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Posted 4-9-2024

The Codes Requiring Service Authorization spreadsheet has been updated.  The following drugs will require SA effective May 1, 2024.

Drug NameHCPCS CodeHCPCS Description 
Alyglo™ (immune globulin, human-stwk)J1599Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg
Asceniv (immune globulin(human)-slra)J1554Injection, immune globulin (asceniv), 500 mg
Cutaquig® (immune globulin(human)-hipp)J1551Injection, immune globulin (cutaquig), 100 mg
Cuvitru (immune globulin (human))J1555Injection, immune globulin (cuvitru), 100 mg
Gammaplex® (immune globulin(human))J1557Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg
Panzyga® (immune globulin (human)ifas)J1576Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg
Xembify® (immune globulin (human)-klhw)J1558Injection, immune globulin (xembify), 100 mg

Posted 4-8-2024

Timely Filing Extension Due to Change Healthcare Cyberattack

Due to the recent cyberattack on Change Healthcare, ND Medicaid will extend timely filing requirements for claims with dates of service on or after 09/21/2023. Claims must be submitted by either 06/25/2024 or the regular timely filing deadline, whichever is later. 

If you are unable to submit claims electronically to the department, you may send them on paper or submit your claims via the MMIS Web Portal. 

ND Medicaid will continue to monitor the situation and adjust timely filing requirements if needed. 

Address to submit paper claims:
Medical Services Division
North Dakota Health and Human Services
600 E. Boulevard Ave., Dept. 325
Bismarck, ND 58505-0250

Questions? Contact our Provider Relations Call Center by calling (701) 328-7098, toll-free (877) 328-7098, 711 (TTY) or emailing mmisinfo@nd.gov.

Posted 4-3-2024

To reduce processing time, please verify your provider is not actively enrolled with North Dakota Medicaid before submitting a new online enrollment application in the MMIS portal. If a provider is actively enrolled, a new online application is not required.

 

You can search for actively enrolled providers by NPI or Name using the following links:

 

When a provider is actively enrolled with North Dakota Medicaid:

Posted 3-27-2024

The Hearing Aid Policy has been updated for services on or after April 1, 2024.  Changes include: 

  • Coverage of binaural hearing aids for all ages 
  • Removal of the primary care documentation requirement 

Posted 3-26-2024

The following Provider Guidelines, Manuals, and Policies have been updated for April 2024.   New language appears between « » symbols throughout the individual policies. 

  • Behavioral Health Rehabilitative Services
  • Chiropractic Services
  • Codes Requiring Service Authorization 
  • Hospital Services
  • Immunizations (Vaccine/Toxoids) 
  • Indian Health Services and Tribal Health Programs 
  • Non-Emergency Medical Transportation
  • Occupational Therapy 
  • Physical Therapy
  • Preventive Services and Chronic Disease Management 
  • Provider Information
  • School-Based Services 
  • Sign and Oral Language Interpreter Services 
  • Speech-Language Services 
  • Substance Use Disorder Treatment Services 
  • Telehealth Approved Services 
  • Telehealth 

Posted 3-18-2024

Update: Licensed Addiction Counselors (LACs) have been removed from this requirement, which was originally posted on January 25, 2024. 

Medicare will begin covering and making payments for the services of marriage and family therapists (MFT), mental health counselors on January 1, 2024.  

For dually eligible beneficiaries (those enrolled in both Medicare and Medicaid) who receive Medicaid coverage of services furnished by MFTs or MHCs services furnished by hospital outpatient departments, community mental health centers (CMHC), rural health clinics (RHC), federally qualified health centers (FQHC), or opioid treatment programs (OTP), beginning on January 1, 2024, Medicare will become the primary payer for these services provided by Medicare-enrolled practitioners or providers. 

What does this mean for Medicaid-enrolled licensed marriage and family therapists (LMFT), licensed addiction counselors (all levels), licensed professional counselors (LPC), or licensed professional clinical counselors (LPCC) providers?  If you are currently enrolled in Medicaid as an LMFT, LPC, or LPCC, you will need to submit your enrollment information to Medicare by January 31, 2024, to prevent any disruption in treatment and payment for dually eligible beneficiaries and payment of claims.    

MFTs and MHCs could begin submitting their Medicare enrollment applications after the CY 2024 PFS final rule was issued on November 2, 2023. The effective date of enrollment may be up to 30 days before the submission of the enrollment application to Medicare, but no earlier than January 1, 2024, which is the date the new benefits authorized by the CAA, 2023 take effect. Newly Medicare-enrolled LMFTs, LPCs, and LPCCs will not be granted an effective date earlier than January 1, 2024, and claims with dates of service before January 1, 2024, will not be payable by Medicare.

Claims submission instructions:

  • If you are not yet enrolled with Medicare: submit your Medicare enrollment by Jan. 31, 2024, per the instructions linked below. Continue to submit claims to ND Medicaid while you are waiting for Medicare enrollment to be approved. Once ND Medicaid has confirmed your enrollment with Medicare, we will recoup claims paid to you as primary and you will need to bill Medicare for those claims. Medicaid will become the secondary payer. ND Medicaid will begin recouping claims in May 2024, to give Medicare ample time to approve provider applications. 
  • If you are enrolled with Medicare: submit claims to Medicare for dates of service of Jan. 1, 2024, and after. Medicaid is now the secondary payer. 

Medicaid-enrolled should follow the enrollment instructions found here marriage-and-family-therapists-and-mental-health-counselors-faq-09052023.pdf (cms.gov).

Thank you for your prompt attention to this matter. If you have questions, please reach out to Alyssa Neis at aneis@nd.gov.

Posted 3-14-2024

The Codes Requiring Service Authorization spreadsheet has been updated.  The following drugs have been added and will require service authorization for dates of service on or after April 1, 2024. 

Drug NameHCPCS CodeHCPCS Description 
Adzynma (apadamtase alfa)C9167Injection, apadamtase alfa, 10 units
Cosentyx® (secukinumab)C9166Injection, secukinumab, intravenous, 1 mg
Eyelea® HD (aflibercept)J0177Injection, afibercept hd, 1 mg 
Izervay™ (avacincaptad pegol)J2782Injection, avacincaptad pegol, 0.1 mg
Omvoh™ (mirikizumab-mrkz)C9168Injection, mirikizumab-mrkz, 1 mg
Pombiliti™ (cipaglucosidase alfa-atga)J1203Injection, cipaglucosidase alfa-atga, 5 mg
Syfovre™ (pegcetacoplan)J2781Injection, pegcetacoplan, intravitreal, 1 mg
Tofidence™ (tocilizumab-bavi)Q5133Injection, tocilizumab-bavi (tofidence), biosimilar, 1 mg
Tyruko®  (natalizumab-sztn)Q5144Injection, natalizumab-sztn (tyruko), biosimilar, 1 mg
Veopoz™ (pozelimab-bbfg)J9376Injection, pozelimab-bbfg, 1 mg

Posted 3-6-2024

Ordering/Referring/Prescribing Provider Claim Requirements - Change effective May 1, 2024

clock on yellow background with sign that says policy update

Effective for dates of service May 1, 2024, and after, ND Medicaid will require that the ordering/referring/prescribing (ORP) provider’s individual National Provider Identifier (NPI) be present on all 837P transactions (professional claims) for the following services.

  • Behavioral Health Rehabilitative Services including:
    • Behavioral Intervention
    • Individual and Group Counseling
    • Intensive in-home for Children
    • Nursing Assessment and Evaluation
    • Skills Integration
    • Skills Restoration
  • Diagnostic services including
    • Audiologic Function Tests
    • Diagnostic and Screening Laboratory Services
    • Diagnostic and Screening Radiology and Imaging Services
    • Echocardiograms
    • Electrocardiograms
    • Electronic Analysis or Interrogation of implanted devices
    • Neurodiagnostic Services (EEG, VEP, EMG, Polysomnography)
    • Pulmonary Function Studies / Testing
    • Psychological and Neuro-psychological Testing
  • Eyeglasses frames, lenses, and contacts
  • Durable Medical Equipment and Supplies
  • Hearing Aids
  • Occupational Therapy Services
  • Physical Therapy Services
  • Physician Administered Drugs (any drug administered in the clinic setting)
  • Preventive Services including:
    • Immunizations
    • Preventive Evaluation and Management Services
      • Well-Child visits
      • Adult preventive exams
    • Counseling for Risk Factor Reduction
      • Tobacco Cessation
    • Prosthetics
    • Speech Therapy Services

Read the Ordering/Referring/Prescribing Providers policy to learn about which provider types may be ORPs and other requirements. The policy also contains a FAQ section.

Posted 2-29-2024

Attn: Organization Administrators - Deactivating inactive user accounts 

It is the responsibility of the Organization Administrator to self-manage their staff members’ user account access to the MMIS Web Portal. The Department strongly encourages all Medicaid providers to establish, at a minimum, one primary and one back-up Organization Administrator.

Effective February 10, 2024, if a user’s account has not been active in 365 days, the MMIS Web Portal system will automatically terminate the user’s account. Questions? Call the Provider Relations Call Center at (701) 328-7098, toll-free (877) 328-7098 or email mmisinfo@nd.gov.

Posted 2-27-2024

Attention Providers: ND Medicaid is aware of a cyber security issue that occurred on February 21, 2024, that impacts providers who use Change Healthcare as their clearinghouse, trading partner, or pharmacy switch vendor. ND Medicaid systems and claims processing are not affected by the cyber security issue. Connections with Change Healthcare will be re-established when Change Healthcare is no longer experiencing cyber security issues.


What does this mean for providers during this temporary shutdown?
 

  • Change Healthcare will not be able to pick up or access any 835s (electronic remitance advices). Providers can log into the MMIS Web Portal to retrieve.
     
  • Change Healthcare will not be able to send us any 270 (eligibility) transactions. Providers can log in the MMIS Web Portal or call into the AVRS system to retrieve.
     
  • Change Healthcare will not be able to send us any 837 (claims) transactions. Providers who have been impacted can submit claims through the MMIS Web Portal or temporarily submit paper claims to:


ND Dept. of Health and Human Services
600 E. Boulevard Ave, Department 325
Bismarck, ND 58505-0250


Providers with questions about this issue should contact their Change Healthcare provider service contact or use their website to find more information.

 

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Accordion Section Title
2024 Provider Updates

Posted 2-13-2024

UPDATED ICD-10-CM Coding Guidance - Administering Abrysvo™ (CPT 90678) to Pregnant Individuals 

CDC recommends one dose of Pfizer’s bivalent RSVpreF vaccine (Abrysvo) during RSV season for people who are 32 through 36 weeks pregnant.  For claims to correctly adjudicate for this population of ND Medicaid members,  an ICD-10-CM code specific to the third trimester of pregnancy AND an ICD-10-CM code from the Z3A.32 - Z3A.36 range must be present on the claim and pointed to the specific line that 90678 is billed on

Posted 2-5-2024

Changes in Ownership
All changes in ownership (both direct and indirect ownership) are required to be reported within 35 days of the change.  If you are a dually enrolled (Medicare/Medicaid) ownership must be updated in your Medicare and Medicaid record. If you are enrolled with Medicaid, we may be unable to complete the application until the update to the Medicare record has been completed.

The following must be submitted:

1. Statement of whether or not the NPI and/or Tax ID of the business has changed
2. Old owner/s first and last name/s and termination date/s (if applicable)
3. New SFN 1168: https://www.nd.gov/eforms/Doc/sfn01168.pdf

4. Effective date of change
5. Name and contact information of the person sending this request
6. Request must be made by a person listed in the record as an authorized representative, managing employee, board member, or owner.

  • Please contact your organization administrator to review the record to ensure the requestor is showing in one of these categories in the web portal prior to submitting your request. If they are not yet in the record, please have your organization administrator add them as an authorized representative and submit an updated SFN 1168 Ownership/Controlling Interest and Conviction form to add them (and any other authorized signers) to the other required sections of the record (Instructions for the SFN 1168).
  • If you have not yet registered an organization administrator, please see the “Web Access Registration” FAQ.
  • If you have issues with your web portal accounts or passwords, please contact customer service 701-328-7098.

Noridian is currently reviewing the following submission dates as of Monday, February 5 for workloads:

  • Individual Application – 1/24/2024
  • Group Application – 1/30/2024
  • Individual Reactivation – 1/25/2024
  • Group Reactivation – current
  • Individual Revalidation – 9/29/2023
  • Group Revalidation – 6/14/2023
  • Affiliation – 1/25/2024
  • EFT – 1/29/2024
  • Taxonomy Update – 1/31/2024
  • Termination Request – 1/26/2024

Any submissions on or before these submission dates can expect either an email/phone call for corrections needed or an approval letter/email within the next 5 business days.

Posted 1-30-2024

Noridian is currently reviewing the following submission dates as of Tuesday, January 30 for workloads:

  • Individual Application – 1/19/2024
  • Group Application – 1/19/2024
  • Individual Reactivation – 1/25/2024
  • Group Reactivation – 1/22/2024
  • Individual Revalidation – 9/26/2023
  • Group Revalidation – 6/14/2023
  • Affiliation – 1/19/2024
  • EFT – 1/22/2024
  • Taxonomy Update – 1/23/2024
  • Termination Request – 1/19/2024

Any submissions on or before these submission dates can expect either an email/phone call for corrections needed or an approval letter/email within the next 5 business days.

Posted 1-25-2024

Medicare will begin covering and making payments for the services of marriage and family therapists (MFT), mental health counselors, and addiction counselors on January 1, 2024.  

For dually eligible beneficiaries (those enrolled in both Medicare and Medicaid) who receive Medicaid coverage of services furnished by MFTs or MHCs services furnished by hospital outpatient departments, community mental health centers (CMHC), rural health clinics (RHC), federally qualified health centers (FQHC), or opioid treatment programs (OTP), beginning on January 1, 2024, Medicare will become the primary payer for these services provided by Medicare-enrolled practitioners or providers. 

What does this mean for Medicaid-enrolled licensed marriage and family therapists (LMFT), licensed addiction counselors (all levels), licensed professional counselors (LPC), or licensed professional clinical counselors (LPCC) providers?  If you are currently enrolled in Medicaid as an LMFT, LAC, LPC, or LPCC, you will need to submit your enrollment information to Medicare by January 31, 2024, to prevent any disruption in treatment and payment for dually eligible beneficiaries and payment of claims.    

MFTs and MHCs could begin submitting their Medicare enrollment applications after the CY 2024 PFS final rule was issued on November 2, 2023. The effective date of enrollment may be up to 30 days before the submission of the enrollment application to Medicare, but no earlier than January 1, 2024, which is the date the new benefits authorized by the CAA, 2023 take effect. Newly Medicare-enrolled LMFTs, LPCs, LPCCs and LACs will not be granted an effective date earlier than January 1, 2024, and claims with dates of service before January 1, 2024, will not be payable by Medicare.

Claims submission instructions:

  • If you are not yet enrolled with Medicare: submit your Medicare enrollment by Jan. 31, 2024, per the instructions linked below. Continue to submit claims to ND Medicaid while you are waiting for Medicare enrollment to be approved. Once ND Medicaid has confirmed your enrollment with Medicare, we will recoup claims paid to you as primary and you will need to bill Medicare for those claims. Medicaid will become the secondary payer. ND Medicaid will begin recouping claims in May 2024, to give Medicare ample time to approve provider applications. 
  • If you are enrolled with Medicare: submit claims to Medicare for dates of service of Jan. 1, 2024, and after. Medicaid is now the secondary payer. 

 Medicaid-enrolled should follow the enrollment instructions found here marriage-and-family-therapists-and-mental-health-counselors-faq-09052023.pdf (cms.gov).

Thank you for your prompt attention to this matter. If you have questions, please reach out to Alyssa Neis at aneis@nd.gov.

Posted 1-18-2024

January 2024 Provider Policy Updates online!

ND Medicaid is committed to having clear, easy-to-find provider guidance and policies. We just published January 2024 Policy updates to the Provider Guidelines, Manuals and Policies webpage.

You'll notice this page has a brand new look. Policies are now located in streamlined lists with topic headings. The General Information for Providers and Behavioral Health Services policy manuals have been broken apart into individually titled policies for your convenience.

The goal is to help you quickly find the policy you need by looking for the policy category and subject matter in our sorted and alphabetized lists.

Provider policies, which now include coding guidelines where appropriate, are organized within these topic headings:

  • General Provider Policies  
    • This is where you'll find Provider Information, Enrollment, Appeals, Telehealth, Third Party Liability, Timely Claims Filing, etc.
  • Behavioral Health
    • includes Behavioral Health Rehabilitative Services, Substance Use Disorder, etc.
  • Dental
  • Durable Medical Equipment
  • Encounter-Based Services
    • Federally Qualified Healthcare Centers (FQHCs), Rural Health Centers (RHCs), and Indian Health Service (IHS)/Tribally Operated 638 Facilities.
  • Institutional Services
    • Hospitals, Ambulatory Surgery Centers, Intermediate Care Facilities, Nursing Facilities, etc.
  • Professional Services
    • This is where the majority of policies located in the General Information for Providers Manual are now located, such as Speech Therapy and Health Tracks
  • Pharmacy
  • Targeted Case Management

Recently updated policies are noted behind the policy title so you know which policies have been updated and when. Changed policy language appears between these symbols «changed policy language».

Upcoming policy changes include a refreshed policy template with definitions and Frequently Asked Questions sections. Questions, comments, concerns? Email Mandy at mrdendy@nd.gov.

Posted 1-16-2024

Noridian is currently reviewing the following submission dates as of Monday, January 15 for workloads:

  • Individual Application – 1/3/2024
  • Group Application – 1/8/2024
  • Individual Reactivation – 1/9/2024
  • Group Reactivation – 1/11/2024
  • Individual Revalidation – 6/21/2023
  • Group Revalidation – 6/14/2023
  • Affiliation – 1/4/2024
  • EFT – 1/11/2024
  • Taxonomy Update – 1/11/2024
  • Termination Request – 1/3/2024

Any submissions on or before these submission dates can expect either an email/phone call for corrections needed or an approval letter/email within the next 5 business days. 

Posted 1-12-2024

Medicare will begin covering and making payments for the services of marriage and family therapists (MFT) and mental health counselors (MHC) on January 1, 2024.

For dually eligible beneficiaries (those enrolled in both Medicare and Medicaid) who receive Medicaid coverage of services furnished by MFTs or MHCs services furnished by hospital outpatient departments, community mental health centers (CMHC), rural health clinics (RHC), federally qualified health centers (FQHC), or opioid treatment programs (OTP), beginning on January 1, 2024, Medicare will become the primary payer for these services provided by Medicare-enrolled practitioners or providers. 

What does this mean for Medicaid-enrolled licensed marriage and family therapists (LMFT) and licensed professional counselors (LPC) or licensed professional clinical counselors (LPCC) providers?  If you are currently enrolled in Medicaid as a LMFT, LPC, or LPCC, you will need to enroll in submit your enrollment information to Medicare by January 31, 2024, to prevent any disruption in treatment and payment for dually eligible beneficiaries and payment of claims.   

MFTs and MHCs could begin submitting their Medicare enrollment applications after the CY 2024 PFS final rule was issued on November 2, 2023. The effective date of an MFT’s or MHC’s enrollment may be up to 30 days before the submission of the enrollment application to Medicare, but no earlier than January 1, 2024, which is the date the new benefits authorized by the CAA, 2023 take effect. Newly Medicare-enrolled MFTs and MHCs will not be granted an effective date earlier than January 1, 2024, and claims with dates of service before January 1, 2024, will not be payable by Medicare.

Claims submission instructions:

  • If you are not yet enrolled with Medicare: submit your Medicare enrollment by Jan. 31, 2024, per the instructions linked below. Continue to submit claims to ND Medicaid while you are waiting for Medicare enrollment to be approved. Once ND Medicaid has confirmed your enrollment with Medicare, we will recoup claims paid to you as primary and you will need to bill Medicare for those claims. Medicaid will become the secondary payer. ND Medicaid will begin recouping claims in May 2024, to give Medicare ample time to approve provider applications. 
  • If you are enrolled with Medicare: submit claims to Medicare for dates of service of Jan. 1, 2024, and after. Medicaid is now the secondary payer.  

Medicaid-enrolled MFTs and MHCs service providers interested in becoming Medicare-enrolled should follow the enrollment instructions found here marriage-and-family-therapists-and-mental-health-counselors-faq-09052023.pdf (cms.gov).

Thank you for your prompt attention to this matter. If you have questions, please reach out to Alyssa Neis at aneis@nd.gov.

Posted 1-10-2024

Noridian is currently reviewing the following submission dates as of Tuesday, January 9 for workloads:

  • Individual Application – 12/27/2023
  • Group Application – 12/29/2023
  • Individual Reactivation – 1/2/2024
  • Group Reactivation – 1/5/2024
  • Individual Revalidation – 6/20/2023
  • Group Revalidation – 6/14/2023
  • Affiliation – 12/28/2023
  • EFT – 12/29/2023
  • Taxonomy Update – 12/20/2023
  • Termination Request – 12/28/2023

Any submissions on or before these submission dates can expect either an email/phone call for corrections needed or an approval letter/email within the next 5 business days.

Accordion Section Title
2023 Provider Updates

Posted 12-29-2023

Effective for dates of services on or after January 1, 2024, North Dakota Medicaid will begin covering revenue code 0921 for inpatient services. 

Posted 12-28-2023

The 2024 Pharmacy Coverage Policy Manual is posted

  • Hepatitis C: Mavyret is no longer a preferred Hepatitis C medication effective January 1, 2024. Generic Epclusa remains a preferred product. Criteria has been updated to allow for one HCV RNA test if the last likely HCV exposure has occurred at least 6 months before the most recent positive test. When requesting this exception, please document the last likely HCV exposure on the PA form or submit documentation for review. There have been several recent updates on Hep C criteria so if your patient has not qualified for Hepatitis C treatment in the past, please reconsider treatment under the new criteria.

  • Migraine Prophylaxis: Aimovig is no longer a preferred migraine prophylaxis agent effective January 1, 2024. All members currently on Aimovig will be grandfathered and allowed to continue their medication.

  • Discontinuations: Levemir will be discontinued early 2024. Lantus will remain a preferred agent. Toujeo and Tresiba U-200 are preferred agents for doses > 100 units/day and ≤ 200 units/day.

Posted 12-22-2023

Attention Dental Providers: The January 2024 Dental Manual is now available. Individual dental policies have been incorporated into the dental manual. The Health Tracks Orthodontia Screening Policy has been updated. Please contact Sara R. with questions 701-328-4825.

Posted 12-15-2023

The December 2023 ND Medicaid provider newsletter is now available. 

In this edition, learn about:

  • An updated Timely Claims Filing policy,
  • Benefits of applying fluoride varnish to children in a medical setting, 
  • A new lookup tool for drug coverage and more!

If you like to receive this newsletter and other updates sent to your inbox, sign up on the ND Medicaid provider webpage.

We welcome your feedback by email to dhsmed@nd.gov

Thank you for being a ND Medicaid provider and serving Medicaid members.

Posted 12-06-2023

Attention All Providers: North Dakota Medicaid’s Timely Claims Filing Policy has been revised to include clarification on when timely filing may be extended, acceptable forms of documentation for proof of timely filing, Frequently Asked Questions section, etc.

Posted 12-01-2023

Provider Enrollment Update - To better serve North Dakota Medicaid Providers, Noridian provider enrollment specialists will be available to answer questions between the hours of 9 a.m. to 3 p.m. CT, Monday-Friday.

You can reach them at 701-277-6999. You will still have the option to leave a voicemail outside of those core hours.

Provider enrollment specialists can assist with questions about enrollment, revalidations, maintenance items and more. 

Posted 11-20-2023

Attention DME Providers: Effective Nov. 17, 2023, the following Certificate of Medical Necessities (CMN) will no longer be required. SFN 522, SFN 526, SFN 789, SFN 726, SFN 785, SFN 781, SFN 724, SFN 728, SFN 528, and SFN 780.

Posted 11-16-2023

Effective Dec. 1, 2023: Phentermine and Contrave (bupropion/naltrexone) will be covered for weight loss with no prior authorization. Other medications are not covered for weight loss at this time.

Effective Jan. 1, 2024: InPen will be covered. BD and Ulticare will remain as covered insulin syringes. No other insulin syringes will be covered.

Posted 11-13-2023

ND Medicaid is processing prior authorization (PA) requests for Synagis (palivizumab) with the current RSV season onset date of October 28, 2023. Palivizumab determinations will be made based on our current RSV prophylaxis criteria, AAP recommendations and the CDC Health Advisory recommendations addressing the limited supply of Beyfortus (nirsevimab).

  • Children aged 8 to 19 months: The CDC recommends palivizumab to be utilized so no further clinical justification is required for that age group.
  • Children aged less than 8 months: When nirsevimab supply is exhausted, please utilize the new check box at the bottom of the RSV Prophylaxis PA form to indicate that reason for clinical justification to use palivizumab outside of the CDC recommendations.

To prevent utilization of palivizumab in the case that an infant has acquired immunity through Abrysvo (respiratory syncytial virus vaccine) or nirsevimab, two immunity assessment questions have been added near the bottom of the form. Please also answer these questions appropriately.

Palivizumab PA approvals will allow up to five weight-based doses within six months from the RSV season onset. The PA approval letter will include the number of authorized units and the duration of the approval.

Posted 11-3-2023

ICD-10-CM Coding Guidance - Administering Abrysvo™ (CPT 90678) to Pregnant Individuals 

CDC recommends one dose of Pfizer’s bivalent RSVpreF vaccine (Abrysvo) during RSV season for people who are 32 through 36 weeks pregnant.   In order for claims to correctly adjudicate for this population of ND Medicaid members,  an ICD-10-CM code specific to the third trimester of pregnancy AND an ICD-10-CM code from the Z3A.32 - Z3A.36 range must be present on the claim. 

Posted 11-2-2023

Payment Error Rate Measurement (PERM)

The PERM audit is important to all Medicaid providers because CMS and the review contractor Empower AI will be sending letters to various Medicaid providers requesting medical records to validate that the service was ordered, provided, documented and billed appropriately. Make sure that your release of information/compliance/audit departments are aware and responding to the records requests in a timely manner. Providers should start receiving the letters sometime in late March or April 2024.

The PERM program measures and reports an unbiased estimate of the true improper payments in Medicaid and CHIP (Optional Children’s Group) and produces error rates for each program. The error rates are based on reviews of the fee-for-service (FFS), managed care and eligibility components of Medicaid and CHIP (Optional Children’s Group) in the fiscal year (FY) under review. It is important to note the error rate is not a “fraud rate” but simply a measurement of payments made that did not meet statutory, regulatory, or administrative requirements.

Review Period: The PERM review period is payments made from July through June to align with state fiscal years and to provide additional time to complete the cycle before reporting improper payment rates. The upcoming cycle will review Medicaid and CHIP (Optional Children’s Group) payments made in Reporting Year (RY) 2025 for July 1, 2023 through June 30, 2024

Statistical Contractor (SC) – The Lewin Group (Lewin): The SC will be collecting state’s claims and payment data, processing the data to ensure completeness and compliance with PERM requirements, and selecting samples. The SC may have questions regarding data differences and changes from last cycle, payment methodologies, and identifying Medicaid versus CHIP (Optional Children’s Group) matched payments. The SC is also responsible for national and state improper payment rate calculations that are provided to states at the end of each cycle.

Eligibility Review Contractor (ERC) – Booz Allen Hamilton (Booz Allen): The ERC will be performing eligibility reviews on the samples selected by the SC to inform the resulting improper payment rate. The ERC may have questions regarding topics such as state eligibility policies, eligibility systems, eligibility processes, and eligibility case documentation.

Review Contractor (RC) – Empower AI: The RC will be performing data processing and medical reviews on the samples selected by the SC to inform the resulting improper payment rate. The RC may have questions regarding topics such as state claims adjudication systems; managed care programs; vendors; third-party administrators, like Pharmacy Benefit Managers (PBMs); fee schedules; special programs (e.g., waivers); and claim submission policies.

More information can be found on the PERM webpage

Posted 10-27-2023

RSV Vaccine Information: Many new products are available for the 2023-2024 Respiratory Syncytial Virus (RSV) season that have been approved by the Food and Drug Administration (FDA) and recommended by the Center for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP). For details on the 2023-2024 recommendations, please refer to CDC RSV ACIP Vaccine Recommendations.

