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Precertification Changes Effective January 1, 2023

Precertification is the process by which the member or the member’s health care provider provides information to Blue Cross Blue Shield of North Dakota (BCBSND) to establish the medical appropriateness and necessity of specified services.
 
The list below is an update to our standard precertification list for January 1, 2023. Some benefit plans have variations to the list.

Additions:

  • Electrical nerve stimulator Phrenic Nerve Stimulator, implantable peripheral nerve stimulator, Occipital Nerve Stimulation
  • Gastric electrical stimulation
  • Hospital Bed
  • Hyperbaric Oxygen therapy
  • Percutaneous balloon kyphoplasty, radiofrequency kyphoplasty, and mechanical vertebral augmentation
  • Unilateral or bilateral fully or partially implantable bone anchored hearing devices
  • All transplants

Deletions:

  • Behavioral modifications for the treatment of Autism Spectrum Disorder including ABA
  • Growth hormone therapy/treatment
  • Hospice
  • Negative pressure wound therapy in an outpatient setting
  • Chronic Pain Management Program
  • Psychiatric and Substance Abuse Admissions, Partial Hospital Program
  • Total ankle replacement
  • Wireless capsule endoscopy 

The member’s benefit plan describes the available covered services as well as the specific cost sharing amounts. Please contact Provider Services at the number listed on the back of the member’s ID card for additional information.
 
Please Note: These changes do not apply to FEP or Medicaid Expansion.