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MEMBERS HOME
Shop for ND's most trusted health care coverage, accepted by every hospital and most doctors in the state. Find individual and grouphealth plans.
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA DRUG FORMULARY Blue Cross Blue Shield of North Dakota Drug Formulary, April 2021 III How to use this list The Formulary is organized into broad categories (e.g. Anti -Infective drugs).PHARMACY TOOLS
Get information on your prescription drug coverage and usage: Log in to your Member Portal account and select Prescriptions. Call Prime Therapeutics at 855-457-0007. Prime Therapeutics is an independent company that helps in the administer of BCBSND’s pharmacy benefits. Plan Sales: 800-280-2583. HEALTH PLAN DOCUMENTS Find your plan documents. To find the documents specific to your benefit plan, access the member portal by logging in here to see your plan documents. If you are shopping for new coverage, browse the plandocuments below.
IMPLANTABLE HORMONE REPLACEMENT PELLETS Hormone replacement therapy (HRT) using formulas in subcutaneously implantable pellet form is an alternative to hormone therapy by injection or oral ingestion. Pellets are implanted in the physician’s office and release their contents over a period of months. Coverage is subject to the specific terms of the member’s benefit plan. Federal PHYSICAL THERAPY (PT) Physical medicine and rehabilitation is a medical specialty concerned with diagnosis, evaluation, and management of persons with physical impairment and disability. This specialty involves diagnosis and treatment of individuals with painful or functionally limiting conditions, the management of comorbidities and co-impairments. RITUXIMAB (RITUXAN), RITUXIMAB BIOSIMILARS, AND RITUXIMAB Description. Rituximab (Rituxan ®) is a genetically engineered chimeric murine/human monoclonal antibody.It binds specifically to the antigen CD20 (human B-lymphocyte-restricted differentiation antigen, Bp35). This antigen is a hydrophobic transmembrane protein that is INTRA-ARTICULAR HYALURONAN INJECTIONS FOR OSTEOARTHRITIS Archived Date: March 31, 2021. Description. Intra-articular injections of hyaluronan (also known as sodium hyaluronate) act as lubricants to restore elasticity and viscosity to the arthritic knee. The procedure involves an arthrocentesis to aspirate the damaged synovial fluid or joint effusion if present from the knee as directed by product. ELECTRONYSTAGMOGRAPHY (ENG) AND VIDEONYSTAGMOGRAPHY (VNG Criteria. Vestibular function testing using ENG and VNG testing batteries, caloric testing, or rotational chair testing may be considered medically necessary when ALL the following conditions have been met: The individual has symptoms of a vestibular disorder (e.g., dizziness, vertigo, imbalance); and A clinical evaluation, including maneuvers such as the Dix-Hallpike test if indicated, has CREDENTIALING AND RECREDENTIALING POLICY Page 4 of 18 Credentialing and Recredentialing Policy is a part, for all providers and enrollees. The Quality Committee of the Board reports credentialing and recredentialing activities to the BoardMEMBERS HOME
Shop for ND's most trusted health care coverage, accepted by every hospital and most doctors in the state. Find individual and grouphealth plans.
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA DRUG FORMULARY Blue Cross Blue Shield of North Dakota Drug Formulary, April 2021 III How to use this list The Formulary is organized into broad categories (e.g. Anti -Infective drugs).PHARMACY TOOLS
Get information on your prescription drug coverage and usage: Log in to your Member Portal account and select Prescriptions. Call Prime Therapeutics at 855-457-0007. Prime Therapeutics is an independent company that helps in the administer of BCBSND’s pharmacy benefits. Plan Sales: 800-280-2583. HEALTH PLAN DOCUMENTS Find your plan documents. To find the documents specific to your benefit plan, access the member portal by logging in here to see your plan documents. If you are shopping for new coverage, browse the plandocuments below.
IMPLANTABLE HORMONE REPLACEMENT PELLETS Hormone replacement therapy (HRT) using formulas in subcutaneously implantable pellet form is an alternative to hormone therapy by injection or oral ingestion. Pellets are implanted in the physician’s office and release their contents over a period of months. Coverage is subject to the specific terms of the member’s benefit plan. Federal PHYSICAL THERAPY (PT) Physical medicine and rehabilitation is a medical specialty concerned with diagnosis, evaluation, and management of persons with physical impairment and disability. This specialty involves diagnosis and treatment of individuals with painful or functionally limiting conditions, the management of comorbidities and co-impairments. RITUXIMAB (RITUXAN), RITUXIMAB BIOSIMILARS, AND RITUXIMAB Description. Rituximab (Rituxan ®) is a genetically engineered chimeric murine/human monoclonal antibody.It binds specifically to the antigen CD20 (human B-lymphocyte-restricted differentiation antigen, Bp35). This antigen is a hydrophobic transmembrane protein that is INTRA-ARTICULAR HYALURONAN INJECTIONS FOR OSTEOARTHRITIS Archived Date: March 31, 2021. Description. Intra-articular injections of hyaluronan (also known as sodium hyaluronate) act as lubricants to restore elasticity and viscosity to the arthritic knee. The procedure involves an arthrocentesis to aspirate the damaged synovial fluid or joint effusion if present from the knee as directed by product. ELECTRONYSTAGMOGRAPHY (ENG) AND VIDEONYSTAGMOGRAPHY (VNG Criteria. Vestibular function testing using ENG and VNG testing batteries, caloric testing, or rotational chair testing may be considered medically necessary when ALL the following conditions have been met: The individual has symptoms of a vestibular disorder (e.g., dizziness, vertigo, imbalance); and A clinical evaluation, including maneuvers such as the Dix-Hallpike test if indicated, has CREDENTIALING AND RECREDENTIALING POLICY Page 4 of 18 Credentialing and Recredentialing Policy is a part, for all providers and enrollees. The Quality Committee of the Board reports credentialing and recredentialing activities to the Board HEALTH PLAN DOCUMENTS Find your plan documents. To find the documents specific to your benefit plan, access the member portal by logging in here to see your plan documents. If you are shopping for new coverage, browse the plandocuments below.
