Quarterly Provider Insights: June 2024

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.

Provider Message

Spotlight on Provider Education

Message from Provider Education

Keeping our provider community informed is our team’s top priority. As we look forward to the second half of 2024, we want to share our teams continued work on our ruthless priority of the customer experience.

Our team focus is to provide self-servicing resources and tools by producing and sharing updates, news, and announcements for our Commercial and Medicaid Expansion provider community through the following methods:

Working closely with our internal BCBSND Leadership, Provider Relations Partners and our Provider Service Centers allows all of your area to be consistence with the information we provide. We want to thank the provider community for their support, suggestions, and collaboration efforts. We are always looking at ways to improve our communication, do you have a suggestion, if so, please email prov.partners@bcbsnd.com.

We look forward to servicing our provider community in the second half of 2024 and beyond.


The Provider Education Team


News and Announcements

It is Back! Strike Out the Stigma

Caring Foundation logo

To continue our support of North Dakota’s mental health concerns, BCBSND is partnering with Nexus-PATH Family Healing to raise awareness about mental health resources this summer.

For every strikeout thrown at July home games by the Bismarck Larks, Minot Hot Tots, Fargo-Moorhead RedHawks, and the Badlands Big Sticks, BCBSND's Caring Foundation will donate $50 to Nexus-PATH to support their mental health programming.

Check our webpage often to see our progress towards ending the stigma. 

Kids wearing Strike out the Stigma T-shirts

Educational Topics

Risk Adjustment Data Validation (RADV) and the Department of Health and Human Services (HHS) medical records request

It is that time of year. BCBSND has been notified by the Department of Health and Human Services that we are required to participate in an Initial Validation Audit for a sample of members both on and off the Health Insurance Exchange. The Medicare Advantage Risk Adjustment Data Validation (RADV) program is the Centers for Medicare & Medicaid Services (CMS) primary way to address improper overpayments to Medicare Advantage Organizations (MAOs). During a RADV audit, CMS confirms that any diagnoses submitted by an MAO for risk adjustment are supported in the enrollee's medical record.  This audit is not specific to you or your practice and is not designed to monitor your practice, and your billing or coding patterns.   

BCBSND does utilize a vendor for this audit. Cognisight will audit in-state providers and ComplexCare Solutions (formally Inovalon) will audit out-of-state providers. Providers may receive letters and requests from these two companies that will request your medical records on behalf of BCBSND.

CMS requires each note to be fully legible, signed with credentials and dated. Therefore, Cognisight will review the records you supply to make sure they meet these requirements. A signed attestation from the provider may be requested if these requirements are not met. 

What You Need to Know About Chart Fees  
Based on the governmental mandated audit, it is a provider’s obligation to provide medical records or obtain records from your vendor and submit the requested medical records with no charge to Cognisight or ComplexCare Solutions. Please do NOT mail, fax, or email any invoice/pre-payment invoice requests. Thank you for your cooperation.  

This audit does not apply to the North Dakota Medicaid Expansion program. Thank you in advance for your prompt response.

If you have any questions and/or prefer to provide access to medical records via electronic medical record or secure file transfer, please contact:

  • Cognisight at 1-877-271-1657 (option #1)
  • ComplexCare Solutions at 1-800-390-3180

Working to make a difference in our Commercial Provider Service Center

BCBSND is thanking providers for your continued patience as our Commercial Provider Service Contact Center has seen continued high call volumes and wait times in the first two quarters of this year.

We are seeing an increase of providers accessing self-service tools to work more efficiently. As a reminder, the self-service tools available are:

  • Interactive Voice Response (IVR) 
  • Check claim status
  • Verify eligibility
  • Verify cost shares accumulated
    • Some services are excluded
  • Availity Essentials
    • Eligibility and benefits verification
    • Direct messaging
    • Viewing your electronic remittance advice (ERA)

With this increased use of self-service tools we have seen improvements in our call volumes and wait times. We thank our provider community for the use of our self-service tools and resources. 

As a reminder to keep providers informed, we place banner messaging on the BCBSND Provider website if or when we are experiencing high call volumes or scheduled or system downtime as shown below. We also notify providers through the banner messaging for additional unplanned downtime and closures. 

Reminder: Provider directory validation

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.

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, providers making changes also need to complete the Provider Directory Maintenance Form (availity.com) and email the form to providerforms@bcbsnd.com. Please allow at least two business days for the update to be processed. For the complete instructions review the Provider Directory Validation process.


For assistance follow the Provider Directory Validation process.

Need help with Availity Essentials or login?

  • Call Availity Client Services at 1-800-282-4548.

For questions about the Provider Directory Validation process, contact Provider Credentialing at: