Under certain circumstances, a provider may request an independent external review to determine if medical care provided was medically necessary and appropriate to the claim submitted by the health care provider and reviewed by Blue Cross Blue Shield of North Dakota (BCBSND).
An independent external review may be requested only after exhausting BCBSND’s provider appeal process. BCBSND has contracted with an Independent Review Agency to conduct independent external reviews. BCBSND will provide the medical information and medical policies used in the provider inquiry and appeals process.
The independent external review process does not apply to the following and review requests will be returned to the provider:
- Benefit plan exclusions
- Self-funded employee benefit plans
- Federal Employee Program (FEP)
Submitting a Request
The independent external review request form can be found on our provider forms and documents page in the claims processing section.
For additional information on independent external reviews, please refer to the provider manual.