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Tips for Pre-Certification Requests

The Blue Cross Blue Shield of North Dakota (BCBSND) Availity portal is used to submit precertification requests for both inpatient and outpatient services.

  1. Currently the Availity portal does not have the functionality to determine if a code requires precertification or not. For precertification verification please go to our BCBSND website at www.bcbsnd.com/providers; that is where the Precertification list is located. Please be sure to enter the member Prefix to ensure you are reviewing the correct precertification requirements for the member.
  2. Please be sure to submit the required clinical documentation for any requests submitted via the Availity portal. Referencing our BCBSND medical policies at www.bcbsnd.com/providers/policies-precertification/medical-policy/disclaimer, can assist in determining what clinical documentation is required for the review. Once a determination is made you will receive a response back through Availity. You may also receive a request for additional information or clarification if needed via the Availity Portal.
  3. If all information required is received, you may see the determination immediately in the Availity Portal. A fax will also be sent to the number which the request was submitted from. Determination letters will also be mailed to both the provider and member.
  4. The Availity portal does not give specific precertification benefits, but it will indicate if a member is active. Please contact Provider Service at 1-800-368-2312 for verification of benefits.
  5. Requests that do not require precertification and have a published BCBSND medical policy will be cancelled. You will be directed to contact Provider Service for benefits, or any questions related to your request.
  6. If you have questions regarding a referral submission, please contact Availity support at 1-800-282-4548.

Inpatient or Outpatient Fax Request
When submitting a request by fax, please complete the appropriate level of service precertification request form found on BCBSND.com: www.bcbsnd.com/providers/policies-precertification/precertification-overview.

  1. Please be sure to include the required clinical documentation, which is required for all medical necessity review requests.
  2. When submitting the request by fax, you will receive all responses, determinations and requests by fax at the number provided on the request form.
  3. Please note all approvals, denials and requests for additional information will display with the same fax format. If additional information is required, your request will remain pended until the requested information is received.
  4. In addition to your faxed response, you will also receive a determination letter which will contain clinical rationale.

Effective August 1, 2021 all pharmacy requests that do not require precertification will no longer be eligible for review. These medications have a published BCBSND medical policy. Requests will be cancelled, and you will be referred to the Drug Indication policy.