Provider Support Hub

As Blue Cross Blue Shield of North Dakota (BCBSND) prepares to migrate members to new systems, processes and policies beginning Jan. 1, 2027, this page will serve as your central source for information, resources and updates to help you prepare.

Beginning Jan. 1, 2027, providers could care for both migrated and non-migrated members through the end of 2027.
- Commercial members will migrate in phases on their plan's anniversary in 2027.
- BlueCard Host claims will be processed on the migrated platforms starting Jan. 1, 2027.
- The Federal Employee Program (FEP) is expected to transition on April 1, 2027.
- Note: Medicaid Expansion members will not migrate in 2027.
Understanding a member's migration status is key to determining which systems, processes and policies apply.
Always check the member's current ID card and verify eligibility before providing services.

Use this page to understand what is changing, what is staying the same and where to find the information you need to support your patients.

Understanding member migration

Throughout the transition, BCBSND will use the following terms:

Migrated members

Members who have received a new member ID card with a 9-digit member ID number whose coverage and claims processing have moved to the new systems, processes and policies. A sample migrated member ID card is included in the member ID menu below.

Non-migrated members

Members whose coverage remains on current systems with a 12-digit member ID number. Continue to follow existing processes for these members until their future migration date.

As updates are introduced, BCBSND will clearly communicate whether they apply to migrated members, non-migrated members or all members.

What’s changing

Commercial members will migrate in phases based on their plan’s anniversary beginning on Jan. 1, 2027. Approximately 65% of BCBSND commercial members will migrate on Jan. 1, 2027.

Migrated members will receive new member ID cards with new 9-digit member ID numbers.

Depending on a member's migration status, the systems, policies and processes related to their claims, medical and pharmacy policy, and other administrative requirements may be different.

Training, tools and resources will be available to help you support migrated members.

What’s staying the same

Many important aspects of working with BCBSND will remain the same.

BCBSND remains your local health plan.

BCBSND will continue to serve North Dakota members and providers.
You will continue to submit claims through Availity Essentials and receive payment from BCBSND whether you care for a migrated or non-migrated member.

We’re here for you.

We remain committed to helping you deliver high-quality care to our members.
Your Provider Relations and Customer Service teams will continue to support your practice.
BCBSND.com/providers will remain the provider resource website for information, instructions, forms, manuals and other materials.
HealthCare News and Quarterly Provider Insights will remain the centralized communication tool for communicating updates to providers.
If you have questions, continue to use your existing provider support channels.

Current processes remain in place for non-migrated members.

Members who have not yet migrated will continue to be served under current systems and processes.
Continue following current BCBSND requirements, policies and workflows for non-migrated members unless otherwise noted.

Your provider agreement and network participation are not changing.

The member transition does not change your current participating provider agreement or network participation status.
Continue to follow the terms and requirements of your existing agreement.

Stay up to date

We will share migration updates in HealthCare News and Quarterly Provider Insights. If you do not subscribe to our publications, subscribe now. Visit this page often for the latest updates and resources to support your practice.

Resources

Click the green drop-down menu below to view resources for the following migration-related topics:

Member ID Cards • Tools and Resources • Product and benefit changes • Care management • Claims and payment • Policies • Prior Authorization • Appeals and disputes • Pharmacy • Trainings • Forms

While you may not begin seeing migrated member ID cards until closer to Jan. 1, 2027, now is a good time to become familiar with the changes and steps below.

1. Ask for the member’s current ID card at each visit.

Throughout 2027, commercial members will receive new member ID cards with updated member information as their health plans renew and their information is migrated. Use the newest member ID card in 2027. Do not rely on a card saved from a previous visit. Note: Do not use a 2027 migrated member card for dates of service in 2026.
Migrated members will have new information, such as shorter member ID numbers (9 digits instead of 12 digits after the prefix) and Customer Service phone numbers.

2. Verify eligibility and benefits before services are provided.

Eligibility verification is the best way to confirm the patient’s current coverage and determine which policies or processes apply.
Continue to use Availity Essentials to verify eligibility.

3. Determine whether the member is migrated or non-migrated.

If the member is identified as migrated (member ID is 9 digits after the prefix), follow the policies, processes and requirements that apply to migrated members.
If the member is identified as non-migrated, continue using the current BCBSND process unless otherwise directed.

Member ID Card Quick Reference Guide

Availity Essentials will remain the provider portal for checking eligibility, benefits, submitting claims, prior authorizations, remittances, etc. for migrated and non-migrated members.

