Blue Cross Blue Shield of North Dakota (BCBSND) is informing our provider community of new changes for precertification for Jan.1, 2025, applying to both our Commercial and Medicaid Expansion plans.
Commercial
The list below is an update to our standard Commercial precertification list for Jan. 1, 2025.
Some benefit plans have variations to the list.
Additions:
- Arthrodesis, sacroiliac joint
- Hypoglossal nerve stimulators
Deletions:
- Targeted Case Management
- RTMS Repetitive transcranial magnetic stimulation (rTMS)
- Surgical treatment of obstructive sleep apnea
The member’s benefit plan describes the available covered services as well as the specific cost sharing amounts.
Note: These changes do not apply to FEP or Medicaid Expansion
Medicaid Expansion
Precertification is the process by which the member or the member’s health care provider provides information to BCBSND to establish the medical appropriateness and necessity of specified services.
The list below is an update to our standard Medicaid Expansion precertification list for Jan. 1, 2025.
Some benefit plans have variations to the list.
Additions:
- Hypoglossal nerve stimulators
Deletions:
- 1915(i) Services home and community services
- Peer support in lieu of services (ILOS), among other ILOS benefits and services
- RTMS Repetitive transcranial magnetic stimulation (rTMS)
- Surgical treatment of obstructive sleep apnea
- Medication therapy management services (MTMS)
Note: These changes do not apply to FEP or Commercial Plans.
Questions?
Contact the Provider Service number on the back of the member’s card for additional information.