Summary of ND Medicaid RSV Coverage

  • CPT 90678 (Abrysvo™) - Respiratory syncytial virus vaccine, preF, subunit, bivalent, for intramuscular use
    • Covered for adults 60 and older
    • Covered for pregnant members during 32-36 weeks gestation
  • CPT 90679 (Arexvy™)- Respiratory syncytial virus vaccine, preF, recombinant, subunit, adjuvanted, for intramuscular use
    • Covered for adults 60 and older
  • CPT 90380 (Beyfortus™)- Respiratory syncytial virus, monoclonal antibody, seasonal dose; 0.5 mL dosage, for intramuscular use
  • CPT 90381 (Beyfortus™)- Respiratory syncytial virus, monoclonal antibody, seasonal dose; 1 mL dosage, for intramuscular use 
    • Beyfortus™: Nirsevimab-alip is available through the Vaccines for Children (VFC) Program and should be reported with modifier -SL.
    • Administration of Beyfortus™ should be reported using the following;
      • CPT 96381- Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection. 

Posted 10-25-2023

RSV Update due to Beyfortus™ (nirsevimab) shortage - ND Medicaid is aware that the CDC has issued a Health Alert Network (HAN) Health Advisory for the 2023-2024 respiratory syncytial virus (RSV) season due to the limited supply of Beyfortus™ (nirsevimab).

In response to the CDC’s guidance, ND Medicaid will follow our Synagis® (palivizumab) coverage criteria, season definition, and prior authorization process for infants 8 months to 19 months who have NOT received nirsevimab and whose mothers did not receive Abrysvo™ [Respiratory Syncytial Virus Vaccine].

The RSV season has not yet started in ND.  Once the season starts, ND Medicaid will begin accepting prior authorization requests for palivizumab and determinations will be based on the current AAP guidelines, CDC recommendations, and product availability.

As a reminder, The ND Medicaid RSV season onset is defined as the first of two consecutive weeks when percentage of polymerase chain reaction (PCR) tests positive for RSV is greater than 3%. Season offset is defined as the last of two consecutive weeks when percentage of positive PCR tests for RSV is less than 3%. This data-driven season better aligns Synagis coverage with RSV outbreaks using data from the National Respiratory and Enteric Virus Surveillance System (NREVSS) Midwest Region as reported to the CDC.

Posted 10-23-2023

REMINDER - Therapy claims (special education unit therapy claims excluded) with dates of service July 1, 2022, and after will require the ordering provider to be submitted on each claim submission.

837P Transactions
The referring/ordering provider should be reported at the claim level in Loop 2310A for services such as diagnostic and laboratory services. To report therapy services at the claim detail line level, report the ordering provider in Loop 2420E and/or the referring provider in Loop 2420F.

When there is only one referral use code “DN – Referring Provider." Use“P3 – Primary Care Provider” in the second iteration of the loop to indicate the initial referral from the primary care provider. Use “DK –Ordering Provider” to indicate the ordering provider.

837I Transactions
The referring provider should be reported at the claim level in Loop2310F when the referring provider is different than the attending provider. When the referring provider on a claim detail line is different than what is reported in Loop 2310F, they are reported in Loop 2420D. An ordering provider is not reported on an 837I. Use “DN – Referring Provider” to indicate the referring provider.

Questions? Reach out to the ND Medicaid call center at (877) 328-7098 or mmisinfo@nd.gov.


Attention DME Hearing Aid Device Providers: Effective immediately, when submitting claims for hearing aid batteries V5266, the laterality modifiers, RT and LT, are no longer required.  If the modifiers are submitted on the claim, it will be denied for inappropriate modifier(s). 

DMEPOS providers are still responsible to maintain the member’s file with all the required supporting documents to support the requested number of batteries.  For example: 4 batteries need documentation showing which hearing aid the batteries are used in, the left hearing aid or the right hearing aid.

Posted 10-19-2023

Attention All Providers: Section 13 of the SFN 615 Medicaid Program Provider Agreement has been revised to include the addition of the last paragraph (see below) relating to a provider’s eligibility to bill for services rendered under a supervising provider. Providers are required to use the most recent forms when submitting applications.

Posted 10-16-2023

Claims guidance for when members lose and regain Medicaid eligibility 

Starting April 1, 2023, North Dakota resumed with regular Medicaid renewals for individuals whose coverage was temporarily extended due to the COVID-19 public health emergency to make sure they still qualify.
Some Medicaid members may lose coverage if they do not return information that is needed to process their renewal.

If members lose and then regain eligibility, providers will have 180 days from the date the eligibility was updated to resubmit any claims that were previously denied for no eligibility.

Providers can verify member eligibility by:

  1. Logging into ND Health Enterprise MMIS https://mmis.nd.gov/portals/wps/portal/EnterpriseHome. Click on the Member tab then select Check Eligibility.
  2. Using the Automated Voice Response System (AVRS), see AVRS chapter in the General Information for Providers manual, page 7.
  3. Calling the Provider Relations Call Center at (701) 328-7098 or (877) 328-7098.

Posted 10-13-2023

On October 12, 2023, ND Medicaid implemented a new prepayment claim editor.  The new claim editor will continue to enforce correct coding and billing practices as well as evaluate current claims against historical claims for editing purposes.

Editing Includes:

  • NCCI for Practitioners, Facilities, and DME providers
  • Invalid Procedure to Modifier
  • Global Surgery
  • Procedure to Age
  • Add on codes
  • Bundled services
  • Assistant at Surgery
  • Noridian Local Coverage Determinations (LCDs) 
    • L35172 Botulinum Toxin Types A and B
    • L35175 MRI and CT scans of the Head and Neck
    • L34051 Vitamin D Assay Testing
    • L37281 Lumbar MRI
    • L36707 Lab: Controlled Substance Monitoring and Drugs of Abuse Testing
    • L37283 Electrocardiograms
    • L36700 Serum Magnesium
    • L36074 Lab: Flow Cytometry
    • L34038 B-type Natriuretic Peptide (BNP) Testing
    • L38904 Wound and Ulcer Care
    • L34074 Immune Globulin Intravenous (IVIg)
  • CMS National Coverage Determinations (NCDs) 
    • 190.12 Urine Culture, Bacterial
    • 190.15 Blood Counts
    • 190.16 Partial Thromboplastin Time (PTT)
    • 190.17 Prothrombin Time (PT)
    • 190.18 Serum Iron Studies
    • 190.21 Glycated Hemoglobin / Glycated Protein
    • 190.22 Thyroid Testing
    • 190.23 Lipid Testing
    • 190.27 Human Chorionic Gonadotropin

Please check this page frequently for updates related to this change.  

Posted 10-2-2023

Attention Providers – October Policy updates are online on the Provider Manuals and Guidelines webpage!

The updated version of the General Information for Providers manual contains updates to the following policy sections:

  • Provider Information (new section on amending medical documentation)
  • Medicaid Covered Services
  • FQHC
  • Hospital Services
  • Medical Nutrition Therapy chapter moved to Preventive Services and Chronic Disease Management chapter
  • Medications for Opioid Use Disorder (MOUD) formerly Medication Assisted Treatment  
  • Noncovered Medicaid Services
  • Other Licensed Providers formerly Nurse Practitioner, Certified Nurse Mid-Wives, Clinical Nurse Specialists and Physician Assistants
  • Occupational Therapy
  • Preventive Services and Chronic Disease Management (New Chapter)
  • Physical Therapy
  • Physician Services (added in clinical trials information)
  • Speech Language Services

 The updated version of the Behavioral Health Services Provider manual contains the following policy section updates:

  • Provider Information (new section on amending medical documentation)
  • Other Licensed Practitioner (New Chapter)
  • Behavioral Health Rehabilitative Services (billing guidelines visual for time-based services)
  • Substance Use Disorder Treatment Services (enhanced Covered Services table, additional language, and definitions section)

Updated versions of the Targeted Case Management policies for Serious Mental Illness (SMI)/Serious Emotional Disturbance (SED) and Child Welfare are also posted online. These policies clarify how to calculate time and appropriately bill for time-based service codes.

Posted 09-26-2023

ND Medicaid is adding coverage for routine circumcision for dates of service on and after October 1, 2023. Service Authorization requirements are also being removed for non-routine circumcision.  The following CPT codes are included in this coverage change:

  • 54150 - Circumcision, using clamp or other device with regional dorsal penile or ring block
  • 54160 - Circumcision, surgical excision other than clamp, device, or dorsal slit, neonate (28 days or less)
  • 54161 - Circumcision, surgical excision other than clamp, device, dorsal slit; older than 28 days of age

Posted 09-22-2023

The Codes Requiring Service Authorization spreadsheet has been updated.  The following drugs have been added and will require service authorization for dates of service on or after October 1, 2023.  

  • J0174 -  Injection, lecanemab-irmb, 1mg  (Leqembi)
  • J9226 -  Histerlin implant, 50 mg (Suppreslin LA) 
  • Q9157 - Injection, lofersen, 1mg (Qalsody)

Posted 09-20-2023

The following COVID-19 Vaccine Codes for members 19 and over have been added to the Vaccine Fee Schedule 

  • 91320 - SARSCV2 VAC 30MCG TRS-SUC IM (COMIRNATY (COVID-19 Vaccine, mRNA) 2023-2024 Formula)
  • 91322 - SARSCOV2 VAC 50 MCG/0.5ML IM (SPIKEVAX 2023-2024 Formula)

The following COVID-19 Vaccines are covered under the Vaccines for Children Program (VFC) and should be billed to ND Mediciad at $0.00 or $0.01. 

  • 91318 - SARSCOV2 VAC 3MCG TRS-SUC (Pfizer-BioNTech COVID-19 Vaccine 2023-2024 Formula (Yellow Cap))
  • 91319-  SARSCV2 VAC 10MCG TRS-SUC IM (Pfizer-BioNTech COVID-19 Vaccine 2023-2024 Formula (Blue Cap))
  • 91320 - SARSCV2 VAC 30MCG TRS-SUC IM (COMIRNATY (COVID-19 Vaccine, mRNA) 2023-2024 Formula) members age 12-18
  • 91321 - SARSCOV2 VAC 25 MCG/.25ML IM (Moderna COVID-19 Vaccine 2023-2024 Formula)
  • 91322 - SARSCOV2 VAC 50 MCG/0.5ML IM (SPIKEVAX 2023-2024 Formula) members age 12-18

The following administration code should be reported with all vaccine codes listed above

  • 90480 - ADMN SARSCOV2 VACC 1 DOSE

Posted 8-2-2023

Attention DME Providers: North Dakota Medicaid accepts home sleep studies G0398, G0399, and G0400 for Continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP). The submitting provider must clarify on the CPAP or BiPAP service authorization request if the home sleep study used is one of the accepted above studies).

Posted 7-25-2023

Health Enterprise (HE) MMIS users are required to clear internet browser cache

Due to the maintenance of HE MMIS (mmis.nd.gov), all users will need to clear their internet browser cache.  Users may experience user interface type of issues if the cache is not cleared out.  Sorry for the inconvenience and thank you for your understanding.  

Please note, these steps may vary, based on your browser version.

Steps for Microsoft Edge
1. Open Microsoft Edge
2. Select Settings, then click on Privacy & services
3. Under Clear Browsing Data, select Choose what to clear
4. At the top choose a time range and select All time
5. Check Cached images and files and Cookies and other site data, then select Clear now 
6. Restart the browser

Steps for Google Chrome
1. Open Google Chrome
2. At the top right, click on More or the settings option
3. Click More tools. Clear browsing data
4. At the top, choose a time range and select All time
5. Next to "Cookies and other site data" and "Cached images and files," check the boxes
6. Click Clear data
7. Restart the browser

Steps for FireFox
1. Open FireFox
2. Select the menu drop-down in the right upper hand corner
3. Select Settings
4. Go to the Privacy & Security tab
5. Click Clear Data under the Cookies and Site Data section
6. Select the Cached Web Content option then click the Clear button 
7. Restart the browser

Posted 7-20-2023

Medicaid Expansion Providers: A Medication Therapy Management Services (MTMS) revision notification is posted on the BCBS ND website.

Posted 7-18-2023

REMINDER: ND Medicaid Health Enterprise MMIS Outage

ND Medicaid is currently undergoing an information technology infrastructure upgrade to our Health Enterprise MMIS (MMIS.ND.GOV) application. This upgrade will require a complete system outage.  All connectivity and access to the system will be shut down during the outage and we will not be able to accept any inbound traffic, including Batch and Realtime Electronic Data Interchange (EDI) X12 transactions (Claims, Eligibility Inquiries, etc.).

If you are an external stakeholder or provider that submits transactions to Health Enterprise MMIS, we are asking that you hold, queue, or disable all transactions to the MMIS system during this outage.  If any transactions are sent during this outage, they will need to be resent after the system maintenance and outage is complete.

Below are the dates and estimated times of the outage.  
 

 System Outage StartSystem Outage Stop
DayTimeDay Time
Pharmacy/OS+/PBM Inbound trafficJuly 21, 20239 p.m. CDTJuly 22, 202311 a.m. CDT
Health Enterprise MMIS*July 21, 20239 p.m. CDTJuly 23, 202312:35 a.m. CDT
 

* This includes all inbound and outbound traffic and individual user interface access to mmis.nd.gov.

If any changes to these dates and times, updates will be posted on this page.

Thank you for your patience and understanding during this system maintenance outage!  If you have any questions, please reach out to mmisinfo@nd.gov.

Posted 6-30-2023

Fee Schedule Update – The fee schedules for dates of services July 1, 2023, have been posted to the website. Provider rates will receive a 3.0% inflationary increase for the first year of the biennium in accordance with the legislative mandate.

Codes which are priced off a fee schedule have been adjusted with the 3.0% inflation increase accordingly. Codes which are priced using the Relative Value Unit (RVU) methodology have had the conversion factor adjusted. The adjustment of the conversion factor accounts for the implementation of the 2023 RVUs for dates of service on or after July 1, 2023.

Based on the previous calendar 12 month’s claims volume, the new relative value unit adjustments, and a 3.0% inflationary increase for the first year of the biennium, the resulting conversion factor effective for July 1, 2023 dates of service and after is $35.6438. The previous conversion factor was $35.1043. Based on the changes to the relative value units, some fees will increase while others may stay the same or decrease. In the aggregate, the providers whose claims are priced off the RVU methodology will see a 3.0% increase in their reimbursement.

The Ambulatory Surgical Center (ASC) conversion factor effective for July 1, 2023 dates of service and after is $30.24 based on the 3.0% inflation increase.

The Anesthesia conversion factor effective for July 1, 2023 dates of service and after is $25.25 based on the 3.0% inflation increase.

Posted 6-23-2023

Attention All Providers: An update has been made to the SFN 615 Medicaid Program Provider Agreement. Providers are required to use the most recent forms when submitting applications.


Attention DME Providers: Effective May 1, 2023, The Incontinence Products policy has been updated for A4520 -incontinence as follows:

  • If member uses 201/month or more, a service authorization is REQUIRED.
  • If member uses 200/month or less may submit directly to claims. 
     

Posted 6-19-2023

The June 2023 ND Medicaid provider newsletter is now available. It has a new look, but the same great content.

In this edition, learn about:

  • Stay Covered ND resources that providers can use to help educate members about ND Medicaid renewals,
  • A scheduled upgrade to ND Medicaid Health Enterprise MMIS in July that will cause a brief system outage and impact provider transactions,
  • ND Medicaid coverage of sports physicals, and more!

If you like to receive this newsletter and other updates sent to your inbox, sign up on the ND Medicaid provider webpage.

We welcome your feedback by email to dhsmed@nd.gov. Thank you for being a ND Medicaid provider and serving Medicaid members.

Posted 6-16-2023

UPDATE - As of 10:45 p.m. on June 15, 2023, all operations have returned to normal and the following vulnerability has been resolved: ND Medicaid has been notified by a vendor on 06/15/2023 of a new vulnerability in an application that is associated with electronic claims submission to the MMIS.

Thank you for your patience and understanding.

Posted 6-15-2023

ND Medicaid has been notified by a vendor on 06/15/2023 of a new vulnerability in an application that is associated with electronic claims submission to the MMIS.

Out of an abundance of caution, we are taking immediate action to implement the following mitigation measure:  All Providers, Clearinghouses, and Trading Partners that submit batch 837 files utilizing HTTP or HTTPS protocols will be offline until we can determine the scope of the issue and ensure a suitable remediation is put in place.

We will keep you informed as we gain a better understanding of the situation. Thank you for your patience and understanding.


ND Medicaid Health Enterprise MMIS Outage

ND Medicaid is currently undergoing an information technology infrastructure upgrade to our Health Enterprise MMIS (MMIS.ND.GOV) application. This upgrade will require a complete system outage.  All connectivity and access to the system will be shut down during the outage and we will not be able to accept any inbound traffic, including Batch and Realtime Electronic Data Interchange (EDI) X12 transactions (Claims, Eligibility Inquiries, etc.).

If you are an external stakeholder or provider that submits transactions to Health Enterprise MMIS, we are asking that you hold, queue, or disable all transactions to the MMIS system during this outage.  If any transactions are sent during this outage, they will need to be resent after the system maintenance and outage is complete.

Below are the dates and estimated times of the outage.  
 

 System Outage StartSystem Outage Stop
DayTimeDay Time
Pharmacy/OS+/PBM Inbound trafficJuly 21, 20239 p.m. CDTJuly 22, 202311 a.m. CDT
Health Enterprise MMIS*July 21, 20239 p.m. CDTJuly 23, 202312:35 a.m. CDT
 

* This includes all inbound and outbound traffic and individual user interface access to mmis.nd.gov.

If any changes to these dates and times, updates will be posted on this page.

Thank you for your patience and understanding during this system maintenance outage!  If you have any questions, please reach out to mmisinfo@nd.gov.

Posted 6-7-2023

The web-based Health Tracks/ Well-Child Check Provider Toolkit is now available.

ND Medicaid's Health Tracks provider outreach team will be providing a short training on how to use the Health Tracks toolkit on Wednesday, July 19 from 12:00-12:30 p.m. CDT and Thursday, July 27 from 12:00-12:30 p.m. CDT. If you are not able to attend one of these trainings, this training will be recorded for viewing later.  

Please fill out the registration form and provide your name, email and preferred date. 

Registration closes on July 10, 2023. 

You will receive a Teams meeting invite once you have registered. 

Posted 6-5-2023

The ND Medicaid Institutions for Mental Diseases (IMD) Policy has been updated to clarify the definition of mental diseases.

Posted 6-1-2023

UPDATE – As of 10 p.m. on May 31, 2023, all issues have been resolved and operations have returned to normal.

Posted 5-31-2023

ND Medicaid has been notified by a vendor of a vulnerability in an application that is associated with electronic claims submission to the MMIS. Out of an abundance of caution, we are taking immediate action to implement the following mitigation measure:  All Providers, Clearinghouses, and Trading Partners that submit batch 837 files utilizing HTTP or HTTPS protocols, will be offline until we can determine the scope of the issue and ensure a suitable remediation is put in place.  We will keep you informed as we gain a better understanding of the situation. Thank you for your patience and understanding.

Posted 5-1-2023

The May 2023 General Information for Providers Manual has been posted to the web.  


The Codes Requiring Service Authorization has been updated for May 2023.   The following drugs will require SA effective May 1, 2023; Q5124 - Injection, ranibizumab-nuna, biosimilar, 0.1 mg, Q2042 - Tisagenlicleucel, up to 600 million car-positive viable t-cells, per therapeutic dose. 


