Precertification for Alternate Care Authorization and Direct Transfer Authorization Notification

This applies to both Commercial and Medicaid Expansion

Blue Cross Blue Shield of North Dakota (BCBSND) is informing providers that the waiver of precertification for medical post-acute/alternate care authorizations will be discontinued starting June 1, 2022.  Precertification will be required for all post-acute/alternative care services included for the following services:

  • Inpatient Rehab Facilities
  • Long Term Acute Care Facilities
  • Skilled Nursing Facilities
  • Transitional Care Units

The direct transfer waiver will continue to apply for Partial Hospital Programs and Residential Treatment Centers. Admission notification of the transfer of patients to these services should be made to BCBSND via Availity Essential. Concurrent review of these cases must be completed by day seven of the patient transfer. At that time, clinical documentation will be required for continued approval.

For questions contact the appropriate Customer Service Center at BCBSND 1-800-368-2312 or BCBSND Medicaid Expansion 1-833-777-5779.