Quarterly Provider Insights: March 2026

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 our Provider Directory Validation Process

Is your provider's directory information up to date?

Members rely on the provider directory to choose in‑network providers for services. To ensure accuracy, providers must validate their information every 90 days through the Availity Essentials Provider Portal and submit updates using the Directory Maintenance form.

For providers unfamiliar with the validation process, it can be found outlined on www.BCBSND.com website here. 

Provider directory information includes:

• Name and any group affiliation
• Street address(es)
• Telephone number(s)
• Website
• Specialty
• Medical school attended, graduation year and residency
• Board certifications
• Gender
• Languages spoken
• Whether the provider will accept new patients
• Whether the provider’s office/facility has accommodations for people with physical disabilities, including offices, exam room(s) and equipment

Promptly notify BCBSND Provider Networks via the directory maintenance form, if:  

• Any contact information changes, including address, phone number, fax number or messaging options
• New providers join your practice  
• Providers leave your practice, including through retirement or termination  
• A business or practice closes or merges  
• Your National Provider Identifier (NPI) number changes  
• Your status regarding accepting new patients changes  
• The list of languages spoken in the office changes  
• Patient gender or age restrictions change  
• A provider’s specialty or board certification has changed for any active service location  
• A new tax ID number is obtained  
• The address for a 1099 form changes  

To ensure our directory is accurate, we will be expanding our review of our provider directory maintenance to a monthly review. BCBSND will be sampling BCBSND Medicaid Expansion providers selected at random.

Provider directory information may be suppressed, if:

• Validation attestations are not completed
• No Medicaid Expansion claims are submitted within a twelve (12) month time period.
  • If a provider does submit claim(s) again, the Update Provider Information form will need to be completed. Providers can fill in the free text area that claim submissions have been done and would like to be added back into the directory.    

Note: In addition to removal from the directory for any Medicaid Expanison provider removed from the directory we will dis-enroll provider from the Medicaid Expansion Network at 12 months. Notification will be sent to provider 3 months prior to dis-enrollment for notification.

Ensure your staff are aware of the provider directory maintenance process, when applicable.

Quick Tip

• If your office uses voicemail for incoming calls, it is important to include a clear return call timeframe so patients know when to expect follow up.

Questions?
For assistance follow the Provider Directory Validation process.

Need help with Availity Essentials or login?

• Call Availity Client Services at 800-282-4548
  

For questions about the Provider Directory Validation process, that are not addressed in the process guide or other resources, email Provider Credentialing at prov.net@bcbsnd.com.

News and Announcements

Provider Collaboration Tour Coming Soon

Our Provider Relations Partners are gearing up to hit the road this June for the yearly Provider in-person collaboration sessions.

We look forward to the opportunity to connect with each of you in-person, provide updates, answer questions, and hear your thoughts. Below are the dates and locations of upcoming sessions. Agenda topics and times to come. Watch future HealthCare News for more detail.

• Tuesday, June 9, 2026 | Minot, ND
• Thursday, June 11, 2026 | Bismarck, ND
• Wednesday, June 17, 2026 | Grand Forks, ND
• Thursday, June 18, 2026 | Fargo, ND
• Tuesday, June 23, 2026 | Virtual Session Only

Our continued connections are important to us, and we also look forward to making new connections. Our commitment and goal is always to continue collaboration. 

Advance Notice of Maternity Global Coding Updates – Effective January 1, 2027

Blue Cross Blue Shield of North Dakota (BCBSND) is providing advance notice of upcoming changes to maternity global coding that will take effect January 1, 2027, based on updates provided by the American Medical Association (AMA).

These updates are intended to align maternity coding and claims processing with evolving coding standards and claims administration practices. At this time, this notice is for awareness only that global maternity coding will no longer be accepted as of the date identified above.

What to expect next:

• Additional details on coding changes, impacted CPT® codes, and billing scenarios will be shared later in 2026
• Education materials and billing guidance will be provided well in advance of the effective date

No action is required at this time. However, we do want to remind providers that shifting to billing non-globally is currently allowed in our system.  You are welcome to start this transition to updated coding practices effective in 2026.  

Watch for future updates for more details as we move closer to implementation.

Investing Where It Matters Most: BCBSND Caring Foundation Funds Innovative Health Solutions Across North Dakota

Big ideas become real change when communities have the support to act on them. Blue Cross Blue Shield of North Dakota (BCBSND) Caring Foundation is announcing the 2026 spring Health Innovation Grant recipients, supporting projects that bring people together, close gaps in care and strengthen health and well-being across the state. These one-year grants invest in new, expanding and innovative programs that address how everyday environments and access to resources shape health outcomes for North Dakotans. Over the past several years, the program has supported more than 40 organizations leading innovative, prevention-focused initiatives across North Dakota.

To find about who received the Caring Foundation Grants this year, and future grant applications, read the press release.

Educational

Providers Charging Members for Services: Understanding Contractual Billing Requirements

Ensuring accurate and compliant billing practices is essential to maintaining trust with members and supporting a positive patient experience. Provider contracts and resources such as the BCBSND provider manual outline specific requirements related to member cost-sharing, covered services, and prohibited charges. When members are charged for services in ways that conflict with their claim processing information, it can lead to confusion, complaints, and potential corrective action required.

What Providers Need to Know

Provider contracts define how and when members may be billed for covered services. In most cases, providers may only collect the applicable member cost share, such as copayments, coinsurance, or deductibles, as outlined in the member’s benefit plan.

Charging members beyond what is contractually allowed — even unintentionally — may result in member dissatisfaction and additional administrative review.

Examples of billing practices that may conflict with contractual requirements include:

• Charging members for covered services that were paid by the health plan
• Collecting amounts above the member’s required copayment, coinsurance, or deductible
• Billing members for administrative or operational fees that are not permitted under the contract
• Requiring upfront payment for covered services beyond the member’s cost share

Why This Matters

When providers adhere to contractually agreed billing practices:

• Members receive a consistent and predictable experience
• Billing disputes and complaints are reduced
• Provider offices avoid issuing refunds
• Trust between providers, members, and the health plan is strengthened

Incorrect billing can create unnecessary barriers to care and may discourage members from seeking needed services.

Tips to Help Prevent Billing Issues

To support compliance and reduce billing errors, providers are encouraged to:

• Review terms within their contract and various resources such as those provided by BCBSND
• Verify member eligibility and benefits prior to rendering services
• Ensure front office and billing staff understand which charges may be collected from members. Collect only the member cost share shown on the Explanation of Benefits. If no member responsibility is listed, do not bill the member for covered services.
• Regularly review explanation of benefits (EOBs) to confirm appropriate member responsibility
• Refund members promptly if an incorrect charge is identified

Ongoing staff education plays a key role in preventing issues, particularly when benefit designs or contractual requirements change.

Questions or Concerns?

If you are unsure whether a charge is permitted under your contract, reviewing your provider agreement or reaching out for clarification before billing the member can help prevent issues. Addressing questions early supports compliance and helps ensure a positive experience for your patients.