Attention Behavioral Health Providers: The Behavioral Health Services Provider Manual has been updated. This manual includes information on 1915(i) services and supports, behavioral health rehabilitative services and substance use disorder services.

Posted 3-22-2023

The Codes Requiring Service Authorization spreadsheet has been updated.   The following drugs will require SA  effective  April 1, 2023:

  • C9149   Injection, teplizumab-mrzw, 5mcg 
  • J0218    Injection, olipudase alfa-rpcp,1mg
  • J1411    Injection, etranacogene dezaparvovec-drlb, per therapeutic dose
  • J2182    Injection, mepolizumab, 1mg
  • Q5128   Injection, ranibizumab-eqrn, biosimilar, 0.1m

Posted 3-10-2023

The latest edition of the ND Medicaid provider e-newsletter is now available.


In the March 2023 edition, learn about Medicaid Renewals – Stay Covered ND resources that providers can use to help members prepare for the start of Medicaid renewals on April 1, Medicaid coverage for sports physicals, autism-related engagement opportunities, how to apply for membership with the Medicaid Medical Advisory Committee and more!

If you have trouble viewing the e-newsletter, cut and paste the URL into another web browser – Chrome, Firefox or Internet Explorer or Safari for Mac users.

A PDF version is also available.

We welcome your feedback by email to dhsmed@nd.gov. Thank you for being a ND Medicaid provider and serving Medicaid members.

Posted 3-6-2023

MMIS Provider Contact Information

North Dakota Provider Enrollment captures contact information in the North Dakota MMIS web portal. Staff are able to include names for a variety of contact categories within your organization. If you would like to make an update to your provider profile with any names in your facility who would be the most appropriate person for these categories, please have your organization administrator send an email to NDMedicaidEnrollment@noridian.com or fax to 701-433-5956, Attention: ND Medicaid Provider Enrollment.

Position NumberPosition NamePosition Description
01CFOChief financial officer
02CEOChief executive officer
03AdminAdministrative assistant or administrative support staff
04BusnMgrBusiness manager
05OfficeMgrOffice manager
06SupervisorSupervisor
07PA-InPatInpatient accounts contact person
08PA-OutPatOutpatient accounts contact person
10PrvEnrOffThis contact person is the contact for all provider enrollment communication
11PERMThis contact person would work with state staff on anything related to PERM
12MedicalThis contact person is the recipient of audit recovery letters
13AuditThis contact person would receive audit record requests letters
14ReferralThis contact person is responsible for creating or obtaining patient referrals
15DirectorDirector
16AccountantAccountant
99OtherOther

Posted 2-7-2023

Effective January 28, the Respiratory Syncytial Virus (RSV) season offset criteria has been met. Season offset is defined as the last of two consecutive weeks when percentage of positive PCR tests for RSV is less than 3%, as reported to the Centers of Disease Control and Prevention. The RSV season is identified using data reported by the National Respiratory and Enteric Virus Surveillance System Midwest Region. No further prior authorization requests will be approved. Current Synagis authorization end dates are not impacted.

Posted 1-23-2023

North Dakota Medicaid’s QIO vendor Kepro is happy to announce the launch of a new enhancement for the ANG Provider Portal. This enhancement is the “create case wizard.” With the wizard, providers can create a case, link parties, and attach documents to the case from the homepage.

Join us for an instructor-led training on one of the below dates/times.

Wednesday, Jan. 25, 2023 - 11 a.m. CST - Register for this training  

Thursday, Jan. 26, 2023 - 2 p.m. CST - Register for this training   

Kepro has added the announcement with registration links to its website. The notice has been placed on both the home page and under announcements. Also, the training video is on the site under the training tab.

Posted 1-20-2023 (originally posted 4-18-2022)

Therapy claims (special education unit therapy claims excluded) with dates of service July 1, 2022, and after will require the ordering provider to be submitted on each claim submission.

837P Transactions
The referring/ordering provider should be reported at the claim level in Loop 2310A for services such as diagnostic and laboratory services. To report therapy services at the claim detail line level, report the ordering provider in Loop 2420E and/or the referring provider in Loop 2420F.

When there is only one referral use code “DN – Referring Provider." Use“P3 – Primary Care Provider” in the second iteration of the loop to indicate the initial referral from the primary care provider. Use “DK –Ordering Provider” to indicate the ordering provider.

837I Transactions
The referring provider should be reported at the claim level in Loop2310F when the referring provider is different than the attending provider. When the referring provider on a claim detail line is different than what is reported in Loop 2310F, they are reported in Loop 2420D. An ordering provider is not reported on an 837I. Use “DN – Referring Provider” to indicate the referring provider.

Questions? Reach out to the ND Medicaid call center at (877) 328-7098 or mmisinfo@nd.gov.

Posted 1-19-2023

All Providers: Providers are advised not to edit properties for any state forms. Once a document has been edited by a provider, the platform used to import the forms is not able to determine what boxes where checked, for example, and it is causing delays in processing applications and enrollment updates.

Posted 1-12-2023

Attention DME Providers:   Effective January 1, 2023  HCPCS Code A4224 - Supplies for maintenance of insulin infusion catheter will only be allowed when Medicare is the primary payer and has made a payment on the claim.  

For Medicaid primary claims as well as claims where Medicaid is secondary to a commercial health plan the following codes should be utilized based on the product dispensed.

  • A4230 - Infusion set for external insulin pump, non-needle cannula type
  • A4231 - Infusion set for external insulin pump, needle type
  • A4232 - Syringe with needle for external insulin pump, sterile, 3 cc

A 90-day supply will be allowed, with a maximum of one unit per day. From and through dates on the claim should reflect the date dispensed.   No service authorization is required. 

Accordion Section Title
2022 Provider Updates

Posted 12-29-2022

Attention Dental Providers: 

The ND Medicaid Dental Manual has been updated.  The following policies have also been updated:

  • Prosthodontics
  • Palliative Treatment of Dental Pain
  • Documentation Requirements for Periodontal Services
  • Fluoride Varnish

Please contact Sara R. with any questions or concerns at 701-328-4825.

Posted 12-27-2022

Noridian is currently reviewing the following submission dates as of Tuesday, December 27 for workloads:

  • Individual Application – 12/20/2022
  • Group Application – 10/25/2022
  • Individual Reactivation – 12/14/2022
  • Group Reactivation – 11/9/2022
  • Individual Revalidation – 12/12/2022
  • Group Revalidation – 12/19/2022
  • Affiliation – 10/28/2022
  • EFT – 12/14/2022
  • Taxonomy Update – 12/16/2022
  • Termination Request – 12/12/2022

Any submissions on or before these submission dates can expect either an email/phone call for corrections needed or an Approval letter/email within the next 5 business days.

Posted 12-22-2022

The latest edition of the ND Medicaid provider e-newsletter is now available.

In the December 2022 edition, learn about expanded coverage for qualifying new moms, Medicaid 1915(i) State Plan Amendment updates, Stay Covered ND resources and more!

If you have trouble viewing the e-newsletter, cut and paste the URL into another web browser – Chrome, Firefox or Internet Explorer or Safari for Mac users.

A PDF version is also available.

We welcome your feedback by email to dhsmed@nd.gov. Thank you for being a ND Medicaid provider and serving Medicaid members.
  

Posted 12-22-2022

No more paper remittance advices

Effective January 1, 2023 providers will no longer receive paper remittance advices (RAs). Refer to the document linked here mmis-accessing-remittance-advice-qrg.pdf (nd.gov) to assist you in accessing the RA via the web portal.

If you have never accessed the web portal, you can register by clicking on the "Register" link located in the Provider Registration section of the ND MMIS Health Enterprise Home Page. The user ID and password will be mailed in separate provider letters. Following that step, additional Organization Administrator accounts and other user accounts can be established. You may want to refer to the following link mmis-organization-administrator-fact-sheet.pdf (nd.gov).  

Security access will need to be set up with a user’s profile to allow staff to view and download the RA.  Once a payment is made, you’ll receive a notice in the “Messages & Announcements” Quick link on the MMIS Home Page. From there you can go to the claims option of the top menu bar and drop down to payment inquiry. Your remittance advice will be located there.

You may contact the call center at 877-328-7098 with any questions.

Posted 12-20-2022

The General Information for Providers Manual has been updated. This manual covers areas regarding provider enrollment and Medicaid Covered services. 

Posted 12-13-2022

The Codes Requiring Service Authorization spreadsheet has been updated.  Please note the following changes in effect for January 1, 2023:   

  • Several genetic testing codes have been moved from the General Medical Services tab to the Kepro tab 
  • Procedures related to gender affirming care have been added to the KEPRO tab 
  • All drugs requiring SA when billed on medical claims are now listed on the Drugs tab including several new requirements

Posted 12-5-2022

Effective January 1, 2023, sports physicals should be coded as CPT® code 99429-unlisted preventive service and ICD-10-CM code Z02.5.  If a well-child visit and a sports physical occur at the same visit the provider should bill the well-child visit only.

Posted 11-23-2022

ND Medicaid Community Partner Webinar - Join us for our live webinar, Wednesday, Dec. 7 from 12:00-12:45 p.m. CT to learn how partners, providers and other community stakeholders can help prepare ND Medicaid members for the end of the Public Health Emergency. Registration is required.

Posted 11-17-2022

No more paper remittance advices

Effective January 1, 2023 providers will no longer receive paper remittance advices (RAs). Refer to the document linked here mmis-accessing-remittance-advice-qrg.pdf (nd.gov) to assist you in accessing the RA via the web portal.

If you have never accessed the web portal, you can register by clicking on the "Register" link located in the Provider Registration section of the ND MMIS Health Enterprise Home Page. The user ID and password will be mailed in separate provider letters. Following that step, additional Organization Administrator accounts and other user accounts can be established. You may want to refer to the following link mmis-organization-administrator-fact-sheet.pdf (nd.gov).  

