September 2025 Quarterly Provider Insights

Quarterly Provider Insights shares information to our provider community in the third month of each quarter.

Quarterly Provider Insights will provide information regarding a company message, news and announcements, educational topics and miscellaneous updates.

Provider Message

Spotlight on Access and Availability Standards

Meeting the Medicaid Expansion Access and Availability Contract Standards

Are you meeting the standards?

In mid-September, your facility may have been randomly selected and received an email from one of our Blue Cross Blue Shield of North Dakota (BCBSND) Education Specialists, requesting the completion of the BCBSND Access and Availability questionnaire by October 8, 2025. If you were notified, it's not too late to complete the requested questionnaire.

BCBSND is required to provide annual reporting of access and availability standard requirements to the North Dakota Department of Health and Human Services for Medicaid Expansion. This ensures that standards are being met. Providers participating in the BCBSND Medicaid Expansion network must adhere to the access and availability standards stated in our Medicaid Expansion Provider Manual to remain compliant.

Our network providers are expected to deliver services in a culturally competent manner to all patients, including those with limited English proficiency, diverse cultural and ethnic backgrounds, disabilities, and regardless of gender, sexual orientation, or gender identity. Providers must also address cultural competency and linguistic needs, including the enrollee's prevalent language(s) and sign language interpreters, in accordance with 42 C.F.R. §438.206(c).

Network providers must ensure physical access, reasonable accommodation, and accessible equipment for patients with physical or behavioral health disabilities, as outlined in 42 C.F.R. §438.206(c)(3).

Contracts with BCBSND require network providers, including primary care providers (PCPs) and specialty care providers, to provide appropriate access for our members.

Please review the Medicaid Expansion Provider Manual, specifically the section on Access and Availability (Pages 23-26), if you have any questions.

We thank the providers who have already completed the questionnaire. As we gather results, we will partner with the North Dakota Department of Health and Human Services for Medicaid Expansion to identify potential needs and work with providers to improve standards for our members and our community.

News and Announcements

Fall Provider Collaboration Sessions

We are gearing up for our yearly fall provider virtual collaboration sessions. Join our Blue Cross Blue Shield of North Dakota (BCBSND) Provider Education and other team members for the fall virtual provider collaboration session.

Agenda Topics include: 

• Organization news and announcements
• Self-Service tools - website tour
• Appeals
• Plan and resources updates
  • Commercial
  • Medicaid Expansion
  • NextBlue

We encourage all providers to attend one of our sessions. We typically find these topics to be helpful for individuals in roles within the revenue cycle, leadership role, and/or administrative staff that process authorization, complete payer reviews or complete billing follow up and anyone looking for self-service tool resources. The topics do have some clinical perspectives and would be minimal in comparison to the practice management or revenue cycle. 

 Fall Provider Collaboration Sessions:

• Tuesday, October 14, 2025
  • 12:00 PM – 1:30 PM (CST)
• Thursday, October 30, 2025
  • 8:30 AM – 10:00 AM (CST)

Register Now ›

We look forward to the opportunity to connect with each of you, provide updates, answer questions, and hear your thoughts.

Caring Foundation News: Finding Hope, Fueling Recovery

Honoring National Recovery Month

September marks National Recovery Month, a time to honor the strength of those navigating addictions and to celebrate the support systems that make recovery possible. At Blue Cross Blue Shield of North Dakota, and through our BCBSND Caring Foundation, we believe recovery is not just a personal journey — it’s a community effort. That’s why we’re proud to partner with Soul Solutions Recovery Center in Fargo, a place where hope isn’t just offered — it’s lived.

Support for Recovery

This year, the Caring Foundation deepened its support for Soul Solutions through several meaningful initiatives. These include funding the Recovery Requires Action 5K on Sept. 9, supporting family programming, and providing 200 free coffees to individuals in recovery and their sponsors at the center’s in-house coffee shop.

Thanks to many BCBSND volunteers, coffee sleeves were decorated with handwritten messages of encouragement — offering warmth and solidarity with every cup.

These efforts are more than gestures — their lifelines. And for one of our own, they’ve made all the difference.

To learn more about our caring foundation visit https://www.bcbsnd.com/caring-foundation. 

Educational

Sport Physical Reminders

North Dakota’s 2025-2026 school year has started, and many students have had their sport physicals.

Blue Cross Blue Shield of North Dakota (BCBSND) like your practice understands there is a difference between sports physical and well-child checkups. To help ensure we are aligned BCBS has a published policy which you can review here: Sports Physical policy.

Key Points

• Sports Physical Only: Bill an appropriate office/outpatient evaluation management (E/M) with the sport’s physical diagnosis.
• Sports Physical included in an Annual Preventive E/M: Bill an appropriate preventive E/M with both the examination diagnosis code and the sports physical diagnosis code.

If you have questions, contact the provider service center listed on the back of the member's insurance card.

On the Radar: What has changed and what is to come at BCBSND

It has been a busy 2025, as we enter Quarter 4 and approach the end of 2025, BCBSND wants to keep our provider community aware of the changes we have made so far. We also want to inform providers of things to expect in 2026.

We continue movement with the following changes:

2025 Projects Completed

• Medical pharmacy prior authorizations process change  
  • Partnered with Medical Pharmacy Solutions team at Prime Therapeutics Management (Prime) 
• Notification for Licensed Associate Professional Counselor’s (LAPC) credentialing and claim submission changes 
• Opened three VitellaCare clinics in ND
• New Administrator for TriWest HealthCare Alliance Provider Contracts  
• New member resource upgrade 
  • BCBSND.me 

2025 Projects Still to Come

• Medical policy view
• National Committee for Quality Assurance (NCQA) implementation
• Medicaid Expansion Community Health Worker (CHW) and Paramedicine Coverage Patient eligibility program

We will continue to keep our provider community informed of movement into these changes through website updates and our HealthCare News.

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Provider Directory Validation

Is your provider's directory information up to date?

Our members (your patients) rely on the information listed in the provider directory to select in-network providers for health care services. Validating your information every 90 days ensures our provider directory displays accurate information.

Blue Cross Blue Shield of North Dakota (BCBSND) asks our provider community to validate their directory information through the Availity Essentials Provider Portal and continue to submit changes through the Availity Essentials directory maintenance form. Making these timely changes and validating information every 90 days allows the directory to be the most accurate. This also assists BCBSND in meeting the No Suprise Act (NSA) Federal Mandate and Utilization Review Accreditation Commission (URAC) requirements.

Your provider's information may be suppressed from the directory if validations are not attested at least once per year. Removal from the directory does not change participation status.

Questions?

For assistance follow the Provider Directory Validation process.

Need help with Availity Essentials or login?

• Call Availity Client Services at 800-282-4548
  

For questions about the Provider Directory Validation process, email Provider Credentialing at prov.net@bcbsnd.com.