Blue Cross Blue Shield of North Dakota (BCBSND) is reminding providers that as of January 1, 2023, the precertification post-claim review process was aligned for Commercial plans to follow the Medicaid Expansion’s precertification process.
Claims submitted on/after January 1, 2023, without precertification review will be denied, and no additional post-claim review will be completed. To assist in making sure services are covered based on precertification requirements, it is important to have the approved precertification in place before the claim is submitted. When services are not, this will result in providers being held liable for charges.
Providers can utilize the precertification search tool on the BCBSND website to verify which services require precertification. Precertification instructions are listed on this page as well.
*Note: Federal Employees Program (FEP) and Dakotas Health Plan (DHP) are excluded from this alignment.
If you have questions, please contact our Provider Service Center at 1-800-368-2312.