Blue Cross Blue Shield of North Dakota (BCBSND) is committed to protecting our members’ interest through education, prevention and detection of healthcare fraud, waste and abuse (FWA). The SIU and Provider Audit department was established to detect and investigate potential cases of fraudulent, wasteful or abusive activity.
To help achieve this objective, the SIU and Provider Audit department has developed processes to identify claims paid by BCBSND that have coding or billing errors or services provided that are not medically appropriate, necessary and delivered in accordance with the member’s benefit plan, accepted medical practice standards and BCBSND policies. The SIU and Provider Audit department works with providers to correct identified errors and provide education based on findings to promote consistency in code utilization among providers.
Collaboration and/or coordination with external agencies may take place to help identify and investigate potential cases of FWA. Pursuant to N.D.A.C. § 45-15-01-01, BCBSND is required to report acts of suspected insurance fraud to the North Dakota Insurance Department.
To find out more about the SIU and Provider Audit department and their processes please refer to the Provider Manual which may be found here: