North Dakota: Start Here
Beginner guide for North Dakota—HealthCare.gov, NCDOI external review, Ch. 26.1-36.12 PA (SB 2280) & internal appeals.
Read guideState playbook
North Dakota
State insurers, legislation, and appeal resources for patients and advocates in North Dakota.
4 guides
North Dakota Prior Authorization Law
Ch. 26.1-36.12—7-day/72-hour PA, deemed authorized, MAT & emergency PA bans, 6–12 month validity.
Read guideNorth Dakota Health Insurance Appeals and Grievances
Ch. 26.1-36.12-14 & Ch. 26.1-26.4—internal appeal, 180-day Marketplace filing, path to NCDOI IRO.
Read guideNorth Dakota External Review (NCDOI / IRO)
Binding on plan—4-month filing with NCDOI, 45-day IRO decision, 72-hour expedited.
Read guidePrior auth & internal appeals
Match the plan on the member ID card. Use the denial letter for where to file appeals.
- Blue Cross Blue Shield of North Dakota
- Sanford Health Plan
- Medica
- HealthCare.gov (North Dakota Marketplace)
- North Dakota Medicaid
External appeals
After internal appeal, for eligible North Dakota fully insured plans only.
- NCDOI — external review
- Medicaid — fair hearing