Precertification Update

Effective January 1, 2023, Blue Cross Blue Shield of North Dakota (BCBSND) will be aligning the precertification post claim review process that applies to commercial plans to follow the Medicaid Expansion’s precertification process.

Claims submitted without precertification review will be denied, and no additional post-claim review will be completed. This may result in providers being held liable for charges.

Moving forward, we ask providers to ensure precertification(s) is complete prior to claim submission. 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.

Thank you for your understanding as we work together to serve our members and your patients. If you have any questions, please reach out to Provider Services at 800-368-2312.