ELIGIBILITY & CLAIMS Get information on the Blue Cross Blue Shield of North Dakota online provider portal, EDI, appeals process, and network referrals, or getpaper claims forms.
FEDERAL EMPLOYEE PROGRAM ADVANCED BENEFIT DETERMINATION Federal Employee Program Advanced Benefit Determination (ABD) Effective June 14, 2021 Blue Cross Blue Shield of North Dakota (BCBSND) only accepts an FEP Advanced Benefit Determination (ABD) request for a service, procedure or Durable Medical Equipment (DME), if the charge is $5,000.00 or greater. The FEP ABD allows providers tocontact the FEP
BELIMUMAB (BENLYSTA) Revised Date: August 31, 2020. Revision Effective Date: October 01, 2020. Last Reviewed: September 21, 2020. Archived Date: April 30, 2021. Description. Belimumab (Benlysta®) is a human monoclonal antibody that specifically recognizes and blocks the CODING AND BILLING GUIDELINES FOR CARE MANAGEMENT SERVICES Draft. Archive. Section: Coding Billing. Effective Date: February 25, 2021. This document provides coding and billing guidelines for Care Management Services. Providers may obtain additional information in the Current Procedural Terminology (CPT) manual for the guidelines and CPT documentation requirements.PROVIDER MANUAL
Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross & Blue Shield Association 29376354 • 5-21 ProviderManual
OCCUPATIONAL THERAPY (OT) Occupational Therapy (OT) is the treatment of neuromusculoskeletal and psychological dysfunction, caused by disease, trauma, congenital anomaly, or prior therapeutic process, through the use of specific tasks or goal-directed activities designed to improve functional performance of the individual. OT services emphasize useful andpurposeful
CONTINUOUS GLUCOSE MONITORS (CGMS) Continuous glucose monitoring systems (CGMS) are devices that automatically measure glucose levels throughout the day. These readings help detect any patterns or trends with an individual’s glucose levels and are intended to assist in calculating the insulin dosage needed to manage glycemic control. CGMS use sensors that areinserted under
SURGICAL TREATMENT OF VARICOSE VEINS Criteria. General medical necessity criteria for coverage of symptomatic varicose veins. Treatment for symptomatic varicose veins may be considered medically necessary when ALL of the following criteria are met for all varicose vein treatments: The individual has ANY ONE of the following: Documented limitations of activities of daily living caused by persistent lower extremity symptoms TREATMENT OF ABNORMAL UTERINE BLEEDING AND FIBROIDS Description. Uterine fibroids are one of the most common conditions affecting women in the reproductive years; symptoms include menorrhagia, pelvic pressure, or pain. Surgery, including hysterectomy and various myomectomy procedures, is considered the criterion standard treatment for symptom resolution. However, there is thepotential for
MEMBERS HOME
Shop for ND's most trusted health care coverage, accepted by every hospital and most doctors in the state. Find individual and grouphealth plans.
HEALTHCARE NEWS SITE Stay updated on HealthCare News. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email. ELIGIBILITY & CLAIMS Get information on the Blue Cross Blue Shield of North Dakota online provider portal, EDI, appeals process, and network referrals, or getpaper claims forms.
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA DRUG FORMULARY Blue Cross Blue Shield of North Dakota Drug Formulary, April 2021 III How to use this list The Formulary is organized into broad categories (e.g. Anti -Infective drugs). HEALTH PLAN DOCUMENTS Find your plan documents. To find the documents specific to your benefit plan, access the member portal by logging in here to see your plan documents. If you are shopping for new coverage, browse the plandocuments below.
PRECERTIFICATION SEARCH The list below is a standard precertification list. Some benefit plans have variations to the list. Wireless capsule endoscopy. No precertification is required when BCBSND is secondary to other insurance, unless other insurance benefits have been exhausted. No precertification is required for maternity admissions that result indelivery.
MEDICAL POLICY INFORMATION Stay updated on HealthCare News. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email.PROVIDER MANUAL
Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross & Blue Shield Association 29376354 • 5-21 ProviderManual
COBRA GUIDELINES
COBRA Guidelines COBRA–THE CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT –allows former employees and family members to temporarily continue the health coverage that was offered to them asan employee if
TREATMENT OF ABNORMAL UTERINE BLEEDING AND FIBROIDS Description. Uterine fibroids are one of the most common conditions affecting women in the reproductive years; symptoms include menorrhagia, pelvic pressure, or pain. Surgery, including hysterectomy and various myomectomy procedures, is considered the criterion standard treatment for symptom resolution. However, there is thepotential for
MEMBERS HOME
Shop for ND's most trusted health care coverage, accepted by every hospital and most doctors in the state. Find individual and grouphealth plans.
