Quarterly Provider Insights shares information to our provider community in the third month of each quarter.
Quarterly Provider Insights will provide information regarding a company message, news and announcements, educational topics and miscellaneous updates.
Message from Jason Pratt, Co-Manager of BCBSND Customer Contact Center
My name is Jason Pratt and I co-manage our Commercial Customer Contact Center (CCC) department here at Blue Cross Blue Shield of North Dakota (BCBSND) alongside Lisa Kienenberger. I‘d like to share the efforts we have taken this year to ensure BCBSND is ready and available to answer provider questions and serve your needs, something we’re calling our CCC Refresh.
One of the principal areas of focus with CCC Refresh is recruitment and retention. We made robust changes to attract and retain the best talent and ensure more security of our workforce. Our efforts included:
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Based on our results – including an exponential increase in the number of qualified candidates for job postings, the doubling of our Customer Advocate staff from February to October and a more than 50% reduction of Average Speed of Answer (ASA) over the same time-period – we believe our approach is successful.
A steady state of staffing and resources is a never-ending battle. We are hearing positive feedback regarding our refresh efforts, and we will continue to work on ways to better serve our provider community.
Thank you for your partnership.
~ Jason Pratt
As part of our commitment to our provider community, we work hard to make a difference in our overall provider satisfaction. Since we began our Commercial CCC Refresh, we’ve concentrated efforts around improving our average speed of answer.
We’ve also enhanced our knowledge base, offering our providers self-service tools to aid in answering questions. These include:
We are committed to improving our provider organizations’ experience when contacting our customer contact centers. Watch for more data in coming months and check out our past article, Provider Service Contact Center Call Volumes and Wait Times | BCBSND, for more information.
We've also made changes to our Medicaid Expansion Customer Contact Center (CCC) – something we continually do to ensure a positive experience and improve overall provider satisfaction.
In the third quarter of the year, the Medicaid Expansion CCC took 3,898 provider calls, 1,697 transportation calls and 4,363 member calls. Our average hold time was 31 seconds across all 9,958 calls received.
On Nov. 11, 2023, Blue Cross Blue Shield of North Dakota (BCBSND) implemented Predictal – the new precertification tool integrated with the Availity Essentials provider portal. I’d like to thank our providers for their continued patience, collaboration and feedback as we navigate this new system.
While faxing requests is available and typically used for system downtime or technical issues, we encourage providers to use the Predictal Resource Guide on our website and submit precertification requests electronically. The benefits of submitting electronically include:
We will continue to update the Predictal Resource Guide as necessary to help navigate this change. We encourage our providers to reference this guide on our website to ensure they have the most current information.
Please verify your Availity Essentials access with your administrator if you will be submitting precertification requests for your office. If you have access to the Patient Registration, Authorization & Referrals tab within Availity Essentials today, you should not need to do anything further.
You can find articles and information related to Predictal by searching the HealthCare News section of our website.
Questions?
For questions related to Availity Essentials registration or administrator functions, contact Availity Essentials Client Services at 1-800-282-4548.
On average, our UM team receives more than 1,000 precertification requests per month that do not require authorization. Our Commercial CCC receives on average 60 calls a day, questioning if authorization is required for a specific service.
Blue Cross Blue Shield of North Dakota (BCBSND) wants to remind providers to use the self-service tools available for checking if precertification is required for a service. Precertification, authorization, prior authorization, prior approval and/or preauthorization are interchangeable terms meaning a service gets reviewed prior to the service being performed, when required by insurance.
Requests to Utilization Management (UM) or the Customer Contact Center (CCC) for Current Procedural Terminology (CPT) codes that do not require authorization may cause delays in your patient receiving or being scheduled for services. It is important to BCBSND that we continue to meet our timely requirements for precertification, and when reviewing CPT codes that do not require precertification, it becomes harder for our teams to meet those requirements.
Claims submitted without precertification review will be denied, and no additional post-claim review will be completed. This may result in providers being held liable for charges.
In early 2024, we will be moving to a new self-service authorization tool called PA Checkpoint, beginning with updating our precertification webpages on our BCBSND provider website. Following the website updates, we plan to implement this tool within Availity Essentials, which will work with our new Predictal precertification tool that was implemented in November 2023.
The new year brings new patients and new cards. Blue Cross Blue Shield of North Dakota (BCBSND) wants to remind providers of the Member Identification Card Quick Reference Guide webpage.
The reference ID card webpage outlines general guidance on how to read a BCBSND member ID card, as well:
Is your provider's directory information up to date? Our members (your patients) rely on the information listed in the provider directory to select in-network providers for health care services. Validating your information every 90 days ensures our provider directory displays accurate information.
Blue Cross Blue Shield of North Dakota (BCBSND) asks our provider community to validate their directory information through the Availity Essentials Provider Portal and continue to submit changes through the Availity Essentials directory maintenance form. Making these timely changes and validating information every 90 days allows for the directory to be the most accurate. This also assists BCBSND in meeting the No Suprise Act (NSA) Federal Mandate and Utilization Review Accreditation Commission (URAC) requirements.
Your provider information may be suppressed from the directory if validations are not attested at least once per year. Removal from the directory does not change participation status.
Questions?
For assistance follow the Provider Directory Validation process.
Need help with Availity Essentials or login?
For questions about the Provider Directory Validation process, contact Provider Credentialing at:
It is that time of year! Time to start making preventive care appointments for 2024.
Preventive care services are for patients without recognized signs or symptoms of a targeted condition. Screening refers to the testing for disease in well individuals so early detection and treatment can be provided, if necessary.
Preventive Health Benefits and Coding Guidelines provide additional information related to specific types of preventive services, as defined under the Patient Protection and Affordable Care Act, which may be covered under a Member's Benefit Plan. Coverage may depend on factors like grandfathered status, product type, anniversary date and contraception exemptions.
The terms and conditions of the written benefit plan govern the benefits available to our members, your patients. These guidelines do not guarantee coverage or payment for a particular service.
Questions?
Providers can reference the Preventive Health Benefits and Coding Guide and also review the preauthorization list as some of the preventive services may require prior authorization to support medical necessity.
Contact Provider Services at the telephone number and address on the back of the patient’s identification card for further preventive service benefits information. Not all benefits apply to all lines of business.
