Update on Authorized (Network) Referrals and Precertification/Authorization Process

Blue Cross Blue Shield of North Dakota (BCBSND) would like to provide an update regarding authorized (network) referrals and precertification/authorization requests and the method for submitting the necessary information for these requests.

Authorized (Network) Referral Process

Previously there were two ways to notify BCBSND of authorized (network) referrals – via paper form or electronically. The paper option – the Authorized Referral form on the BCBSND website – was removed on January 2, 2019. Any paper forms received will now be returned to the provider. For providers needing to submit authorized (network) referrals, this can be done electronically through the Availity Provider Portal. The electronic referral feature can be accessed on the Availity Portal by first choosing Authorizations & Referrals under the Patient Registration drop-down menu, and then selecting Referrals under the “Multi-Payer Authorizations & Referrals” heading. This feature gives providers the ability to submit the referral form directly from the Availity portal. Access to the feature is controlled by each provider organization’s Availity portal administrator. The organization’s portal administrator must assign the “Authorization and Referral Request” user role to each user designated to submit referral requests for the organization. To find out who in your organization has been designated as the portal administrator, click My Account Dashboard on the upper right corner of the Availity portal home page, and then click the My Administrators link.

As a reminder, it is the requesting provider’s responsibility to notify the member of the referral status, including its approval or denial. Members calling in for details on specific referral requests will be directed to contact their provider. For more information on the authorized (network) referral process, please refer to the BCBSND Provider Manual. For questions on the Availity Provider Portal, please reach out to Availity Client Services at 1-800-AVAILITY (282-4548).

Precertification/Authorization Process

Currently providers submit precertification requests via a form found on the BCBSND website. BCBSND has also been testing the functionality of the authorization request process in the Availity Provider Portal. After reviewing this process and evaluating feedback provided by pilot users of this function, BCBSND has chosen to pursue an updated electronic authorization request solution. This updated solution aligns with Availity portal features used by other BCBS plans for electronic authorization requests, and will provide a more streamlined experience for portal users. BCBSND will be refocusing efforts on this updated solution and projects to have it deployed in quarter 3 of 2019. In the interim, the process for submitting authorization requests will be limited to the current paper option only – submitting the form via fax or mail to BCBSND.

As a reminder, this process is as follows:

To request Precertification, providers should use one of the following forms found on the BCBSND website under Precertification:

  • Inpatient Authorization Request
  • Outpatient Authorization Request
  • ABA Service for Autism Spectrum Disorder Request
  • APDS, CGM, Insulin Pump Supplement (also requires the Outpatient Authorization Request)

Procedure for submitting a precertification request to BCBSND:

  1. Complete the appropriate Precertification Request form, including any supporting clinical documentation
  2. Print a copy
  3. Save a copy for your records (electronic or hard copy)
  4. Send to BCBSND – follow instructions on the form.
    Fax to: 701-277-2971
    Note: This fax line is used exclusively for the Utilization Management platform. Please use this fax number for Precertification Requests ONLY.

    OR

    Mail to:
    4510 13th Ave. S.
    Attn: Utilization Management
    Fargo, ND 58121

  5. Once a decision has been made, BCBSND will send a fax notification of the determination to the fax number listed for the requesting provider on the Precertification Request form, which will be followed by a letter.