HEALTHCARE NEWS SITE Stay updated on HealthCare News. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email. ELIGIBILITY & CLAIMS Get information on the Blue Cross Blue Shield of North Dakota online provider portal, EDI, appeals process, and network referrals, or getpaper claims forms.
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA DRUG FORMULARY Blue Cross Blue Shield of North Dakota Drug Formulary, April 2021 III How to use this list The Formulary is organized into broad categories (e.g. Anti -Infective drugs). HEALTH PLAN DOCUMENTS Find your plan documents. To find the documents specific to your benefit plan, access the member portal by logging in here to see your plan documents. If you are shopping for new coverage, browse the plandocuments below.
PRECERTIFICATION SEARCH The list below is a standard precertification list. Some benefit plans have variations to the list. Wireless capsule endoscopy. No precertification is required when BCBSND is secondary to other insurance, unless other insurance benefits have been exhausted. No precertification is required for maternity admissions that result indelivery.
MEDICAL POLICY INFORMATION Stay updated on HealthCare News. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email.PROVIDER MANUAL
Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross & Blue Shield Association 29376354 • 5-21 ProviderManual
COBRA GUIDELINES
COBRA Guidelines COBRA–THE CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT –allows former employees and family members to temporarily continue the health coverage that was offered to them asan employee if
TREATMENT OF ABNORMAL UTERINE BLEEDING AND FIBROIDS Description. Uterine fibroids are one of the most common conditions affecting women in the reproductive years; symptoms include menorrhagia, pelvic pressure, or pain. Surgery, including hysterectomy and various myomectomy procedures, is considered the criterion standard treatment for symptom resolution. However, there is thepotential for
ELIGIBILITY & CLAIMS Get information on the Blue Cross Blue Shield of North Dakota online provider portal, EDI, appeals process, and network referrals, or getpaper claims forms.
PROVIDER FORMS AND DOCUMENTS The following forms are located in Availity Payer Spaces under the Resources tab: Change of Tax ID. Provider Directory Maintenance. Update Provider Information. New Location / Business Relationship. Electronic Remit and EFT requests can be submitted through Availityunder My
AMERICAN RESCUE PLAN ACT ARPA is a government response to the economic impact COVID-19. It offers temporary insurance premium relief through 2022. Discounts take the form of tax credits. Credit amounts are determined based on a sliding scale—they’re more generous at lowerBCBSND FEE SCHEDULE
BCBSND Online Fee Schedule. For questions regarding fee schedules, please email feeschedules@bcbsnd.com. Provider Service: 800-368-2312. About. News. Careers. Caring Foundation. HEALTHYBLUE ONLINE WELLNESS CENTER HealthyBlue helps employees know their numbers, what they mean, and how to make improvements toward total well-being. Health assessment. Personal health record. Device and app connection center. Optional biometric screenings. HealthyBlue personal health data. CODING AND BILLING GUIDELINES FOR CARE MANAGEMENT Draft. Archive. Section: Coding Billing. Effective Date: February 25, 2021. This document provides coding and billing guidelines for Care Management Services. Providers may obtain additional information in the Current Procedural Terminology (CPT) manual for the guidelines and CPT documentation requirements. MYOCARDIAL STRAIN IMAGING Myocardial strain refers to the deformation (shortening, lengthening, or thickening) of the myocardium through the cardiac cycle. Myocardial strain can be measured by tissue Doppler imaging or, more recently, speckle-tracking echocardiography. Speckle-tracking echocardiography uses imaging software to assess the movement of specific markers in RITUXIMAB (RITUXAN), RITUXIMAB BIOSIMILARS, AND RITUXIMAB Description. Rituximab (Rituxan ®) is a genetically engineered chimeric murine/human monoclonal antibody.It binds specifically to the antigen CD20 (human B-lymphocyte-restricted differentiation antigen, Bp35). This antigen is a hydrophobic transmembrane protein that is REMOVAL OF BENIGN OR PREMALIGNANT SKIN LESIONS Removal of a benign skin lesion (e.g., skin tags, nevus , sebaceous cyst, wart, seborrheic keratosis, or pigmented lesion) may be considered medically necessary when ANY of the following criteria are met: There is drainage, bleeding, burning, intense itching, or pain associated with the lesion; or. Inflammation, as evidenced bypurulence
CT (VIRTUAL) COLONOSCOPY Computed tomographic (CT) colonography, also referred to as virtual colonoscopy, is used to examine the colon and rectum to detect abnormalities such as polyps and cancer. In addition to its use as a diagnostic test in symptomatic individuals, CT colonography may be used in asymptomatic individuals with a high risk of developingcolorectal cancer.
MEMBERS HOME
Shop for ND's most trusted health care coverage, accepted by every hospital and most doctors in the state. Find individual and grouphealth plans.
HEALTHCARE NEWS SITE Stay updated on HealthCare News. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email. ELIGIBILITY & CLAIMS Get information on the Blue Cross Blue Shield of North Dakota online provider portal, EDI, appeals process, and network referrals, or getpaper claims forms.
