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 Medicaid Expansion.

Medicaid Expansion is being implemented in phases starting with one group ID, so providers will see claims process differently with this population. The remaining groups will be implemented later at a date to be determined.

Claims will be reviewed on the following concepts:

  • Duplicate, including professional and technical components
  • Modifier usage
  • 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 BCBSND Payment Integrity Program for more information on Payment Integrity.

If you have any specific questions regarding the program, please contact BCBSND Provider Services.