In collaboration with all other Blues plans, Blue Cross Blue Shield of North Dakota is beginning work to advance our current payment integrity program. BCBSND will be partnering with Cotiviti to enhance the accuracy of claims processing and payment.
Enhanced Payment Integrity Program Frequently Asked Questions (FAQ)
The enhanced BCBSND payment integrity program expands the current program capabilities and will include several additional reviews during and after the claims processing cycle to safeguard member’s health care dollars. Examples include:
Duplicate claims checking
Coordination of benefits, subrogation, and credit balance recoveries
Enhanced fraud, waste, and abuse programs supported by new data analysis capabilities
High dollar case reviews & inpatient (DRG) claim coding audits
Enhanced coding edits and validations to meet national standards
A few Blues plans started implementing this program effective July 1, 2021. Through our BlueCard system, BCBSND customers may see claims enhancements and program results with services and associated claims after July 1, 2021.
BCBSND will begin the process of implementing enhancements to our existing program. We are evaluating a phased rollout and will communicate more details when available.
The Blues’ system recently conducted a market assessment of the payment integrity landscape within plans across the country and found that there was an opportunity to create greater consistency in claims processing payments for national employer groups.
As we begin to implement the enhancements here in North Dakota starting later this year, we will keep you updated and informed. We will communicate through Health Care News articles and eBlasts starting in October.