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA DRUG FORMULARY Blue Cross Blue Shield of North Dakota Drug Formulary, April 2021 III How to use this list The Formulary is organized into broad categories (e.g. Anti -Infective drugs). HEALTH PLAN DOCUMENTS Find your plan documents. To find the documents specific to your benefit plan, access the member portal by logging in here to see your plan documents. If you are shopping for new coverage, browse the plandocuments below.
PRECERTIFICATION SEARCH The list below is a standard precertification list. Some benefit plans have variations to the list. Wireless capsule endoscopy. No precertification is required when BCBSND is secondary to other insurance, unless other insurance benefits have been exhausted. No precertification is required for maternity admissions that result indelivery.
MEDICAL POLICY INFORMATION Stay updated on HealthCare News. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email.PROVIDER MANUAL
Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross & Blue Shield Association 29376354 • 5-21 ProviderManual
COBRA GUIDELINES
COBRA Guidelines COBRA–THE CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT –allows former employees and family members to temporarily continue the health coverage that was offered to them asan employee if
TREATMENT OF ABNORMAL UTERINE BLEEDING AND FIBROIDS Description. Uterine fibroids are one of the most common conditions affecting women in the reproductive years; symptoms include menorrhagia, pelvic pressure, or pain. Surgery, including hysterectomy and various myomectomy procedures, is considered the criterion standard treatment for symptom resolution. However, there is thepotential for
MEMBERS HOME
Shop for ND's most trusted health care coverage, accepted by every hospital and most doctors in the state. Find individual and grouphealth plans.
HEALTHCARE NEWS SITE Stay updated on HealthCare News. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email. ELIGIBILITY & CLAIMS Get information on the Blue Cross Blue Shield of North Dakota online provider portal, EDI, appeals process, and network referrals, or getpaper claims forms.
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA DRUG FORMULARY Blue Cross Blue Shield of North Dakota Drug Formulary, April 2021 III How to use this list The Formulary is organized into broad categories (e.g. Anti -Infective drugs). HEALTH PLAN DOCUMENTS Find your plan documents. To find the documents specific to your benefit plan, access the member portal by logging in here to see your plan documents. If you are shopping for new coverage, browse the plandocuments below.
PRECERTIFICATION SEARCH The list below is a standard precertification list. Some benefit plans have variations to the list. Wireless capsule endoscopy. No precertification is required when BCBSND is secondary to other insurance, unless other insurance benefits have been exhausted. No precertification is required for maternity admissions that result indelivery.
MEDICAL POLICY INFORMATION Stay updated on HealthCare News. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email.PROVIDER MANUAL
Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross & Blue Shield Association 29376354 • 5-21 ProviderManual
COBRA GUIDELINES
COBRA Guidelines COBRA–THE CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT –allows former employees and family members to temporarily continue the health coverage that was offered to them asan employee if
TREATMENT OF ABNORMAL UTERINE BLEEDING AND FIBROIDS Description. Uterine fibroids are one of the most common conditions affecting women in the reproductive years; symptoms include menorrhagia, pelvic pressure, or pain. Surgery, including hysterectomy and various myomectomy procedures, is considered the criterion standard treatment for symptom resolution. However, there is thepotential for
ELIGIBILITY & CLAIMS Get information on the Blue Cross Blue Shield of North Dakota online provider portal, EDI, appeals process, and network referrals, or getpaper claims forms.
PROVIDER FORMS AND DOCUMENTS The following forms are located in Availity Payer Spaces under the Resources tab: Change of Tax ID. Provider Directory Maintenance. Update Provider Information. New Location / Business Relationship. Electronic Remit and EFT requests can be submitted through Availityunder My
AMERICAN RESCUE PLAN ACT ARPA is a government response to the economic impact COVID-19. It offers temporary insurance premium relief through 2022. Discounts take the form of tax credits. Credit amounts are determined based on a sliding scale—they’re more generous at lowerBCBSND FEE SCHEDULE
BCBSND Online Fee Schedule. For questions regarding fee schedules, please email feeschedules@bcbsnd.com. Provider Service: 800-368-2312. About. News. Careers. Caring Foundation. HEALTHYBLUE ONLINE WELLNESS CENTER HealthyBlue helps employees know their numbers, what they mean, and how to make improvements toward total well-being. Health assessment. Personal health record. Device and app connection center. Optional biometric screenings. HealthyBlue personal health data. CODING AND BILLING GUIDELINES FOR CARE MANAGEMENT Draft. Archive. Section: Coding Billing. Effective Date: February 25, 2021. This document provides coding and billing guidelines for Care Management Services. Providers may obtain additional information in the Current Procedural Terminology (CPT) manual for the guidelines and CPT documentation requirements. MYOCARDIAL STRAIN IMAGING Myocardial strain refers to the deformation (shortening, lengthening, or thickening) of the myocardium through the cardiac cycle. Myocardial strain can be measured by tissue Doppler imaging or, more recently, speckle-tracking echocardiography. Speckle-tracking echocardiography uses imaging software to assess the movement of specific markers in RITUXIMAB (RITUXAN), RITUXIMAB BIOSIMILARS, AND RITUXIMAB Description. Rituximab (Rituxan ®) is a genetically engineered chimeric murine/human monoclonal antibody.It binds specifically to the antigen CD20 (human B-lymphocyte-restricted differentiation antigen, Bp35). This antigen is a hydrophobic transmembrane protein that is REMOVAL OF BENIGN OR PREMALIGNANT SKIN LESIONS Removal of a benign skin lesion (e.g., skin tags, nevus , sebaceous cyst, wart, seborrheic keratosis, or pigmented lesion) may be considered medically necessary when ANY of the following criteria are met: There is drainage, bleeding, burning, intense itching, or pain associated with the lesion; or. Inflammation, as evidenced bypurulence
CT (VIRTUAL) COLONOSCOPY Computed tomographic (CT) colonography, also referred to as virtual colonoscopy, is used to examine the colon and rectum to detect abnormalities such as polyps and cancer. In addition to its use as a diagnostic test in symptomatic individuals, CT colonography may be used in asymptomatic individuals with a high risk of developingcolorectal cancer.
