CommercialAdministrativeMedium impact
Reminder Tips for Medical Drug Claim Submission
Blue Cross Blue Shield of North Dakota·ND·Pharmacy
Effective date
Jul 17, 2025
We identified it
Jun 19, 2026
Summary
BCBS North Dakota reminds providers to use accurate, specific diagnosis codes when submitting medical drug claims to reduce appeals from post-service claim edits. For dosing or frequency changes to previously approved medical drugs, providers must call the Medical Pharmacy Solutions team instead of submitting new prior authorization requests.
Action Required
Immediately: Billing team must ensure accurate and specific diagnosis codes are used on all medical drug procedure code claims to reduce appeals. For any dosing or frequency changes to previously approved medical drugs, call 800-424-1708 to reach Medical Pharmacy Solutions team at Prime instead of submitting new prior auth requests. Review current medical pharmacy prior authorization list at gatewaypa.com/policydisplay/52.