Security access will need to be set up with a user’s profile to allow staff to view and download the RA.  Once a payment is made, you’ll receive a notice in the “Messages & Announcements” Quick link on the MMIS Home Page. From there you can go to the claims option of the top menu bar and drop down to payment inquiry. Your remittance advice will be located there.

You may contact the call center at 877-328-7098 with any questions.

Posted 11-9-2022

International Fraud Awareness Week 11/13-11/19/2022

The National Health Care Anti-Fraud Association (NHCAA) estimates that the financial losses due to health care fraud are in the tens of billions of dollars each year.

In honor of International Fraud Awareness Week 11/13-11/19/2022, below are resources to help providers prevent, detect, and report fraud against the Medicaid program.

Report suspicions of North Dakota Medicaid fraud, waste, and abuse via:

Posted 9-28-2022

The latest edition of the ND Medicaid provider e-newsletter is now available. In the September 2022 edition, learn about expanded postpartum coverage for qualifying new moms, newly redesigned ND Medicaid ID cards, funding opportunities to expand in-home and community-based care services for people with disabilities and more.

If you have trouble viewing the e-newsletter, cut and paste the URL into another web browser – Chrome, Firefox or Internet Explorer or Safari for Mac users.

 A PDF version is also available. We welcome your feedback by email to dhsmed@nd.gov. Thank you for being a ND Medicaid provider and serving Medicaid members.

Posted 9-21-2022

Effective Oct.1, ND Medicaid will cover Omnipod DASH and Omnipod 5 Tubeless Automated Insulin Delivery Systems. 

These will be covered through pharmacy point-of-sale billing for Medicaid members with Type 1 diabetes who are under the age of 21. Providers can refer to the Preferred Drug List for prior authorization forms, clinical criteria and frequently asked questions regarding coverage and billing. 
 


Effective Sept. 7, to better align Synagis coverage with respiratory syncytial virus (RSV) outbreaks as reported to the Centers of Disease Control and Prevention, the RSV season will be identified using data reported by the National Respiratory and Enteric Virus Surveillance System (NREVSS) Midwest Region.  

The RSV season onset will be defined as the first of two consecutive weeks when percentage of polymerase chain reaction (PCR) tests positive for RSV is greater than 3%. 

Season offset will be defined as the last of two consecutive weeks when percentage of positive PCR tests for RSV is less than 3%. 

What to do next - prior authorization requests
Up to five weight-based doses will be authorized within six months from the RSV season onset. No further prior authorization requests (PA) will be approved following the season offset. The PA approval letter will include the number of authorized units and the duration of the approval. 

The current season started on Aug. 27, 2022.

Posted 9-21-2022

HHS has established a set rate of reimbursement for HCPCS E2599, a speech generating device eye gazing camera of $3642.78. This rate is effective for service authorization request start dates of Sept. 1, 2022, and forward.

Posted 8-24-2022

Effective January 1, 2023, North Dakota Medicaid will require a valid HCPCS code for revenue code 250 on all outpatient services. A NDC must also be submitted if the HCPCS code requires it.

Posted 8-2-2022

Attention DME Hearing Aid Device Providers: Effective July 1, 2022, ND Medicaid will cover BICROC ITE and BTE per the hearing aid device policy’s coverage criteria. When submitting a service authorization, providers are to use the binaural codes V5211 or V5221 and the binaural dispensing code V5240 when providing 1 hearing aid and 1 contralateral routing device with a unit of 1. The BICROC and dispensing code reimbursement will match other binaural hearing aid and dispensing existing rates.

Posted 7-13-2022

Attention Dental Providers: The ND Medicaid Dental Manual has been updated.

Posted 6-28-2022

The General Information for Providers Manual has been updated.  This manual covers areas regarding provider enrollment and Medicaid Covered services.

Posted 6-27-2022

Fee Schedule Update – The fee schedules for dates of services July 1, 2022, have been posted to the website. Provider rates will receive a one-fourth inflationary increase for the second year of the biennium in accordance with the legislative mandate.

Codes that are priced off a fee schedule have been adjusted with the one-fourth percent inflation increase accordingly. Codes that are priced using the Relative Value Unit (RVU) methodology have had the conversion factor adjusted. The adjustment of the conversion factor takes into account the implementation of the 2022 RVUs for dates of service on or after July 1, 2022.

Based on the previous calendar 12 months’ claims volume, the new relative value unit adjustments, and a one-fourth percent inflationary increase for the second year of the biennium, the resulting conversion factor effective for July 1, 2022 dates of service and after is $35.1043. The previous conversion factor was $34.9990. Based on the changes to the relative value units, some fees will increase while others may stay the same or decrease. In the aggregate, the providers whose claims are priced off the RVU methodology will see a one-fourth percent increase in their reimbursement.

The Ambulatory Surgical Center (ASC) conversion factor effective for July 1, 2022 dates of service and after is $29.36 based on the one-fourth percent inflation increase.

The Anesthesia conversion factor effective for July 1, 2022 dates of service and after is $24.51 based on the one-fourth percent inflation increase.


The latest edition of the N.D Medicaid Provider e-newsletter is now available.

In the June 2022 edition, learn about efforts to increase access to preventive health care services for children, benefits of primary care providers applying fluoride varnish during well-child visits, upcoming training opportunity for Medicaid 1915(i) providers, a new timely filing policy for Medicaid claims and more!

If you have trouble viewing the e-newsletter, cut and paste the URL into another web browser – Chrome, Firefox or Internet Explorer or Safari for Mac users.

PDF version is also available.

We welcome your feedback by email to dhsmed@nd.gov.  

Thank you for being a N.D. Medicaid provider and serving our Medicaid members.


Announcing new Medicaid 1915(i) training and technical assistance opportunity for providers

Starting in August, the North Dakota Department of Human Services, in partnership with the Corporation for Supportive Housing (CSH), will be offering a six-week Medicaid Academy that focuses on providing services through the state’s Medicaid 1915(i) State Plan Amendment.

This training opportunity will help new Medicaid 1915(i) providers:

  • Complete their group and individual provider enrollments,
  • Develop policy and procedures,
  • Update their business model to incorporate Medicaid billing, claims submissions and more.  

The Medicaid Academy is also available for providers who have started the enrollment process and for those who are currently enrolled but need technical assistance.

In addition to the six weekly training sessions, providers will have the opportunity to join a weekly technical assistance call and connect by email with a member of the CSH team for any additional technical assistance needs.

To register or to learn more about the Medicaid Academy, contact Monica Haugen, Behavioral Health Division Medicaid 1915(i) program administrator at mohaugen@nd.gov.

Posted 6-21-2022

Noridian is now able to accept secure emails from providers and providers are encouraged to submit information via secure email versus faxing.


EFT Requirement: The Department of Human Services is requiring all enrolled providers to participate in electronic funds transfers (EFT) in order to receive Medicaid payments.  (NDCC 50-24.1-42).

Currently, enrolled providers have until December 31, 2022 to comply. Because this requirement is specific to Medicaid payments, it is advised that you also enroll with EFT for Medicaid Expansion, Blue Cross and Blue Shield of North Dakota (BCBSND) if you’re participating in that Managed Care Organization. EFT enrollment for BCBSND’s Medicaid Expansion network can be submitted through Availity at https://apps.availity.com/availity/web/public.elegant.login within the Transaction Enrollment section. BCBSND may be reached by emailing prov.net@bcbsnd.com or calling (800) 756-2749.

Complete and return the following items to ND Medicaid Enrollment by faxing 701-433-5956. If you prefer to send via secure email, you may either submit securely or request a secure link from Noridian staff NDMedicaidEnrollment@Noridian.com. You’ll need to submit a SFN 661 and a bank letter or voided check. The information on the form must match the information provided in the bank letter or voided check.

Posted 5-26-2022

Attention Dental Providers: ND Medicaid will hold a virtual training session on Wednesday, June 1, 10-11 a.m. CT, on filing secondary dental claims using the MMIS web portal and e-attachments. Join virtually by computer or mobile device (video and audio) Click here to join the meeting or by phone (701) 328-0950, Conference ID: 739 138 311#.

Posted 5-16-2022

The Medication Therapy Management Provider (MTM) Manual has been updated and renamed Provider Manual for Pharmacy Medical Billing. It now includes additional medical services that may be billed by pharmacies/pharmacists.

Posted 5-13-2022

The General Information for Provider Manual has been updated. This manual covers areas regarding provider enrollment and Medicaid covered services.

Posted 5-12-2022

Reminder that the North Dakota Department of Human Services  Timely Filing Policy has changed for claim dates of service on or after Jan. 1, 2022.

Posted 4-18-2022

Therapy claims (special education unit therapy claims excluded) with dates of service July 1, 2022, and after will require the ordering provider to be submitted on each claim submission.

837P Transactions
The referring/ordering provider should be reported at the claim level in Loop 2310A for services such as diagnostic and laboratory services. To report therapy services at the claim detail line level, report the ordering provider in Loop 2420E and/or the referring provider in Loop 2420F.

When there is only one referral use code “DN – Referring Provider." Use“P3 – Primary Care Provider” in the second iteration of the loop to indicate the initial referral from the primary care provider. Use “DK –Ordering Provider” to indicate the ordering provider.

837I Transactions
The referring provider should be reported at the claim level in Loop2310F when the referring provider is different than the attending provider. When the referring provider on a claim detail line is different than what is reported in Loop 2310F, they are reported in Loop 2420D. An ordering provider is not reported on an 837I. Use “DN – Referring Provider” to indicate the referring provider.

Questions? Reach out to the ND Medicaid call center at (877) 328-7098 or mmisinfo@nd.gov.