MEMBERS HOME
Shop for ND's most trusted health care coverage, accepted by every hospital and most doctors in the state. Find individual and grouphealth plans.
HEALTHCARE NEWS SITE Stay updated on HealthCare News. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email. ELIGIBILITY & CLAIMS Get information on the Blue Cross Blue Shield of North Dakota online provider portal, EDI, appeals process, and network referrals, or getpaper claims forms.
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA DRUG FORMULARY Blue Cross Blue Shield of North Dakota Drug Formulary, April 2021 III How to use this list The Formulary is organized into broad categories (e.g. Anti -Infective drugs). HEALTH PLAN DOCUMENTS Find your plan documents. To find the documents specific to your benefit plan, access the member portal by logging in here to see your plan documents. If you are shopping for new coverage, browse the plandocuments below.
PRECERTIFICATION SEARCH The list below is a standard precertification list. Some benefit plans have variations to the list. Wireless capsule endoscopy. No precertification is required when BCBSND is secondary to other insurance, unless other insurance benefits have been exhausted. No precertification is required for maternity admissions that result indelivery.
MEDICAL POLICY INFORMATION Stay updated on HealthCare News. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email.PROVIDER MANUAL
Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross & Blue Shield Association 29376354 • 5-21 ProviderManual
COBRA GUIDELINES
COBRA Guidelines COBRA–THE CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT –allows former employees and family members to temporarily continue the health coverage that was offered to them asan employee if
TREATMENT OF ABNORMAL UTERINE BLEEDING AND FIBROIDS Description. Uterine fibroids are one of the most common conditions affecting women in the reproductive years; symptoms include menorrhagia, pelvic pressure, or pain. Surgery, including hysterectomy and various myomectomy procedures, is considered the criterion standard treatment for symptom resolution. However, there is thepotential for
MEMBERS HOME
Shop for ND's most trusted health care coverage, accepted by every hospital and most doctors in the state. Find individual and grouphealth plans.
HEALTHCARE NEWS SITE Stay updated on HealthCare News. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email. ELIGIBILITY & CLAIMS Get information on the Blue Cross Blue Shield of North Dakota online provider portal, EDI, appeals process, and network referrals, or getpaper claims forms.
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA DRUG FORMULARY Blue Cross Blue Shield of North Dakota Drug Formulary, April 2021 III How to use this list The Formulary is organized into broad categories (e.g. Anti -Infective drugs). HEALTH PLAN DOCUMENTS Find your plan documents. To find the documents specific to your benefit plan, access the member portal by logging in here to see your plan documents. If you are shopping for new coverage, browse the plandocuments below.
PRECERTIFICATION SEARCH The list below is a standard precertification list. Some benefit plans have variations to the list. Wireless capsule endoscopy. No precertification is required when BCBSND is secondary to other insurance, unless other insurance benefits have been exhausted. No precertification is required for maternity admissions that result indelivery.
MEDICAL POLICY INFORMATION Stay updated on HealthCare News. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email.PROVIDER MANUAL
Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross & Blue Shield Association 29376354 • 5-21 ProviderManual
COBRA GUIDELINES
COBRA Guidelines COBRA–THE CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT –allows former employees and family members to temporarily continue the health coverage that was offered to them asan employee if
TREATMENT OF ABNORMAL UTERINE BLEEDING AND FIBROIDS Description. Uterine fibroids are one of the most common conditions affecting women in the reproductive years; symptoms include menorrhagia, pelvic pressure, or pain. Surgery, including hysterectomy and various myomectomy procedures, is considered the criterion standard treatment for symptom resolution. However, there is thepotential for
ELIGIBILITY & CLAIMS Get information on the Blue Cross Blue Shield of North Dakota online provider portal, EDI, appeals process, and network referrals, or getpaper claims forms.
