ND Medicaid provider revalidation plan
Gov. Kelly Armstrong announced that North Dakota Health and Human Services has launched a new strategy to strengthen oversight, prevent fraud and ensure the integrity of the ND Medicaid program. This strategy aligns with a directive from the U.S. Centers for Medicare and Medicaid Services to accelerate provider revalidation activities and develop a comprehensive, long-term strategy to ensure only qualified and legitimate providers participate in ND Medicaid.
Beginning July 1, North Dakota will expand oversight of three high-risk categories, including qualified service providers, non-emergency medical transportation providers and 1915(i) providers. This oversight will include more frequent revalidations, enhanced enrollment requirements, increased competency assessments and site visits and a provider enrollment moratorium for certain services.
Read more about the revalidation strategy.
Funding opportunities are available through North Dakota's Rural Health Transformation Program
If you're looking for new ways to strengthen services, address workforce challenges or improve access to care in your community, the Rural Health Transformation Program (RHTP) may have opportunities that can help. Through funding opportunities and other resources, RHTP is supporting innovative approaches to healthcare delivery across North Dakota.
Current opportunities include funding for clinical capital equipment to help rural providers expand services and bring high-quality care closer to home.
We encourage providers to explore current opportunities and consider how they align with the needs of your organization and the patients you serve. Application assistance is available at hhs.nd.gov/rural-health-transformation/support.
You can also sign up to receive email notifications on all funding opportunities and other updates on the RHPT webpage.
Physical, speech and occupational therapy service authorization determinations update
Beginning July 1, 2026, ND Medicaid will no longer be faxing back the SFN 481 determinations for physical, speech or occupational therapy. The determination letters will be mailed to providers and providers will also be able to check the status of the authorization in the web portal. If guidance is needed on how to access these, contact the call center at 701-328-7098 or 877-328-7098.
School nursing services added to school-based Medicaid
ND Medicaid is expanding school nursing services for Medicaid‑eligible students who have an Individualized Education Program (IEP), 504 Plan or Individualized Health Plan (IHP). Beginning July 1, 2026, the following CPT® codes will be added to school‑based Medicaid coverage:
- T1001 – Nursing assessment or evaluation (IEP, 504 or IHP)
- T1002 – RN services, per 15 minutes (IEP, 504 or IHP)
- T1003 – LPN services, per 15 minutes (IEP, 504 or IHP)
These updates will be reflected in the School‑Based Services Policy on July 1, 2026.
Updated orthodontic screening guide
We are excited to announce that the new, improved and ADA compliant ND Medicaid Orthodontic Screening Guide for EPSDT has been completed and is now available. You can access the guide on the Wellness Visits for Providers webpage under the Orthodontia Screening tab in the Wellness Visits Provider Toolkit.
The updated guide also includes information for those providers who are interested in becoming orthodontic screeners. Expanding our pool of trained screeners supports timely, appropriate access to orthodontic services for children across North Dakota. We welcome your participation.
Becoming a screener
- Orthodontic screening training is available online at ND TRAIN.
- Current TRAIN ID is Course ID#: 1101233. Please note, the online training will be updated soon to reflect the changes in the new guide. Orthodontic training molds that correlate with the Orthodontic Screening Guide are housed at Medical Services Division offices. If you would like to check out the molds for training, complete the check-out request form on our Wellness Visits for Providers webpage or reach out to us at DHSMedicaidQuality@nd.gov if you have questions.
- Updated EPSDT Comprehensive Orthodontic screening form (1-2026): SFN 61.
Acentra now reviewing wheelchair service authorization requests
As of April 1, 2026, Acentra has officially taken over the review of all wheelchair service authorization requests. Providers are now required to submit requests through the Atrezzo provider portal, where reviews are conducted using the Manual and Power Wheelchair Policy as well as InterQual criteria.
Providers who have not yet accessed the Atrezzo portal are encouraged to do so as soon as possible to ensure timely processing. Training materials remain available on Acentra’s website, offering step-by-step guidance for navigating and submitting requests through the system.
To support providers, the following resources are available:
- Multi-Factor Registration and Login Process for New Portal Users
- How to Change Context for Multiple Provider Locations
For direct assistance, providers may contact Acentra by emailing ndumnurses@acentra.com.
DMEPOS provider manual and policies will feature an updated, modernized layout
The Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Provider Manual and related policies are currently being updated to improve accessibility and comply with ADA requirements. As part of this effort, the manual and its associated policies will feature a new look and format designed to support easier navigation, clearer structure and enhanced accessibility for all users.
Providers are encouraged to periodically visit the Durable Medical Equipment (DME) webpage for updates, revised materials and newly released ADA‑compliant documents.
Pharmacy updates
The following drugs will require service authorization effective for dates of service on and after April 1, 2026.
Drug Name | HCPCS Code | Description |
|---|---|---|
| Yimmungo® | J1553 | Injection, immune globulin (yimmugo), 100 mg |
| Papzimeos™ | J3404 | Injection, zopapogene imadenovec-drba suspension, per therapeutic dose |
| Vyalev™ | J7356 | Injection, foscarbidopa 0.25 mg/foslevodopa 5 mg |
| Keytruda Qlex™ | J9277 | Injection, pembrolizumab, 1 mg and berahyaluronidase alfa-pmph |
| Aukelso™ | Q5161 | Injection, denosumab-kyqq (aukelso/bosaya), biosimilar, 1 mg |
| Itvisma® | C9309 | Injection, onasemnogene abeparvovec-brve |
| Avtozma® | Q0237 | Injection, tocilizumab-anoh, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, 1 mg (does not require Service Authorization when administered in the inpatient setting) |
| TYENNE® | Q0238 | Injection, tocilizumab-aazg, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, 1 mg (does not requrie Service Authorization when administered in the inpatient setting) |
Service Authorization Requirements have been removed from the following code effective March 31, 2026.
Drug Name | HCPCS Code | Description |
|---|---|---|
| Fulphila® | Q5108 | Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg |