MedicaidAdministrativeMedium impact
Reminder: When to Mark an Appeal as Urgent
Blue Cross Blue Shield of North Dakota·ND·Provider News
Effective date
Jun 25, 2026
We identified it
Jul 3, 2026
Summary
Blue Cross Blue Shield of North Dakota (BCBSND) issued a reminder on June 25, 2026 clarifying when appeals should be marked as urgent. Providers must only use the urgent designation when delay could seriously jeopardize patient life, health, or function. All urgent appeals now require clear clinical documentation explaining the time-sensitive risk and direct contact information to enable timely communication.
Action Required
Immediately: Billing and clinical staff must review and enforce urgent appeal criteria. Providers should mark appeals as urgent ONLY when there is clear time-sensitive clinical risk (rapid condition worsening, loss of function, severe uncontrolled symptoms, or interruption of necessary treatment). When submitting urgent appeals: (1) clearly document the clinical risk of delay in the appeal narrative, (2) include supporting medical records or physician rationale, (3) provide direct contact phone number for follow-up. Update provider communication templates and appeal submission guidelines to reflect this standard. Train all staff submitting appeals to BCBSND to validate urgent designation before submission. Failure to appropriately use the urgent designation may result in appeals being downgraded to standard review, delaying patient care authorization.