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

Quarterly Provider Insights Purpose

Message from Tracy Farahmand, Director of Network Management

Good day all! My name is Tracy Farahmand and I oversee our provider engagement teams at Blue Cross Blue Shield of North Dakota (BCBSND). I am excited to a share the new quarterly provider insight with you all. Keeping our provider community informed is one of the goals of our Provider Engagement teams. We felt by creating weekly newsletters and quarterly insights it would increase predictability of when to expect news from us and consolidate information for easier reading. 

Going forward, you can expect these quarterly insights to provide information regarding a company message, news and announcements, educational topics on all lines of business, along with coding, reimbursement, policy and benefit updates.

You will continue seeing weekly newsletters on more current events and topics. We hope you enjoy the new method of communication, and we look forward to working with you this year. 

~ Tracy Farahmand

News and Announcements

Blue Cross Blue Shield of North Dakota Caring Foundation Event Review:
A Social Determinants of Health Perspective

On February 15, 2023 and February 22, 2023, Blue Cross Blue Shield of North Dakota (BCBSND) Caring Foundation hosted events in Bismarck and Fargo, North Dakota for individuals and organizations working to advance better health outcomes in North Dakota. Providers joined in conversation with leading health influencers surrounding a new study that looks at Social Determinants of Health (SDoH) and their impacts in North Dakota.  

SDoH are the conditions in which people are born, grow, live, work and age. SDoH shapes the health of North Dakotans and the communities where they live.

Individuals who attended this event learned:

• Information about study findings
• Heard from key leaders working on SDoH issues across North Dakota
• Engaged in roundtable discussions to identify actionable solutions

Attendees now understand the disparities and barriers that impact North Dakotan’s health. This will help to drive engagement and create alignment among key stakeholders as organizations advocate and develop solutions.

Thank you to those of you who took the time to attend our event. We look forward to more events like this in the future. 

Questions?

To learn more on this program visit Social Determinants of Health Study | BCBSND.

Blue Cross Blue Shield of North Dakota Medicaid Expansion: A Year in Review

On January 1, 2022, Blue Cross Blue Shield of North Dakota (BCBSND) became the administrator for North Dakota Medicaid Expansion. Our partnership with North Dakota’s Department of Health and Human Services (DHHS) began with servicing around 30,000 enrolled Medicaid Expansion members, after which enrollment steadily climbed to just over 34,000 enrolled members throughout 2022. We currently have 1,302 provider facilities participating within the Medicaid Expansion network.

In the first year, BCBSND processed around 657,000 claims and assisted with over 33,000 phone calls. Along with claims processing and phone calls, our Utilization Management team looked at 8,911 precertification reviews and 487 referrals.

BCBSND worked closely with DHHS to assist in the development of the 1915(i) program and to expand the non-emergency medical transportation program across the state of North Dakota. 

BCBSND partnered with Arkos Healthcare to enhance our care management support to Medicaid Expansion members. Arkos Healthcare is a population health management company that works with health insurers and members’ primary care team to help provide supplemental coordinated care to Medicaid Expansion members at no additional cost to the patient or provider. Visit BCBSND Arkos Health Management to learn more.

BCBSND expanded the Medicaid Expansion Provider Information website to provide new information to providers who joined the Medicaid Expansion network. Three educational videos were developed and a specific Medicaid Expansion provider manual was created. 

BCBSND wants to thank the provider community for their engagement throughout 2022. We look forward to the continued partnerships in 2023 as we strive to improve the health and well-being of North Dakota’s Medicaid Expansion members.

Educational Topics

No Surprises Act (NSA) Directory Validation 

As 2023 begins, Blue Cross Blue Shield of North Dakota (BCBSND) is thanking the 73 percent of our provider community that validated their organizations provider directory information in 2022. As a requirement of the NSA, we are following the federal mandate which will continue into the years to come.

As a reminder providers will be required to validate once a year. There is still time to validate to make sure your 2023 information is up-to-date. Validating your information ensures our directory reflects accurate information. Our members and your patients rely on the provider directory to assist in finding health care services available within their network.

As new patients and providers join our network, the directory informs providers and our members that you are available. When your information is not correct, this may cause members and provider referrals to go elsewhere. Follow these instructions to complete the directory validation process.

Questions?

Need help with Availity Essentials or login? 

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

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

• Phone – 1-800-756-2749
• Email – prov.net@bcbsnd.com

Medical Record Submission Process Reminder

Blue Cross Blue Shield of North Dakota (BCBSND) wants to remind providers of the medical record submission process. 

BCBSND will not review medical records received from participating providers if the medical records are sent without one of the following:

• The BCBSND medical record request letter
• The Medical record submission form located on the BCBSND provider website

Medical records submitted without one of the above, will be considered unsolicited. This may also include records received with the wrong member or claim information supplied. Unsolicited records will not be reviewed and will purge from the BCBSND system after 180 days. 

If the above process is followed, but there is not enough information to make a determination, you may receive another request for additional documentation, please follow the same process when submitting additional requested records. If the claim denies for lack of supporting documentation, you will receive notification on your remittance and will need to proceed with appropriate next steps, such as an appeal if applicable.

Exceptions that may apply to the above process: 

• Utilization Management (UM) precertification/authorization requests from providers.
  • UM will allow standard cover pages for records required for these types of submissions.
• Payment Integrity Program record requests 
  • You can visit the Payment Integrity Program webpage for more information.

If you want to check the status of medical records, you can utilize the direct messaging feature of the Availity Essentials portal or contact the Provider Services phone number found on the back of the members ID card.