PROVIDER FORMS AND DOCUMENTS The following forms are located in Availity Payer Spaces under the Resources tab: Change of Tax ID. Provider Directory Maintenance. Update Provider Information. New Location / Business Relationship. Electronic Remit and EFT requests can be submitted through Availityunder My
AMERICAN RESCUE PLAN ACT ARPA is a government response to the economic impact COVID-19. It offers temporary insurance premium relief through 2022. Discounts take the form of tax credits. Credit amounts are determined based on a sliding scale—they’re more generous at lowerBCBSND FEE SCHEDULE
BCBSND Online Fee Schedule. For questions regarding fee schedules, please email feeschedules@bcbsnd.com. Provider Service: 800-368-2312. About. News. Careers. Caring Foundation. HEALTHYBLUE ONLINE WELLNESS CENTER HealthyBlue helps employees know their numbers, what they mean, and how to make improvements toward total well-being. Health assessment. Personal health record. Device and app connection center. Optional biometric screenings. HealthyBlue personal health data. CODING AND BILLING GUIDELINES FOR CARE MANAGEMENT Draft. Archive. Section: Coding Billing. Effective Date: February 25, 2021. This document provides coding and billing guidelines for Care Management Services. Providers may obtain additional information in the Current Procedural Terminology (CPT) manual for the guidelines and CPT documentation requirements. MYOCARDIAL STRAIN IMAGING Myocardial strain refers to the deformation (shortening, lengthening, or thickening) of the myocardium through the cardiac cycle. Myocardial strain can be measured by tissue Doppler imaging or, more recently, speckle-tracking echocardiography. Speckle-tracking echocardiography uses imaging software to assess the movement of specific markers in RITUXIMAB (RITUXAN), RITUXIMAB BIOSIMILARS, AND RITUXIMAB Description. Rituximab (Rituxan ®) is a genetically engineered chimeric murine/human monoclonal antibody.It binds specifically to the antigen CD20 (human B-lymphocyte-restricted differentiation antigen, Bp35). This antigen is a hydrophobic transmembrane protein that is REMOVAL OF BENIGN OR PREMALIGNANT SKIN LESIONS Removal of a benign skin lesion (e.g., skin tags, nevus , sebaceous cyst, wart, seborrheic keratosis, or pigmented lesion) may be considered medically necessary when ANY of the following criteria are met: There is drainage, bleeding, burning, intense itching, or pain associated with the lesion; or. Inflammation, as evidenced bypurulence
CT (VIRTUAL) COLONOSCOPY Computed tomographic (CT) colonography, also referred to as virtual colonoscopy, is used to examine the colon and rectum to detect abnormalities such as polyps and cancer. In addition to its use as a diagnostic test in symptomatic individuals, CT colonography may be used in asymptomatic individuals with a high risk of developingcolorectal cancer.
MEMBERS HOME
Shop for ND's most trusted health care coverage, accepted by every hospital and most doctors in the state. Find individual and grouphealth plans.
HEALTHCARE NEWS SITE Stay updated on HealthCare News. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email. ELIGIBILITY & CLAIMS Get information on the Blue Cross Blue Shield of North Dakota online provider portal, EDI, appeals process, and network referrals, or getpaper claims forms.
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA DRUG FORMULARY Blue Cross Blue Shield of North Dakota Drug Formulary, April 2021 III How to use this list The Formulary is organized into broad categories (e.g. Anti -Infective drugs). HEALTH PLAN DOCUMENTS Find your plan documents. To find the documents specific to your benefit plan, access the member portal by logging in here to see your plan documents. If you are shopping for new coverage, browse the plandocuments below.
PRECERTIFICATION SEARCH The list below is a standard precertification list. Some benefit plans have variations to the list. Wireless capsule endoscopy. No precertification is required when BCBSND is secondary to other insurance, unless other insurance benefits have been exhausted. No precertification is required for maternity admissions that result indelivery.
MEDICAL POLICY INFORMATION Stay updated on HealthCare News. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email.PROVIDER MANUAL
Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross & Blue Shield Association 29376354 • 5-21 ProviderManual
COBRA GUIDELINES
COBRA Guidelines COBRA–THE CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT –allows former employees and family members to temporarily continue the health coverage that was offered to them asan employee if
TREATMENT OF ABNORMAL UTERINE BLEEDING AND FIBROIDS Description. Uterine fibroids are one of the most common conditions affecting women in the reproductive years; symptoms include menorrhagia, pelvic pressure, or pain. Surgery, including hysterectomy and various myomectomy procedures, is considered the criterion standard treatment for symptom resolution. However, there is thepotential for
MEMBERS HOME
Shop for ND's most trusted health care coverage, accepted by every hospital and most doctors in the state. Find individual and grouphealth plans.
HEALTHCARE NEWS SITE Stay updated on HealthCare News. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email. ELIGIBILITY & CLAIMS Get information on the Blue Cross Blue Shield of North Dakota online provider portal, EDI, appeals process, and network referrals, or getpaper claims forms.
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA DRUG FORMULARY Blue Cross Blue Shield of North Dakota Drug Formulary, April 2021 III How to use this list The Formulary is organized into broad categories (e.g. Anti -Infective drugs). HEALTH PLAN DOCUMENTS Find your plan documents. To find the documents specific to your benefit plan, access the member portal by logging in here to see your plan documents. If you are shopping for new coverage, browse the plandocuments below.
PRECERTIFICATION SEARCH The list below is a standard precertification list. Some benefit plans have variations to the list. Wireless capsule endoscopy. No precertification is required when BCBSND is secondary to other insurance, unless other insurance benefits have been exhausted. No precertification is required for maternity admissions that result indelivery.