Direct messaging in Availity Essentials will continue for all BCBSND providers in 2027.

Use the correct member ID for the date of service to ensure the authorization request is routed through the correct experience.

This new Provider Support Hub will be the centralized source for information about changes. This page will include links to updated websites with more detailed information.

HealthCare News and Quarterly Provider Insights will remain the centralized communication tool for communicating updates to providers.

Tools will be added to the website to help guide providers to appropriate resources for migrated and non-migrated members by entering the member prefix.

Local Provider Relations teams will continue to collaborate with providers.

BCBSND will continue to offer the Provider Contact Center for phone support. A new phone number will be released at a later date for migrated members with extended hours of operations.

Direct messaging in Availity Essentials will continue to be offered for migrated and non-migrated members.

Most medical plan designs are not changing significantly for members.
BCBSND grandfathered plans are ending, and customers will map to new 2027 plans. Providers should continue checking benefits before providing services.
Starting Jan. 1, 2027, providers may notice new terminology—administrative services only (ASO)—used on our website. These were previously referred to as self-funded groups.

BCBSND will continue to offer care management to all members. Our Care Management program supports members with complex, chronic and acute health needs. Care management services connect members with experienced clinical professionals who provide education, care coordination and support throughout their health care journey.

To help ensure accurate claims submission and payment:

Verify the member’s eligibility and migration status in Availity Essentials before submitting claims.
Select the appropriate reimbursement policies, coding rules and claim editing guidance for the members’ migration status.
We will continue to announce new or revised reimbursement policies in HealthCare News(HCN). Sign up to receive HCN.
Follow applicable coding, billing and documentation requirements.
Keep supporting documentation for billed services and submit records when requested.

Providers should continue to use nationally recognized coding standards, submit claims with the appropriate CPT^®, HCPCS and modifier information and maintain supporting documentation for billed services.

Claims for migrated members are subject to new or expanded coding and claims editing processes. This could result in claims processing differently for migrated members.

Non-migrated members: Continue following existing BCBSND coding, billing, reimbursement and documentation requirements until the member migrates.
Migrated members: Claims for migrated members will process using expanded claims review, coding validation and reimbursement editing capabilities within the new claims platform. For providers, this means the claims-review process may become more proactive, with more validation occurring during adjudication rather than through retrospective audit activity alone. To support you through this process, we created a Coding Toolkit for migrated members.

Before submitting claims for migrated members, review the Coding Toolkit to determine whether any coding, billing or editing requirements apply to the billed services. The toolkit can help you:

Understand coding and documentation requirements.
Identify edits that may affect claim payment.
Review modifier requirements.
Understand bundling and unbundling rules.
Verify billing requirements before claim submission.

The Coding Toolkit is designed to help providers submit accurate claims and reduce avoidable rework, denials and payment delays. The Coding Toolkit includes information about:

ClaimsXten and other claim-editing information.
National Correct Coding Initiative (NCCI) and supplemental code pair edits.
Bundling guidance.
Clinical edits and Outpatient Code Editor (OCE) edits.
Modifier, maximum units and global period edits.
Other coding and billing requirements that may impact claim processing.

Because claims for migrated and non-migrated members will process in different systems during the transition, different reimbursement policies will apply depending on a member’s migration status.

The reimbursement policies for migrated and non-migrated members are available online. A reimbursement policy search tool is also available to find the policy that applies to the member’s migration status.

In the reimbursement policy search tool, you may see policy pages or policy labels that distinguish migrated and non-migrated members. If a policy includes an Applies to label or asks you to choose Commercial Migrated or Commercial Non-Migrated, select the option that matches the member’s status before submitting claims, requesting reconsideration or disputing a payment decision.

Non-migrated members: Claims will process following current BCBSND reimbursement policies, reimbursement methodologies and claims-processing requirements. Existing reimbursement rules remain in effect until the member transitions to the new system.
Migrated members: While many reimbursement principles will remain the same, you may notice differences in how claims are reviewed and reimbursed for migrated members. Reimbursement determinations may incorporate additional coding edits, clinical edits, bundling logic and payment-policy reviews during claims adjudication.

BCBSND will continue to communicate policy updates and newly published reimbursement policy information through HealthCare News.

Continue to submit claims electronically through Availity Essentials or your clearinghouse as you do today for all members. Providers must continue to adhere to their contracted timely filing requirements for all BCBSND commercial members. The correction and void process will remain the same, using frequency codes “7” and/or “8” within Availity Essentials.

Note: Effective Jan. 1, 2027, paper claims will no longer be accepted for any member. See paper claims section below.

The following changes apply to migrated member claim processing:

If the wrong member ID is submitted on the claim, the claim will deny and the provider will need to resubmit the claim under the correct ID number.
Inpatient APR-DRG Claims
- All members: Inpatient APR-DRG claims will continue to be grouped and reimbursed based on discharge  date.
Other methodologies, including inpatient per-diem and outpatient services, will have a process change.
- For non-migrated members: Inpatient per-diem, EAPG and other outpatient claims grouping and reimbursement are based on the last (“discharge”) date.
- For migrated members: Inpatient per-diem, EAPG and other outpatient claims grouping and reimbursement will be based on the first (“admit”) date.
  - It is recommended to submit services/claim(s) monthly for providers who provide outpatient services such as home health, hospice, physical and/or occupational therapy.
Claims for members with two BCBSND plans (also known as Blue-on-Blue claims), will not automatically cross over when the secondary ID number is in a different system. Providers can identify if the plan is migrated or non-migrated based on the length of the member ID number. See the Member ID cards tab for more details.
- Example 1: Member has a migrated ID number as primary, and a non-migrated ID number as a secondary plan. The provider is responsible for filing the claim to the secondary plan.
- Example 2: Member has a non-migrated ID number as primary, and a migrated ID number as a secondary plan. The provider is responsible for filing the claim to the secondary plan.
- Example 3: Both ID numbers are migrated and in same system, the claims will autocross over. The provider will not need to file a secondary claim.

Strategic National Implementation Process (SNIP) front end edits will continue to be used within Availity Essentials. Providers may notice additional and more robust information validation for the migrated member process flow. This will help ensure that the data is accurate and complete, upfront, while preventing potential errors in claims processing.
For migrated members, previously approved prior authorizations will transfer to the new system if the authorization end date is after the member’s migration. If the authorization does not apply, as expected to a claim, contact the Provider Contact Center.
New referrals for migrated members will no longer have visit limits as a requirement within Availity Essentials. This field will become optional.
If a migrated member had a previously approved referral and it was not applied to the claim date of service in question, please contact the Provider Contact Center.
If a member is seen at an out-of-network hospital for emergency services and is admitted:
- Non-migrated members: Claim(s) process as out-of-network once the level of care is downgraded to non-emergency care.
- Migrated members: Claim(s) will be paid as in-network until the member is discharged.
Claim numbers:
- Non-migrated members: Claim numbers will remain numerical only.
- Migrated members: Claim numbers will be assigned a unique 12-character identification number, including a letter within the claim number.
  - The migrated claim characters provide key information about how the claim was received and its processing history.
    - The first character identifies how it was received:
      - E – Electronically submitted claims (local or BlueCard Host claim)
      - T – BlueCard Home claim
      - 2 – Manually keyed claims or duplicated claims which could be local or BlueCard Home or Host
    - The last two characters represent the iteration number, which can indicate either:
      - The number of times a claim has been adjusted, or
      - That the claim is a segmented claim
    - The last claim processed number is still required in the Payer Control Number (ICN / DCN) field when selecting Billing Frequency "7" (Replacement of prior claim) or "8" (Void/Cancel of prior claim).
    - If a corrected claim (frequency 7) is submitted without capitalizing the first letter of the claim number that is being corrected (i.e., the last claim processed) the claim will be rejected up front. This applies to medical (professional and institutional) and medical dental corrected claims.
      - Example: If the provider attempts to correct E12312300000 by entering e12312300000 (or any mismatch), they will receive an upfront rejection.

Effective Jan. 1, 2027, paper claims will not be accepted for non-migrated or migrated members with dates of service on or after Jan. 1, 2027.

Providers must submit claims electronically whenever possible. Paper claims submitted for dates of service on or after Jan. 1, 2027, will be returned unless an approved exception applies.
Providers who cannot submit claims electronically should call the Provider Contact Center number on the back of the ID card prior to submitting a paper claim.
- If a provider is granted a paper claim exception, the mailing address for the form depends on the date of service.
  - Dates of service prior to Jan. 1, 2027, mail to 4510 13th Ave. S. Fargo, N.D., 58121
  - Dates of service after 1, 2027, should be mailed to P.O. Box 1106 Lewiston, ID 83501-1106

Non-migrated members: All providers are encouraged to submit their claims electronically and timely. If electronic claims submission is not possible, continue to follow current paper claim rules and guidance until Jan. 1, 2027.

Fragmented professional billing occurs when the same provider submits professional services for the same date of service on multiple professional claim forms.

Migrated member claims will require all professional services rendered by the same provider for the same date of service to be submitted on one claim form with the Place of Service (POS) 11.

If this is done incorrectly, the claim will be denied with Remittance Advice Remark Codes (RARC) codes: N380, N149 - The original claim has been processed, submit a corrected claim.
Submit a corrected claim to add all applicable services on one single claim.

Exceptions:

When a Medicare patient receives services that Medicare specifically requires to be submitted on separate claim forms.

Home infusion providers who bill for the initial and subsequent therapy administration code on the same day using modifier SH or SJ.

Claims or payment reviews may require medical records or supporting documentation. Workflows and phone numbers may differ based on the member’s migration status. Providers should submit requested documentation using the instructions in the request letter or notice. If a provider is unsure what is being requested, call the Provider Contact Center.

Note: It is important to attach the medical record request letter to the top of the records submission. If the letter is not available, use the Medical record submission form.

Effective Jan. 1, 2027, the unsolicited refund process will change for all BCBSND members, including migrated and non-migrated members.

Providers should always submit a claim correction or claim void when possible.

Currently, providers send unsolicited refunds with the Unsolicited Refund form and a check. As of Jan. 1, 2027, if a provider is unable to do the standard adjustment process, it will be required to submit the form with a claim number and the claim will be adjusted by BCBSND.

Today, the form is called an Unsolicited Refund Form. Please note, this form will change. Information will be shared with providers if changes are made to the process or form.

Providers may notice differences in coordination of benefits payments due to the different methodologies used for migrated and non-migrated members.

In addition to different methodologies, Accident/Workers Compensation/Subrogation timelines will vary:

Non-migrated members: Accident/Workers Compensation/Subrogation claim suspension timelines will continue to be 10 business days.
Migrated members: Timelines will change to 25 business days for migrated members. This means the claim will be suspended for 25 business days, waiting for the member to return the requested information. If no response is received during that time, the claim will be systematically rejected as member liable, indicating BCBSND is waiting for information from the member.

EFT information will automatically move into the new system for providers already enrolled. Currently enrolled providers will not have to do anything additional with their EFT, whether they see migrated or non-migrated members.

Providers not yet enrolled in EFT or those who need to make updates to their EFT information can do so by logging into Availity Essentials. Learn more about Availity Essentials.

As BCBSND members migrate to new systems, policies and processes, migrated and non-migrated members will be subject to different policies, clinical criteria and related workflows. Before reviewing a policy or submitting a request, verify the member’s eligibility in Availity Essentials, review the member ID number to confirm migration status, then use the information and links that apply to that member. 

Non-migrated members: Continue using current BCBSND policies, criteria and workflows until the member migrates.

Migrated members: Use the policies, clinical criteria, forms, tools and instructions identified for migrated members.

If a policy page or tool asks for a member type, select the option that matches the member’s current eligibility and migration status.

Whether the member has a migrated or non-migrated status, always include clinical documentation that supports the level of care requested and follow instructions in authorization decisions or denial letters.

Reimbursement policies explain how services are reviewed and reimbursed under BCBSND plans. Migrated members’ claims will process using policies, claims-editing rules and reimbursement processes that support the new claims-processing platform.

For further definition on the migrated vs. non-migrated experience related to reimbursement policies, click on the claims and payment section of the Provider Support Hub.

Click here to view the reimbursement policies.

Medical policies and medical necessity criteria may differ based on a member’s migration status. Providers should verify eligibility and migration status, select the applicable member status and review the policy, prior authorization requirements and clinical documentation expectations before providing services. 

Non-migrated members: Continue using current BCBSND medical policies and criteria, including InterQual® where applicable, until the member migrates.

Migrated members: Medical necessity reviews will use MCG® clinical criteria. Behavioral health reviews will use CALOCUS/LOCUS criteria, as applicable.

If a member is in an active course of treatment or stay during migration, the same BCBSND medical policy applies through the course of treatment or stay. Follow the instructions in the applicable authorization letter or determination communication.

Prior authorization will continue to apply for coverage of certain inpatient and residential behavioral health services. Many outpatient behavioral health services may not require review, but providers should always check current requirements before providing services. 

Non-migrated members: Behavioral health reviews continue using current BCBSND criteria until the member migrates.

Migrated members: Behavioral health reviews will use CALOCUS/LOCUS criteria, as applicable.

