Spotlight on Appeals

Message from Celine Schmidt, Manager of Medical Policy, Appeals and Grievances

My name is Celine Schmidt and I oversee our Medical Policy and Appeals department here at Blue Cross Blue Shield of North Dakota (BCBSND).

Today, we are going to focus on the appeals aspect of BCBSND. As we know, appeals are a part of any insurance company. Having the option for an appeal allows a provider to submit additional information to support more details of necessity a member may have had, that may not be showcased on a claim because of the information allowed on a 1500 or UB04 claim form. For 2023, our Appeals team has received 100-150 appeals on average per day.

While speaking of appeal submissions, we look forward to the use of our new electronic Appeals form that will become available in the near future. The electronic version of this form will enhance user experience and include attaching files, cutting out the mailing process and timeframes associated with mailing. More information on this to come!

We hope to continue to hear positive feedback regarding this new form's implementation and look forward to other ways to better serve our provider community.

~ Celine Schmidt