CommercialAdministrativeMedium impact
December 2025 Quarterly Provider Insights
Blue Cross Blue Shield of North Dakota·ND · Psychiatry·Provider News
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of North Dakota announces their 2026 Provider Audit Work Plan targeting specific services including Non-emergency Medical Transportation (Modifier AF), Laboratory Services, and Psychotherapy Treatment Modalities. The policy also emphasizes proper appeals documentation requirements with specific timeframes: 180 days for Commercial appeals and 60 days for Medicaid Expansion appeals.
Action Required
Immediately: Review and ensure compliance with appeals documentation requirements - submit Commercial appeals within 180 days and Medicaid Expansion appeals within 60 days of adverse determination. Include complete supporting documentation to avoid delays and denials. Billing teams should verify proper use of anatomical modifiers, especially for procedures like CPT 11751. Providers offering NEMT services, laboratory services, or psychotherapy should prepare for potential audits in 2026 by ensuring accurate coding and documentation.