Blue Cross Blue Shield of North Dakota (BCBSND) would like to inform providers of the following updates made to the BCBSND Commercial and Medicaid Expansion (ME) provider manuals.
We always encourage our providers to review our website and provider manuals to answer questions or when looking for guidance.
Updated sections apply for both manuals, unless noted otherwise:
- Small verbiage updates throughout both manuals
- Compliance with the Confidentiality of Substance Use Disorder Patient Records Rule (42 C.F.R. Part 2)
- Updated entire section and added information on consent form usage.
- BCBSND Accreditation
- Updates to content for Mental Health and Substance Use Disorder Parity
- Contracting and Credentialing
- Corrected the timeframe for fee schedule notification to 60 days
- Documentation requirements
- Added clarity on time-based codes
- Added clarity on NEMT mileage documentation
- Billing for services provided to immediate family members
- Added clarity for coverage of this
- Removed bulleted types of services.
- Notification responsibility
- Added information on what to do if an admission date gets moved.
- Additional instructions added to the Inpatient discharge notification section
- Medical policies
- Added information about who to contact with findings of a discrepancy
- Added clarity for the three tabs displayed within a medical policy
- Removed draft policy section
- Added information regarding the Medical Policy and Development, Adoption and Reviewing form
- Enhanced Ambulatory Patient Group
- Removed Significant procedure consolidation and Same Significant Procedure consolidation as no longer relevant
- Appeals
- Added information regarding the BlueCard Provider appeal form
- Quality Management
- Added more details on patient surveys
- Care Management
- Updated language with reference to our website page
- Disease Management – Commercial only
- Added clarity to the referral process
- BlueCard – Commercial manual only
- Contiguous counties/overlapping service areas
- Updated scenarios one and three
- Updated content in the BlueCard Coordination of Benefits section
- Surgical roll-up methodology – Commercial manual only
- Removed as this is no longer relevant
- Prenatal Plus Program - ME manual only
- Removed as this is not applicable for ME
Questions?
For questions relating to the changes in the provider manual, please email prov.partners@bcbsnd.com.
