Summary of Benefit Changes
Issue: #411 NOV2019
Behavioral Health Case Management is available to all members at no additional cost. It is a voluntary service providing assessment and care coordination for members telephonically. The case management team is comprised of both registered nurses and a Licensed Masters Social Worker. Case Management works with the member, their support systems and health care delivery systems to utilize the benefits available through the member’s health plan as well as access community resources. Case managers will assist the member to identify long-term and short-term health goals that are member centric and driven based on each individual member’s needs.
Case Management’s goal is to guide the member through the complexities of the healthcare system and their insurance benefits in order to meet their personalized healthcare needs wherever they are at in their recovery process. We strive to empower members to make healthy choices and achieve their optimal health goals, while supporting providers with transition of care plans and locating outside education and resources. If you have a member you would like to refer to our program or have any additional questions, please contact the Blue Cross Blue Shield of North Dakota (BCBSND) Case Management department at 1-800-336-2488 and request to speak with a behavioral health case manager.
Summary of Benefit Changes
The following information is a brief summary of benefit plan changes. These changes do not apply to FEP. The member’s benefit plan describes the available covered services as well as the specific cost sharing amounts. Please contact Provider Services at the number on the back of the member’s card for additional information.
Licensed Master Social Worker (LMSW) and Licensed Professional Counselor (LPC)
Effective January 1, 2020, and on group anniversary thereafter, benefits for services provided by LMSW’s and LPC’s will be payable. Services performed by LMSW’s or LPC’s prior to the member’s anniversary date will be considered non-payable.
An online Practitioner credentialing application can be found in the Participation & Credentialing section of the Blue Cross Blue Shield of North Dakota (BCBSND) website at https://www.bcbsnd.com/web/providers/new-provider/apply.
The online application is in a fillable PDF format with required fields outlined in red. If providers receive an error message after clicking on the “Submit” button, please review the application and complete any required missing fields. Please attach a copy of the practice’s malpractice insurance face sheet with submissions, which must specifically include the name of the provider applicant as covered by the policy, along with any other necessary documentation.
Outpatient Nutritional Care Services
Effective January 1, 2020, and on group anniversary thereafter, the outpatient nutritional benefit category has been updated for grandfathered and non-grandfathered plans and benefits have been added to metallic products as indicated below.
Anorexia Nervosa and Bulimia language has been updated to reflect the current DSM terminology of feeding and eating disorders. Maximum benefit allowance for LRD visits for feeding and eating disorders has been removed from non-metallic plans and benefits have been added to metallic plans.
Benefits have been added for Licensed Registered Dietician visits for the diagnosis of Celiac Disease. A maximum benefit allowance of two (2) visits by a LRD per benefit period.
Outpatient Therapy Services-Pulmonary Rehabilitation
Effective January 1, 2020, and on group anniversary thereafter, the maximum benefit allowance of three (3) educational visits for pulmonary rehabilitation will be removed from non-metallic products.
Effective January 1, 2021, and on group anniversary thereafter, the maximum benefit allowance of three (3) educational visits for pulmonary rehabilitation will be removed from metallic products.
Precertification Changes Effective 1-1-2020
Precertification is the process by which the member or the member’s health care provider provides information to Blue Cross Blue Shield of North Dakota (BCBSND) to establish the medical appropriateness and necessity of specified services.
The list below is an update to our standard precertification list. Some benefit plans have variations to the list.
- Air ambulance (non-emergent)
- Artificial intervertebral disc
- Chimeric antigen receptor (CAR) t-cell therapy
- Limb lengthening
- Molecular and genomic testing
- Positron emission tomography (PET) scan
- Proton beam therapy
- Repetitive transcranial magnetic stimulation (rTMS)
Family Therapy under the age of 19 added to metallic products
Effective January 1, 2020, and on group anniversary thereafter, family therapy will be added to all metallic products. Services performed prior to the member’s anniversary date will be considered non-payable.
National Diabetes Prevention Program
Effective January 1, 2020, and on anniversary, coverage is available for North Dakota facilities that meet CDC recognition as a National Diabetes Prevention Program.
Effective January 1, 2020, and on anniversary, coverage for the Diabetes Prevention Program will be available to all non-metallic and metallic group products.
Diabetes Prevention Program – A 12-month lifestyle change program using the Centers for Disease Control’s research-based approved curriculum for members age 18 and older at a high risk of developing type 2 diabetes. Coverage is limited to one enrollment in a Diabetes Prevention Program per year, regardless of whether the member completes the Diabetes Prevention Program.
Diabetes Prevention Provider – A Participating Health Care Provider, or an individual or entity affiliated or associated with a Participating Health Care Provider, using trained lifestyle coaches to provide a Diabetes Prevention Program.