits
  • Global services 

Providers will receive results of these reviews on their Electronic Remittance Advice (ERA). If a provider disagrees with a payment determination, request a reconsideration using the Appeal form.
 
If you have any specific questions to the program, please contact BCBSND Provider Services at 800-368-2312.