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:
Commercial
- Access and Availability Standards
- Updates to comply with the CMS Appointment Wait Time Standards outlined in 42 C.F.R. §438.68(e), BCBSND is updating the required appointment wait time standards as outlined below:
- Primary Care Providers:
- New standard: 15 business days
- Old standard: 30 calendar days
- OB/GYN:
- New standard: 15 business days
- Old standard: 30 calendar days
- Prenatal Visits:
- First Trimester:
- New standard: within 10 business days of first request
- Old standard: within 14 calendar days of first request
- Second Trimester:
- New standard: within 5 business days of first request
- Old standard: within 7 calendar days of first request
- Third Trimester:
- New standard: within 3 business days of first request
- Old standard: within 3 calendar days of first request
- First Trimester:
- Primary Care Providers:
- Updates to comply with the CMS Appointment Wait Time Standards outlined in 42 C.F.R. §438.68(e), BCBSND is updating the required appointment wait time standards as outlined below:
- BlueCard Coordination of Benefits
- Language update
- Appeals- Independent external review process
- Removal of Independent external review process-provider
Medicaid Expansion
- Access and Availability Standards
- Updates to comply with the CMS Appointment Wait Time Standards outlined in 42 C.F.R. §438.68(e), BCBSND is updating the required appointment wait time standards as outlined below
- Primary Care Providers:
- New standard: 15 business days
- Old standard: 30 calendar days
- OB/GYN:
- New standard: 15 business days
- Old standard: 30 calendar days
- Prenatal Visits
- Removal of prenatal appointment availability
- 1915i
- Updated to reference website
- Providers should refer to https://www.bcbsnd.com/providers/medicaid-expansion/resources/medicaid-expansion-1915-i-providers for more information on the program and requirements to get started.
- Primary Care Providers:
- Updates to comply with the CMS Appointment Wait Time Standards outlined in 42 C.F.R. §438.68(e), BCBSND is updating the required appointment wait time standards as outlined below
Questions?
For questions relating to the changes in the provider manual, please email prov.partners@bcbsnd.com.
