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Provider Group Participation Agreement Contract Amendment

Blue Cross Blue Shield of North Dakota (BCBSND) is informing providers who have a BCBSND Provider Group Participation Agreement that to comply with the Consolidated Appropriations Act (“CAA”) confidentiality and “Gag Clause” contracting requirements, an amendment to the Provider Group Participation Agreement (“Agreement”) between Provider Groups and Blue Cross Blue Shield of North Dakota (“BCBSND”) is required.  Amendments to comply with applicable laws or regulations is permitted by the Agreement to be distributed via newsletters, such as HealthCare News.

Therefore, as of Wednesday, Sept. 6, 2023, Provider Group Participation Agreements are automatically amended as follows. Other than amended herein, all terms and provisions of the Agreement shall remain in full force and effect:

Section 2.8 is deleted and replaced with the following:

BCBSND shall keep confidential all medical records and documentation required for audit and claims processing in compliance with state and federal laws related to privacy and confidentiality of a Member’s medical record.

Notwithstanding the foregoing, nothing in this Agreement shall be construed as restricting a group health plan or BCBSND from:

  • Providing the Provider Group or Provider specific cost or quality of care information or data through a consumer engagement tool or any other means, to referring Providers, a plan sponsor, Subscribers or Members, or individuals eligible to become Subscribers or Members of and BCBSND Benefit Plan or health plan.
  • Electronically accessing deidentified claims and encounter information or data for each Subscriber or Member in a Benefit plan or that has BCBSND coverage, upon request and consistent with all applicable state and federal privacy regulations including, on a per claim basis; i) financial information, such as the allowed amount, or any other claim-related financial obligations included in the provider contract; ii) Provider or Provider Group information, including name and clinical designation; iii) service codes, or iv) any other data element included in claim or encounter transactions, or
  • Sharing information or data as described in this section or directing that such data be shared with business associates of the group health plan or BCBSND consistent with applicable state and federal privacy regulations.


Nothing in this Section 2.8 shall be construed as:

  • Preventing the Provider Group or Provider from placing reasonable restrictions on the public disclosure of the information as described.
  • Modifying or eliminating existing privacy protections and standards under state and federal law.
  • Limiting access by a group health plan or BCBSND to data as permitted under applicable state and federal privacy regulations.


Section 5.2 is deleted and replaced with the following:

  • All information and materials exchanged between the parties shall remain proprietary to the disclosing party, including contracts, reimbursement rates and methodology, operation manuals, utilization statistics and any information regarding the parties’ business activities, which are not otherwise available to the general public. The parties shall not disclose any such information or materials or use them except as may be required to perform the obligations of this Agreement or required by law. This provision is subject to Section 2.8 of this Agreement, and nothing herein shall be interpreted as restricting or otherwise limiting the ability of the group health plan or BCBSND from accessing or sharing any data and information as set forth in Section 2.8. This provision shall survive the termination of this Agreement.


Questions?
Please email providercontracting@bcbsnd.com with any questions.