This applies to our Commercial lines of business only
Blue Cross Blue Shield of North Dakota (BCBSND) is offering tips for providers on using accurate diagnosis codes for medical drug claims and handling prior authorization changes for medical drugs for dosing and frequency changes.
Using the most accurate and specific diagnosis codes when submitting medical pharmacy claims for drug procedure codes is extremely important. Utilizing precise diagnosis codes will reduce the need for appeals on medical drug procedure codes subject to post-service claim edits. For more information, review the post-service claim edit policies at gatewaypa.com/policydisplay/52.
Changes in dosing or frequency of previously approved prior authorization medical drugs should be requested by calling 800-424-1708 to reach the Medical Pharmacy Solutions team at Prime. For a list of medical pharmacy drugs requiring prior authorization, visit gatewaypa.com/policydisplay/52 or www.bcbsnd.com.
