Precertifications for Medicaid Expansion

Some services, procedures, and equipment require precertification before the service is performed. The ordering provider is typically responsible for obtaining precertification.

Precertification Instructions

  1. When a procedure, service or DME is ordered, use the search function below to check precertification requirements associated with the member's contract. For best results, double check the spelling or code you entered.
  2. If the item indicates "precertification required," submit your request through Availity Essentials. 
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  3. If you see no results for the code or search term entered, precertification is not required. Instead, refer to the medical necessity guidelines in the BCBSND medical policy.

NOTE: Any service that is potentially cosmetic does require precertification.
NOTE: Dental anesthesia and hospitalization for dental care, precertification is required.
NOTE: Repair of a covered wheelchair does not require pre certification. Benefits are allowed for repairs of latest wheelchair that has been covered by insurance.

Precertification is not required:

  • Emergency/post-stabilization services and maternity admissions

NOTE: The search results listed apply ONLY to Medicaid Expansion plans.

Medicaid Expansion precertification search

This code does not require a precertification. Medical policy may apply.

Any service that is potentially cosmetic does require precertification.

NOTE:  Dental anesthesia and hospitalization for dental care, precertification is required for all Members age 9 and older.

This keyword does not require a precertification. Medical policy may apply.

Any service that is potentially cosmetic does require precertification.

NOTE:  Dental anesthesia and hospitalization for dental care, precertification is required for all Members age 9 and older.

If this is a genomic code, BCBSND contracts with eviCore for its Laboratory Management Program. eviCore in an independent company providing specific medical policy and precertification services to BCBSND. Effective 1-1-2020, Lab Management (molecular and genomic testing) is delegated to eviCore.

Visit eviCore for Genomic Testing Policy

To view InterQual criteria, go to Authorizations and Referrals in Availity Essentials.

For more information visit InterQual.

Precertification required. Log into Availity Essentials.

Precertification required

Submit precertification requests

Questions related to Availity Essentials

Phone: Availity Client Services at 1-800-282-4548

Monday through Friday 7 a.m. - 6:30 p.m. CST