Health care students training at Dakota College at Bottineau.
Blue Cross Blue Shield of North Dakota (BCBSND) Caring Foundation is honored to announce that 30 recipients are receiving scholarships related to this year’s 2024-2025 annual Health Profession Scholarship awards for students in North Dakota. Scholarships awarded for 2024-2025 total $80,000.
This is the seventh year the BCBSND Caring Foundation has provided this scholarship opportunity which aims to help address the health care workforce shortage and provide financial assistance to aspiring students who are pursuing a health profession to strengthen the workforce. According to previous recipient, Joslyn N., scholarships are a helpful tool for growing the health care workforce in North Dakota.
“I am an occupational therapy student at the University of North Dakota. I applied for and received the Health Profession Scholarship last year. This scholarship helped make graduate school possible for me. It changed my graduate school experience and my life in general as it relieved a lot of financial burdens so I could focus better on my studies. That really paid off because I am currently in the honors society for occupational therapy now!”
About the Blue Cross Blue Shield of North Dakota Caring Foundation
Established in 1989, the BCBSND Caring Foundation is a private 501(c)(3) charitable organization. Through giving and investing, the Caring Foundation focuses on key health issues to help improve the health and well-being of North Dakotans and their communities. Caring Foundation staff collaborate with grantees to support non-profit sustainability, promote shared outcomes, and create lasting change.
Preventive care services are for patients without recognized signs or symptoms of the target condition. Screening is the testing for disease in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease. It’s that time of year to start making appointments for 2025.
Blue Cross Blue Shield of North Dakota (BCBSND) wants to remind providers regarding the 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 depending on factors such as grandfathered status, product type and anniversary date, and contraception exemptions.
The terms and conditions of the written benefit plan govern the benefits available to our members, your patients, and the 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 prior authorization list as some of the preventive services may require prior authorization to support medical necessity.
Providers should 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.
Blue Cross Blue Shield of North Dakota (BCBSND) is live with our new medical pharmacy prior authorization process as of Dec.9, 2024. This has changed our process for clinician administered drug prior authorization requests for our Commercial and Health Insurance Marketplace members. This change is how providers request prior authorizations for clinician administered drugs on the medical benefit.
BCBSND is working with the Medical Pharmacy Solutions team at Prime Therapeutics Management (PrimeRx) to assist with clinician administered drug prior authorization reviews through www.gatewaypa.com.
Provider training was completed in November 2024. Visit our Medical Pharmacy Solutions webpage to review our FAQ and to learn more.
This applies to both Commercial and Medicaid Expansion
As of Jan.1, 2025, prior authorization faxes received on/or after Jan.1, 2025, will be cancelled going forward as we announced in August 2024.
Faxed authorization cancelations will occur unless one or more of the situations below apply:
1. Provider received an error while trying to submit the electronic request
a. Providers will need to contact Availity at 1-800-282-4548 or Availity Technical Support Direct message at www.availity.com for technical support.
2. Authorization needed is a Medicaid Expansion inpatient discharge notification
a. Reference page 46 of the Medicaid Expansion Provider Manual for more information on this process.
3. When Availity Essentials or Predictal has downtime
a. BCBSND will notify providers if this occurs and utilize a fax option if necessary.
Not familiar with electronic submission?
Providers can learn more about electronic submission through Availity/Predictal through the following Predictal Resource Guide.
Questions?
Contact the Provider Service Center phone number on the back of the member’s ID card.
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.
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.
Submitting a Directory Maintenance Form
As a reminder provider making changes also needs to complete the Provider Directory Maintenance Form (availity.com) and email the form to providerforms@bcbsnd.com and allow at least two business days for the update to be processed. For the complete instructions review the Provider Directory Validation process.
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:
