Medical Policy Information

The medical policies are developed under guidance of the Internal Medical Policy Committee. The Committee is composed of Blue Cross Blue Shield of North Dakota clinical and coding staff with medical policy accountability. This Committee provides a formal internal review for consensus, awareness and implementation throughout the company.

These Medical Policy guidelines are viewable and searchable.

To help direct you to the correct medical policy, please enter the 3 character prefix on the patient's BCBSND Member ID card.


     


Don't have a member ID handy? Access both versions of the Medical Policy.

Member - Medical Policy »
BCBSND members now on upgraded BCBSND systems and products will follow the migrated medical policy. In 2019, this medical policy will be the only policy in place.

If you are unable to find a policy or article, please verify with BCBSND that no written documentation exists on the topic.
 

Genomic Testing - Medical Policy »
BCBSND contracts with eviCore for its Laboratory Management Program. Services apply to all members in accordance with their benefit plan policy. Effective 1-1-2020 Lab Management (molecular and genomic testing) is delegated to eviCore. Please follow the link to access clinical guidelines.

By clicking the link above you will be leaving the Blue Cross Blue Shield of North Dakota (BCBSND) site and be redirected to eviCore. eviCore in an independent company providing specific medical policy and precertification services to BCBSND.

Retail Pharmacy - Medical Policy »

How Is Medical Policy Evaluated?
The Internal Medical Policy Committee reviews medical technologies according to the following technology assessment criteria which have been established by the national Blue Cross Blue Shield Association (BCBSA) and endorsed by BCBSND:

  • The technology must have final approval from the appropriate government regulatory bodies.
  • The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes.
  • The technology must improve the net health outcome.
  • The technology must be as beneficial as any established alternatives.
  • The improvement must be attainable outside the investigational settings.

Sources for Policy Development

Blue Cross Blue Shield Association

  • The Office of Clinical Affairs serves as a technical resource on medical policy issues to Plans.
  • The Association's Technology Evaluation Center (TEC) provides scientific analysis and opinions of complex medical technology issues. This information allows Plan medical personnel to make decisions about which treatments best improve a patient's health outcomes, resulting in efficient use of health care resources.
  • TEC is guided by the Association's Medical Advisory Panel (MAP), a panel comprised of nationally recognized experts in technology assessment, clinical research methodology and implementation, and clinical practice.

Specialty Input

  • Local providers or specialty organizations are asked for input on community standards of care and treatments.
  • Opinions and evaluations by national and state medical associations or consensus panels are researched.
  • External Review Organization reviews appeals.

Peer Reviewed Journals

  • Part of the research includes published reports and articles in the authoritative medical and scientific literature. The quality of the body of studies and the consistency of the results are considered in evaluating the evidence. The evidence should consist of well designed and well conducted investigations.

Centers for Medicare & Medicaid Services

Member Services/Provider Services

Physicians
Inquire or share documentation with BCBSND about recent medical advances and guidelines that could enhance our medical policies by contacting:

BCBSND Provider Services
4510 13th Ave S
Fargo, ND 58121
800-368-2312

Members
Inquiry information is listed below. You may also wish to discuss your individual medical situation with your physician. 

BCBSND Member Services
4510 13th Ave S
Fargo, ND 58121
844-363-8457