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 Self-Funded.
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.
Visit the Payment Integrity page for more information.
If you have any specific questions about the program, please contact BCBSND Provider Services.