Billing & Reimbursement

This information is subject to change at any given time without notice. It should be used as a tool in conjunction with HealthCare News, Provider News, Provider Agreements and other publications.

In a highly regulated health care environment, reimbursement coding can be complex. Please review the Reimbursement document to help expedite your payment.

PDF IconReimbursement Guidelines


Guidelines & Policies
Coverage decisions are subject to all terms and conditions of the applicable benefit plan, including specific exclusions and limitations, and to applicable state and/or federal law. Any policies contained in the Coding, Billing & Reimbursement section do not constitute plan authorization, nor are these an explanation of benefits. Providers should contact BCBSND Provider Service for specific coverage or policy information.

Acute Inpatient (DRGs) - Hospital Billing
Ambulance Reference Guide
Ambulatory Surgery Center
Chemotherapy Administration, Hydration and Therapeutic, Prophylactic, and Diagnostic Injections and Infusions
Chiropractic Reference Manual
Chronic Pain Management
HME - Definition
HME - Guidelines
HME - HCPCS Category Summary
HME - Hearing Aids
HME - Hospital Beds
HME - Nebulizer
HME - Orthotics
HME - Oxygen Contents and Equipment
HME - Prosthetics
HME - Vacuum-Assisted Wound Closure Negative Pressure Wound Therapy
HME - Wheelchairs
Home Health Services
Home Infusion Therapy
Hospice Services
Preventive Health Services and Coding Guidelines
Standard Code Sets

Payment Listing
Understanding Your Physician Payment Listing

DRG Validation Program
DRG (Diagnosis Related Groupings) Validation Program
DVAC Application Form

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