Provider Manual Updates

The Provider Manual December 2020 updates include changes in the following chapters:

Claim Submission

  • Timeframe for Claim Submission

Documentation

  • Evaluation and Management (E/M) Documentation Requirements

Documentation Removed

(Information is now available through the Availity Provider Portal)

  • Documentation Guide for InterQual- Behavioral Health
    • Behavioral Interventions for the treatment of Autism
    • Child Psychiatric Residential Treatment Program
    • Psychiatric Partial Hospital Program
    • Substance Use Disorder Residential Treatment Program
    • Substance Use Disorder Partial Hospital Program
    • Adult Psychiatric Residential Treatment Program

Reimbursement & Billing Guidelines

The following chapters have been updated or relocated due to new reimbursement policies or notices:

  • All Patient Refined -Diagnosis Related Groups (APR-DRG)
    • Acute Inpatient (APR-DRGS) Hospital Billing
    • Behavioral Health Inpatient Acute (APR DRGS)- Institutional Billing

New chapter additions

  • Enhanced Ambulatory Patient Group (EAPG)

To view the updated Provider Manual, please visit
https://www.bcbsnd.com/content/dam/bcbsnd/documents/manuals/provider-manual-full.pdf

For reimbursement policies, please visit our website at www.BCBSND.com.

Reimbursement notices are found in our fee schedule portal at https://id.BCBSND.com/nidp/idff/sso?id=BCBSNDfeeschedule&sid=0&option=credential&sid=0&target=https://feeschedules.bcbsnd.com/feeschedule.