MEDICAL POLICY INFORMATION Stay updated on HealthCare News. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email.PROVIDER MANUAL
Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross & Blue Shield Association 29376354 • 5-21 ProviderManual
COBRA GUIDELINES
COBRA Guidelines COBRA–THE CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT –allows former employees and family members to temporarily continue the health coverage that was offered to them asan employee if
TREATMENT OF ABNORMAL UTERINE BLEEDING AND FIBROIDS Description. Uterine fibroids are one of the most common conditions affecting women in the reproductive years; symptoms include menorrhagia, pelvic pressure, or pain. Surgery, including hysterectomy and various myomectomy procedures, is considered the criterion standard treatment for symptom resolution. However, there is thepotential for
ELIGIBILITY & CLAIMS Get information on the Blue Cross Blue Shield of North Dakota online provider portal, EDI, appeals process, and network referrals, or getpaper claims forms.
PROVIDER FORMS AND DOCUMENTS The following forms are located in Availity Payer Spaces under the Resources tab: Change of Tax ID. Provider Directory Maintenance. Update Provider Information. New Location / Business Relationship. Electronic Remit and EFT requests can be submitted through Availityunder My
AMERICAN RESCUE PLAN ACT ARPA is a government response to the economic impact COVID-19. It offers temporary insurance premium relief through 2022. Discounts take the form of tax credits. Credit amounts are determined based on a sliding scale—they’re more generous at lowerBCBSND FEE SCHEDULE
BCBSND Online Fee Schedule. For questions regarding fee schedules, please email feeschedules@bcbsnd.com. Provider Service: 800-368-2312. About. News. Careers. Caring Foundation. HEALTHYBLUE ONLINE WELLNESS CENTER HealthyBlue helps employees know their numbers, what they mean, and how to make improvements toward total well-being. Health assessment. Personal health record. Device and app connection center. Optional biometric screenings. HealthyBlue personal health data. CODING AND BILLING GUIDELINES FOR CARE MANAGEMENT Draft. Archive. Section: Coding Billing. Effective Date: February 25, 2021. This document provides coding and billing guidelines for Care Management Services. Providers may obtain additional information in the Current Procedural Terminology (CPT) manual for the guidelines and CPT documentation requirements. MYOCARDIAL STRAIN IMAGING Myocardial strain refers to the deformation (shortening, lengthening, or thickening) of the myocardium through the cardiac cycle. Myocardial strain can be measured by tissue Doppler imaging or, more recently, speckle-tracking echocardiography. Speckle-tracking echocardiography uses imaging software to assess the movement of specific markers in RITUXIMAB (RITUXAN), RITUXIMAB BIOSIMILARS, AND RITUXIMAB Description. Rituximab (Rituxan ®) is a genetically engineered chimeric murine/human monoclonal antibody.It binds specifically to the antigen CD20 (human B-lymphocyte-restricted differentiation antigen, Bp35). This antigen is a hydrophobic transmembrane protein that is REMOVAL OF BENIGN OR PREMALIGNANT SKIN LESIONS Removal of a benign skin lesion (e.g., skin tags, nevus , sebaceous cyst, wart, seborrheic keratosis, or pigmented lesion) may be considered medically necessary when ANY of the following criteria are met: There is drainage, bleeding, burning, intense itching, or pain associated with the lesion; or. Inflammation, as evidenced bypurulence
CT (VIRTUAL) COLONOSCOPY Computed tomographic (CT) colonography, also referred to as virtual colonoscopy, is used to examine the colon and rectum to detect abnormalities such as polyps and cancer. In addition to its use as a diagnostic test in symptomatic individuals, CT colonography may be used in asymptomatic individuals with a high risk of developingcolorectal cancer.
MEMBERS HOME
Shop for ND's most trusted health care coverage, accepted by every hospital and most doctors in the state. Find individual and grouphealth plans.
PROVIDERS HOME
May 18, 2021. Availity Provider Portal Eligibility and Benefits Verification. May 17, 2021. Telehealth Originating Site Facility Fee: CPT Q3014. May 12, 2021. eviCore Healthcare Partnership for Molecular and Genomic Testing Reminders. View All News. ELIGIBILITY & CLAIMS Get information on the Blue Cross Blue Shield of North Dakota online provider portal, EDI, appeals process, and network referrals, or getpaper claims forms.
PROVIDER FORMS AND DOCUMENTS The following forms are located in Availity Payer Spaces under the Resources tab: Change of Tax ID. Provider Directory Maintenance. Update Provider Information. New Location / Business Relationship. Electronic Remit and EFT requests can be submitted through Availityunder My
HEALTH PLAN DOCUMENTS Find your plan documents. To find the documents specific to your benefit plan, access the member portal by logging in here to see your plan documents. If you are shopping for new coverage, browse the plandocuments below.
APPLY TO BECOME A PROVIDER Vision Provider Applications. Apply to become a vision provider. BCBSND partners with Vision Service Plan (VSP) for network management (provider contracting), claims administration and member/provider customer service. Our products continue to be Blue branded and we partner with VSP to develop and market dental products. HEALTHCARE NEWS SITE Stay updated on HealthCare News. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email. PRECERTIFICATION SEARCH The list below is a standard precertification list. Some benefit plans have variations to the list. Wireless capsule endoscopy. No precertification is required when BCBSND is secondary to other insurance, unless other insurance benefits have been exhausted. No precertification is required for maternity admissions that result indelivery.