Prior authorization requirements and workflows are changing for migrated members beginning Jan. 1, 2027. Before requesting prior authorization, always:

Use the most current member ID number for the date of service you are requesting.
Verify the member's eligibility in Availity Essentials using the Eligibility & Benefits check.
Providers can select the member’s migration status and review applicable prior authorization requirements on our website for authorization details and clinical criteria, when applicable, before providing services.
Use the Prior Authorization function within Availity Essentials to check for authorization requirements.
- Once in the Prior Authorization Request screen, enter service and member details.
- Review the applicable policy that displays
If a service requires authorization, submit your request with the appropriate supporting clinical documentation.

For migrated members, providers should be aware that:

Some services may now require prior authorization, even if they did not before. A list of prior authorization requirements for migrated commercial members is now available for providers to review to better understand what is changing.
Additional clinical information and documentation may be required when submitting requests.
Prior authorization must be requested before providing services. The current practice of pre-claim review will not continue for migrated members. Contracted providers may receive administrative denials if prior authorization is not obtained before the service is performed.
Different medical criteria and medical policies will apply. As a result, providers may see differences in prior authorization and utilization management reviews for some services. Refer to the list of prior authorization requirements linked in the first bullet above to understand what is changing.

For non-migrated members, continue using current prior authorization processes, policies, medical criteria and workflows until the member’s migration date.

Authorization requests for all members should be submitted using Availity Essentials:

Non-migrated members: Continue to use existing prior authorization processes and workflows, including Predictal, to submit requests until the member migrates.
Migrated members: Some views on Availity Essentials are different for migrated members. BCBSND will provide resources to help providers prepare for these changes. For select CPT codes, Availity automatically routes you to MCG Health's website where you can document specific clinical criteria for your patient. If all criteria are met, you will see the approval on the Auth/Referral Dashboard soon after you click submit. Once all criteria are documented, you will then be routed back to Availity Essentials to attach supporting documentation and submit the request. Documenting complete and accurate clinical information for your patients helps to reduce the overall time it takes to review a request. View the services that may receive automated approval.

Availity Essentials error: Member not found

During the transition, Availity Essentials may return an error indicating the member cannot be found. This may occur when:

The authorization request is submitted before the member ID is effective in Availity Essentials.
An old member ID is used for a member who has already migrated.

If you receive this message:

Confirm you are using the most current member ID number for the date of service.
Verify eligibility in Availity Essentials.
Submit the request using the fax process for migrated members. Fax forms will be available by Dec. 1, 2026.
Include all required clinical documentation with the request.

Providers will route to EviCore from Availity Essentials to submit their requests.

Non-migrated members: EviCore currently manages genomic testing but does not manage joint and spine services.
Migrated members: To support the Utilization Management program, EviCore by Evernorth (EviCore) will manage joint and spine services as part of the Physical Medicine program. Learn more about the Physical Medicine program and EviCore.

Prior authorization will continue to apply to certain inpatient and residential behavioral health services, while many outpatient services may not require review. Checking member migration status and current authorization requirements before providing services can help avoid denials and ensure a smoother experience.

Non-migrated members: Reviews will continue to use current BCBSND criteria until migration.
Migrated members: Reviews will use CALOCUS/LOCUS criteria, as applicable.

Different medical policies will apply to migrated and non-migrated members. Before requesting prior authorization, providers should:

Check member migration status with the member ID number and verify eligibility in Availity Essentials.
Review the applicable medical policy by selecting Commercial Migrated or Commercial Non-Migrated.
Confirm if authorization is required.
Review applicable clinical criteria and documentation requirements.

Providers using Availity Essentials to submit a prior authorization may be prompted to review applicable medical policies and confirm that clinical criteria are met before submitting a request.

Different medical criteria apply depending on a member’s migration status. As a result, providers may see differences in prior authorization and utilization management reviews for some services.

Non-migrated members: Continue to use previously established criteria, including InterQual^® Criteria. Behavioral health reviews will continue to use current BCBSND criteria until migration.
Migrated members: Medical necessity reviews will use MCG^®criteria. Behavioral health reviews will use CALOCUS/LOCUS criteria, as applicable.

Providers will continue to have a clear path to request review of benefit, authorization, medical policy criteria, coding, reimbursement and payment determinations. During the transition, providers should continue to follow the instructions provided in the applicable denial, determination, audit or appeal letter.

The right to request a review of a prior authorization or benefit decision is not changing. Providers should continue to use the existing appeals process, timelines and appeal form for both migrated and non-migrated members unless instructed to do otherwise.

