HealthCare News

Fee Schedules Posted to Online Fee Schedule Portal

Issue: #402 JUL2018

Topic: Reimbursement


The July 2018 Fee Schedules and Reimbursement Notice have been posted to the online fee schedule portal. The fee schedules reflect Blue Cross Blue Shield of North Dakota’s (BCBSND) annual update of rates that have been established for all procedure codes released by the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA). Posted fee schedules will be in effect July 1, 2018, through June 30, 2019. The fee schedules will only be available through the portal; we will not be distributing fee schedules through other channels.

Payment is based on the lesser of charges or fee schedule amount unless otherwise noted in the reimbursement notices. Specific product discounts or contractual arrangements that you may have with BCBSND are not reflected in the fee schedules. These fee schedules are considered confidential and proprietary and are intended for the exclusive use of BCBSND participating providers. Participating providers may only use or disclose the information for practice management, billing activities and other business operations, or to disclose the information to the insurance commissioner. Any other use or redistribution of these fee schedules without the written consent of BCBSND is prohibited.

The most current version of each code set (ICD-10-CM, CPT® and HCPCS) must be used and services coded to the required level of specificity. Services are billed based on the definitions, units and parenthetical information as identified by the AMA for CPT® and CMS for HCPCS. Code sets are updated based on release of new codes by the owners of the code sets (AMA, CMS, etc.). Codes cannot be used prior to their effective date or after their termed date. Specific coding guidelines related to a particular policy are published in HealthCare News.

The existence of a procedure code on these fee schedules is not a guarantee that the code is valid or covered. These fee schedules may contain procedure codes that have been replaced by other HCPCS or CPT® codes. Edits in BCBSND’s system check for procedure validity and will reject invalid codes. Some codes may represent services for which benefits are not available.

For questions concerning this notice, please email feeschedules@bcbsnd.com.

How to Request Access to the Online Fee Schedule Portal

To access the online fee schedule portal and the fee schedules associated with your facility, you will need to request access to the portal by following this link to the registration screen (image below): www.BCBSND.com/FeeSchedules.

To register, you will need to enter the following information:

  1. Entity Name
  2. User First Name and User Last Name
  3. Email Address – The email address you enter will be your username.
  4. Phone Number where you can be reached
  5. Street Address; Apartment, Suite, Unit, etc. (Optional); Town/City, State and ZIP Code
  6. EIN associated with the provider entity
    1. Type EIN in box under “EIN Number.”
    2. Click “Add.”
    3. Repeat to add additional EINs – Add all the EINs associated with the entities for which you want fee schedule access. Access will not be granted unless a valid EIN is submitted.
  7. Review the User Attestation and the Terms and Conditions for Use.
    1. The User Attestation asks you to attest that the information that you provided is accurate and that you are designated to request this access on behalf of the entity.
    2. The Terms and Conditions for Use covers the terms and conditions associated with user access, user equipment, conduct of user, etc.
    3. Click in the boxes next to the documents once you have read through them.
    4. Review the information you entered to make sure it’s accurate, paying special attention to the EIN(s). If an EIN is invalid, it will slow the registration process and your access to the
      fee schedules.
  8. When you’re finished, click “Submit.”

After you click “Submit,” you will receive an email from BCBSND asking you to verify your email address.

As your request moves through the registration process, please follow the instructions you receive as soon as possible so your request is processed in a timely manner.

If you have any questions or encounter any problems during the registration process, please contact us at 800-544-8467 or feeschedules@bcbsnd.com.

If you’ve already been granted access to the online fee schedule portal, follow this link to access the fee schedules: https://www.BCBSND.com/FeeSchedules/feeschedulemanagement/list.