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.
BCBSND is migrating Commercial members to new systems, policies and products in phases through the end of 2027. Providers may serve both migrated and non-migrated members during the transition.
Because of this migration plan, providers serving BCBSND members will need to follow certain processes and policies based on the member’s migration status. Two terms will start becoming very important in the upcoming months:
We understand this change may be impactful to everyday business operations, which is why we have begun sending a new series of HealthCare News (HCN) articles with a subject line of “2027 Change Notification Series:” starting on 09/01/2026. This notification series was created to give providers a heads up of changes coming starting 01/01/2027. Those changes can be found on a newly created page, called the Provider Support Hub. The Provider Support Hub will contain information that is pertinent to providers navigating this change.
We highly recommend becoming familiar with the Provider Support Hub, it will be updated as new information or training sessions become available.
We are gearing up for our yearly fall provider virtual collaboration sessions. Join our Provider Relations team members for the fall virtual provider collaboration session(s).
Beginning Jan. 1, 2027, BCBSND commercial members will begin migrating to new systems, processes, and policies. To help our provider partners prepare for these changes, BCBSND is hosting a series of training sessions in October and November to provide information, answer questions and share resources. All sessions will be held virtually from 12 to 1 p.m. CT on the dates noted below.
Agenda Topics include:
We encourage all providers to attend the session(s) that apply to your business role.
As outlined in the BCBSND Reimbursement Policies for Correct Coding—Commercial NDRP-GC-001 and Medicaid Expansion NDRP-GC-030—BCBSND expects providers to bill units up to the Medically Unlikely Edit (MUE) value on one claim line, with any units exceeding the MUE billed on subsequent lines.
To reduce confusion, BCBSND has clarified that it does not apply span-date billing with multiple units per line for MUE editing.
Providers are encouraged to bill itemized dates of service, up to the MUE value on one line, with any remaining units billed on a separate line using the appropriate modifier, when applicable.
Information regarding National Correct Coding Initiative Medically Unlike Edits (MUES) refer to the National Correct Coding Initiative.
As a reminder, providers should also check the Provider Support hub mentioned earlier in this article for any changes that may apply starting Jan. 1, 2027.
BCBSND is required to provide annual reporting of access and availability standard requirements to the North Dakota Department of Health and Human Services for Medicaid Expansion. This ensures that standards are being met. Providers participating in the BCBSND Medicaid Expansion network must adhere to the access and availability standards stated in our Medicaid Expansion Provider Manual to remain compliant.
Our network providers are expected to deliver services in a culturally competent manner to all patients, including those with limited English proficiency, diverse cultural and ethnic backgrounds, disabilities, and regardless of gender, sexual orientation, or gender identity. Providers must also address cultural competency and linguistic needs, including the enrollee's prevalent language(s) and sign language interpreters, in accordance with 42 C.F.R. §438.206(c).
Network providers must ensure physical access, reasonable accommodation, and accessible equipment for patients with physical or behavioral health disabilities, as outlined in 42 C.F.R. §438.206(c)(3).
Contracts with BCBSND require network providers, including primary care providers (PCPs) and specialty care providers, to provide appropriate access for our members.
Please review the Medicaid Expansion Provider Manual, specifically the section on Access and Availability (Pages 13-14), if you have any questions.
We thank all of our network provider partners for ensuring they are meeting these standards to provide the best possible experience for the Medicaid Expansion populations.
Practitioner applications must be submitted through the Council for Affordable Quality Healthcare (CAQH) Provider Data Portal and are no longer accepted via paper submission.
Benefits of utilizing CAQH:
We encourage those who have not yet registered with CAQH to do so as soon as possible to help ensure a timely and efficient credentialing process.
Visit our webpage Recredentialing & Credentialing Applications for more information on CAQH.
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.
We ask 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 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's 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. More information on the process of suppression can be found in the last Quarterly Insights article.
Questions?
For assistance follow the Provider Directory Validation process.
Need help with Availity Essentials or login?
For questions about the Provider Directory Validation process, email Provider Credentialing at prov.net@bcbsnd.com.