Explanation of Benefits (EOBs) for migrated members will include post-service appeal rights information.
EOBs for non-migrated members do not include post-service appeal rights information.

Non-migrated members:

Continue to follow the current processes outlined in the provider manual.

Migrated members:

Pre-Service: Providers will be able to appeal an authorization within Availity Essentials, only when the authorization submitted was for a migrated member ID.
Post-service appeals involving member liability: These will go through the member appeals process when the provider is acting on the member’s behalf with appropriate authorization. They are limited to one level of review.
Post-service provider appeals involving provider liability: Contracted providers can submit provider appeals for post-service claim review when the provider is financially liable.

Providers should continue to use the existing appeals process, timelines and appeal form for all members.

Non-migrated members:

Medical/Surgical and Behavioral Health reviews will continue to use previously established criteria, including InterQual® Criteria.

Migrated members:

Medical/Surgical reviews will use MCG® clinical criteria instead of InterQual®.
Behavioral health reviews will use CALOCUS/LOCUS criteria, as applicable.
Providers should follow the instructions in the applicable denial or determination letter and include supporting medical records or rationale needed for review.

Real-time Pharmacy Benefit Check

Starting Jan. 1, 2027, providers may access real-time prescription benefit information for all BCBSND commercial members through Arrive Health when integrated with their electronic medical record (EMR) system.

This capability can help identify:

Lower-cost drug alternatives
Coverage information
Formulary options available at the time of prescribing

Learn more about the real-time pharmacy benefit check tool.

Retail drug benefits

Retail drugs generally include self-administered medications that members pick up at their pharmacy (e.g., tablets, syrups, capsules, creams, etc.).

Continue to submit requests electronically, via fax or phone.
- Electronically: CoverMyMeds
- Fax: 1-855-212-8110
- Phone: 1-877-277-7912
Prior authorization information:
- View the prior authorization information for non-migrated and migrated members effective Jan. 1, 2027.
- Non-migrated members: Continue to submit prior authorization using your current process. Retail drug benefit prior authorization is administered by Prime Therapeutics. View our provider pharmacy information.
- Migrated members: View the prior authorization flyer. This flyer provides medications which have prior authorization requirements. Additionally, preferred product information is provided. Prime Therapeutics will continue to process retail drug benefit prior authorizations.
Retail drug benefit policies:
- Non-migrated members: View our drug policies.
- Migrated members: A link to the drug policies will be available on our provider website on Jan. 1, 2027.
  - View the prior authorization flyer retail drug benefit policy changes and updates to review to understand the policy changes.

Policy updates will continue to be available through HealthCare News.

Medical drugs benefits

Medical drugs are generally administered by the provider (e.g., a drug infused at the provider’s office). These are also referred to as clinician administered drugs (CADs).

Non-migrated members: View our provider pharmacy information.

Migrated members: A link to the medical drug benefit policies will be available on our provider website on Jan. 1, 2027. View the prior authorization flyer for details about medications with prior authorization requirements. Additionally, preferred product information is provided.

Policy updates will continue to be available through HealthCare News.

Medical drug benefit prior authorization requirements will differ from current processes as members migrate.

View the prior authorization information for non-migrated and migrated members effective Jan. 1, 2027.
Non-migrated members: View our prior authorization policies.
- Continue to submit medical drug prior authorizations through current process.
- Medical drug benefit prior authorizations for non-migrated members are administered by the Medical Pharmacy Solutions (MPS) team at Prime Therapeutics.
Migrated members: View the prior authorization flyer for information about changes to prior authorization requirements for migrated members.
- Prior authorization will be submitted via fax.
- Medical benefit prior authorizations for migrated members will be administered by the health plan.

Training sessions are scheduled to go over updates related to member migration. Providers can register for these sessions here.

Monday Oct. 12, 2026 – Website navigation, tools and system
Monday Oct.19, 2026 – Coding and reimbursement resources
Monday Oct. 26, 2026 – Medical policies, appeals, and prior authorization
Monday Nov. 2, 2026 – Claims processing and updates
Monday Nov. 9, 2026 – Pharmacy updates
Monday Nov. 16, 2026 - Physical Medicine program for spine and joint

Some of the current BCBSND forms providers use will update to align with the changes for migrated members. These forms are noted throughout the Provider Support Hub. Once the forms are available, additional directions will be given in this tab.

Current forms can be located on our website at https://www.bcbsnd.com/providers/news-resources/forms-documents.