COBRA GUIDELINES
COBRA Guidelines COBRA–THE CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT –allows former employees and family members to temporarily continue the health coverage that was offered to them asan employee if
MEDICAL POLICY INFORMATION Stay updated on HealthCare News. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email.MEMBERS HOME
Shop for ND's most trusted health care coverage, accepted by every hospital and most doctors in the state. Find individual and grouphealth plans.
PROVIDERS HOME
HealthCare News. May 18, 2021 Availity Provider Portal Eligibility and Benefits Verification; May 17, 2021 Telehealth Originating Site Facility Fee: CPT Q3014; May 12, 2021 eviCore Healthcare Partnership for Molecular and Genomic Testing Reminders; View All News PROVIDER FORMS AND DOCUMENTS Providers can get Blue Cross Blue Shield of North Dakota forms for claims, appeals, precertification, referrals, pharmacy and more. ELIGIBILITY & CLAIMS Get information on the Blue Cross Blue Shield of North Dakota online provider portal, EDI, appeals process, and network referrals, or getpaper claims forms.
HEALTH PLAN DOCUMENTS To find the documents specific to your benefit plan, access the member portal by logging in here to see your plan documents.. If you are shopping for new coverage, browse the plan documents below. APPLY TO BECOME A PROVIDER The National Provider Identifier, or NPI, is a 10-digit intelligence free number that will be required of all covered entities as of May23, 2007.
HEALTHCARE NEWS SITE Stay updated on HealthCare News. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email. PRECERTIFICATION SEARCH Precertification. Some services, procedures, and equipment requires precertification before the service is performed. The ordering provider is typically responsible for obtaining precertification.COBRA GUIDELINES
COBRA Guidelines COBRA–THE CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT –allows former employees and family members to temporarily continue the health coverage that was offered to them asan employee if
TREATMENT OF ABNORMAL UTERINE BLEEDING AND FIBROIDS Laparoscopic ultrasound-guided radiofrequency ablation (e.g., Acessa TM) for the treatment of uterine fibroids may be considered medically necessary when the individual is experiencing any ONE of the following symptoms: Menorrhagia (excessive menstrual bleeding lasting more than eight (8) days) as a direct result of the fibroid (e.g., not resulting from hyperplasia, atypia, or cancer) thatMEMBER RESOURCES
Manage your health coverage. Take control of your BCBSND health insurance coverage in the online Member Services portal. When you register and use your online account, you also gain access to HealthyBlue, the online wellness center. Log In or Register.CONTACT US | BCBSND
An appeal can be verbal or written. Verbal appeals: call 844-363-8457. Written appeal: use this form and mail or fax to: Fax: 701-277-2209. Mail: Blue Cross Blue Shield ofPHARMACY TOOLS
Get information on your prescription drug coverage and usage: Log in to your Member Portal account and select Prescriptions. Call Prime Therapeutics at 855-457-0007. Prime Therapeutics is an independent company that helps in the administer of BCBSND’s pharmacy benefits. Plan Sales: 800-280-2583. INDIVIDUAL AND FAMILY HEALTH INSURANCE IN ND A few things to know about BCBSND health plans: Preventive services are covered at 100% when you use a BCBSND network provider. 99% of North Dakota providers are in the BCBSND network. Every North Dakota hospital takes BCBSND insurance. We negotiate low rates with providerson your behalf.
HEALTHCARE NEWS SITE Stay updated on HealthCare News. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email. BLUECARE HEALTH INSURANCE PLAN Low copays for doctor visits. Covers the 10 essential health benefits. Gold Plan. Silver Plans. BlueCare 70 2000. BlueCare 70 5000. BlueCare 70 4200. All cost sharing amounts apply to covered services you receive within the Preferred Blue PPO network. Covered services received out-of-network are paid at a lesser benefit or no benefitamount.
MEDICAL POLICY INFORMATION Stay updated on HealthCare News. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email.PROVIDER MANUAL
Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross & Blue Shield Association 29376354 • 5-21 ProviderManual
TREATMENT OF ABNORMAL UTERINE BLEEDING AND FIBROIDS Description. Uterine fibroids are one of the most common conditions affecting women in the reproductive years; symptoms include menorrhagia, pelvic pressure, or pain. Surgery, including hysterectomy and various myomectomy procedures, is considered the criterion standard treatment for symptom resolution. However, there is thepotential for
CREDENTIALING AND RECREDENTIALING POLICY Page 4 of 18 Credentialing and Recredentialing Policy is a part, for all providers and enrollees. The Quality Committee of the Board reports credentialing and recredentialing activities to the BoardMembers
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WHY ARE BLUE CROSS BLUE SHIELD OF NORTH DAKOTA MEMBERS AMONG THE MOST SATISFIED IN THE NATION? It's the widely accepted coverage and superior service from fellow North Dakotans at 10 offices across the state.ACROSS THE STATE
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Nearly every one in North Dakota100%
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Rural and urban, across the State80
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85% of hospitals and physician in the U.S.200
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Fargo, North Dakota 58121 Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross Blue Shield Association, serving residents and business in North Dakota. All rights reserved 2020 Blue Cross Blue Shield of North Dakota * Non-Discrimination Notice* Español
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