Update: Policy Application Language Transparency

We are informing our provider community of clarifying language providers will see in our medical, reimbursement & coding and medical pharmacy policies related to claim processing based on date of service (DOS) versus date of process (DOP). This will apply to both Commercial and Medicaid Expansion. 

All policies will have a new policy section under the description of policy application that will add clarity to how claims are processed. This language will not change how claims are being processed.

Example:

Application status:

• Policies with only DOP claims logic will be listed under Policy Application as:
  • All claims submitted for this policy will be processed according to the policy effective date and associated revision effective dates in effect on the date of processing, regardless of service date.
• Policies with only DOS claims logic will be listed under Policy Application as:
  • All claims submitted for this policy will be processed according to the policy effective date and associated revision effective dates in effect on the date of service.
• Policies with a combination of DOP and DOS claim logic criteria have the claim policy application listed within each section of the policy. The Policy Application will indicate as:
  • Determination whether the policy rules apply to initial and adjustment claims based on date of DOP or DOS.

Based on the number of policies we have on record; our completion target date is February 2025. 

Questions?

For more information on our policy format, refer to the September 2023 Quarterly Provider Insights article “Understanding the Blue Cross Blue Shield of North Dakota (BCBSND) Medical, Pharmacy, Reimbursement or Coding Policy Format.”

Contact the appropriate Provider Service Center or email prov.partners@bcbsnd.com for policy application questions.