Posted 3-28-2022

The North Dakota Medicaid Program Integrity Unit provided program updates on Feb. 23 and 24, 2022 by video conference.  Providers can access the PowerPointQ & A and an audio recording of that presentation. 

If you were not sent an email invitation to the event and would like to be included in future video conferences, please email Missy Rosales at melrosales@nd.gov.


The latest edition of the N.D Medicaid Provider e-newsletter is now available.

In the March 2022 edition, learn about member eligibility renewals, primary care provider referrals, a new timely filing policy for Medicaid claims, common reasons why claims are denied or suspended and more!

If you have trouble viewing the e-newsletter, cut and paste the URL into another web browser – Chrome, Firefox or Internet Explorer or Safari for Mac users.

PDF verison is also available.

We welcome your feedback by email to dhsmed@nd.gov.  

Thank you for being a N.D. Medicaid provider and serving our Medicaid members.

Posted 3-18-2022

Attention Dental Providers: As of May 1, 2022, North Dakota Medicaid will no longer be accepting any paper dental claims.  Paper dental claims received on or after May 1, 2022, will be returned to the provider unless an exemption has been approved by North Dakota Medicaid. 

Requesting an Exemption
Providers who are not included on the automatic exemption list above and wish to receive an exemption will need to submit an exemption request in writing or via email using the department-approved form.

Submit by fax, email, or mail to:

Fax: (701) 328-1544 - ATTN:  Michelle Adams
Email: mladams@nd.gov
Mailing Address:

Medical Services – ATTN: Michelle Adams
ND Department of Human Services
600 E. Boulevard Ave., Dept 325
Bismarck, N.D. 58505-0250

All dental claims must be submitted as/an 837D electronic transaction or through the ND Provider Web Portal.

Electronic claims submission instructions can be located on our webpage.

NOTE: FAXED claims are not accepted for submitting for payment.

If you have questions or concerns, contact ND Medicaid Call Center at (877) 328-7098 / (701) 328-7098 or email mmisinfo@nd.gov.

Posted 1-26-2022

Attention Dental Providers: The ND Medicaid Dental Manual has been updated and is now available. This manual includes all CDT 2022 code updates.

Posted 1-6-2022

Attention Behavioral Health Providers: A new provider manual specific to behavioral health services covered by ND Medicaid is now available. The manual contains chapters on:

  • Partial Hospitalization Psychiatric (PHP) Services
  • 1915(i) Behavioral Health Services
  • Psychiatric Residential Treatment Facilities (PRTFs)
  • Qualified Residential Treatment Programs (QRTPs)
  • Rehabilitative Services
  • Substance Use Disorder Treatment Services

Posted 1-3-2022

Attention DME Providers: Fee Schedules and the Professional Fee Schedule, both effective Jan. 1, 2022, have been posted to the ND Medicaid provider fee schedule webpage.

Accordion Section Title
2021 Provider Updates

Posted 12-30-2021

The General Information for Provider Manual has been updated. This manual covers areas regarding provider enrollment and Medicaid covered services.

Posted 12-23-2021

Attention All Providers: The North Dakota Department of Human Services has a new Timely Filing Policy that will be going into effect with claim dates of service on or after January 1, 2022.

Posted 12-21-2021

Notification of Request for Non-Obligatory Letters Of Intent from Prospective PACE Organizations

The North Dakota Department of Human Services (Department) is requesting Non-Obligatory Letters Of Intent (LOI) from Prospective PACE Organizations (PPO). 

The Department is planning to increase PACE access in North Dakota by contracting with more PACE providers. Face-to-face meetings were held across the state in August 2021, and the related information was posted to the state’s PACE website.

The Department is now requesting LOI from PPO for the purpose of determining the level of interest and how the available American Rescue Plan Act home and community-based services (HCBS) enhanced Federal Medical Assistance Percentage (FMAP) dollars can best be used to support these efforts.

Prospective PACE Organizations authorized personal shall submit a signed letter of intent to the Department no later than Jan. 28, 2022.

The Non-Obligatory Letter of Intent Content:

  • This letter should clearly specify the service area, by zip codes, for which the PPO wishes consideration.
  • The prospective PACE organization interested in more than one zip code shall rank each zip code in order of interest from most desirable to least desirable.
  • Share how you have successfully worked with the elderly within North Dakota Medicaid in the past.
  • Outline what the PPO plans to use the money from the American Rescue Plan Act HCBS enhanced FMAP for.
  • Outline anything other than money that the PPO might need to start a PACE organization.  

Submission of Information

The submission must be sent to the PACE program administrator, Annette Fischer at afischer@nd.gov

Following the submission of the Non-Obligatory LOI and the discussion that will follow regarding the available American Rescue Plan Act HCBS enhanced FMAP dollars, all PPOs that want to move forward will be required to complete the submission requirements outlined in the Instruction for Prospective PACE Organizations that will be posted on the states PACE website listed above.

Posted 12-20-2021

Attention Providers:  The latest edition of the North Dakota Medicaid Provider e-newsletter is now available.

In the December 2021 edition, learn about the transition of ND Medicaid Expansion to Blue Cross Blue Shield of North Dakota, upcoming changes to select ND Medicaid service limits, Medicaid 1915(i) provider development grants, expanded tobacco cessation counseling coverage for all members and more!

PDF version is also available. We welcome your feedback by email to dhsmed@nd.gov.  

Thank you for being a North Dakota Medicaid provider and serving North Dakota Medicaid members.

Posted 12-15-2021

Attention Providers: The Codes Requiring Service Authorization spreadsheet has been updated for dates of services on or after 01/01/2022. Changes include additional dental services on the Dental tab as well as several physician administered drugs on the General Medical Services tab. 

Posted 12-10-2021

Tobacco cessation counseling coverage expands to all ND Medicaid members - For dates of services on or after Jan. 1, 2022, ND Medicaid will cover tobacco cessation counseling for all members. Prior to Jan. 1, 2022, this service was only covered for pregnant women. Counseling must be provided face-to-face by or under the supervision of a physician or other health care professional who is legally authorized to furnish such services under state law and within their scope of practice and is enrolled as a ND Medicaid provider.

CPT© Code: 99406 – Smoking and tobacco cessation counseling visit; intermediate, greater than three minutes up to 10 minutes.
CPT© Code: 99407 - Smoking and tobacco cessation counseling visit; intensive, greater than 10 minutes.

Posted 11-8-2021

Did you know? The National Health Care Anti-Fraud Association estimates that the financial losses due to health care fraud are in the tens of billions of dollars each year.

In honor of International Fraud Awareness Week Nov. 14-20, 2021, below are resources to help providers prevent, detect, and report fraud against the Medicaid program.

Report suspicions of fraud, waste, and abuse against the North Dakota Medicaid program by:

Phone: (701) 328-4024 or 1-800-755-2604 (option 3)
EmailMedicaidFraud@nd.gov
Complete a SFN 20 and return it via mail, fax, or e-mail as instructed on the form

Posted 11-5-2021

All Providers:  The North Dakota Medicaid Program Integrity Unit provided program updates Oct. 27 and 28, 2021 via a video conference.  Click to access the PowerPoint, Q & A and an audio recording of that presentation.  If you were not sent an email invitation to the event and would like to be included in future video conferences please email Missy Rosales at melrosales@nd.gov.

Posted 10-29-2021

North Dakota Medicaid now covers Continuous Glucose Monitors (CGM) through the pharmacy benefit. Providers who previously supplied CGM from their office by billing CPT code 95250 should now issue a prescription to the member to fill the CGM at a pharmacy. Startup training can be billed using CPT code 95249. Pharmacists can also bill CPT code 95249 by enrolling in the Medication Therapy Management (MTM) program. CPT code 95250 will only be allowed if other insurance requires CGM to be billed through the medical benefit.

Posted 10-19-2021

Attention all providers:  The SFN 615 Medicaid Provider Agreement was updated this month and providers should be using the most recent version when submitting paperwork. As of Nov. 1, the previous version will not be accepted.

Posted 10-11-2021

Attention All Providers: Effective at 12:00 p.m. today, Oct. 11, 2021, incoming PERM faxes to NCI will not be accepted for processing. NCI will resume acceptance of incoming faxes on Tuesday, Oct. 12, 2021 at 7 a.m. Thank you.

Posted 10-4-2021

The General Information for Provider Manual has been updated. This manual covers areas regarding provider enrollment and Medicaid covered services.

Posted 9-23-2021

Attention Providers:  The latest edition of the North Dakota Medicaid Provider e-newsletter is now available.

In the September 2021 edition, learn about the return of provider revalidations, resources for using Kepro’s Atrezzo online provider portal for prior authorizations, the Payment Error Rate Measurement review year for 2022 and more.

If you have trouble viewing the e-newsletter, cut and paste the URL into another web browser – Chrome, Firefox or Internet Explorer or Safari for Mac users.

PDF version is also available. We welcome your feedback by email to dhsmed@nd.gov.  

Thank you for being a North Dakota Medicaid provider and serving North Dakota Medicaid members.

Posted 9-2-2021

All Providers:  The COVID-19 Vaccine policy has been updated to reflect the reimbursement rates effective July 1, 2021, as well as the new CPT codes for the administration of the third dose of Pfizer and Moderna vaccine. 

Posted 8-10-2021

The North Dakota Department of Human Services is working to expand in-home and community-based long-term care and support services, including PACE services.

PACE provides coordinated care for older adults living in the community who have significant support needs. Services include preventive and primary health care, and short-term and long-term care services.

Individuals interested in learning more about PACE and how to expand direct services to older adults by becoming a PACE provider can attend an upcoming meeting in Bismarck, Grand Forks, Fargo or Watford City. See meeting flyer for details.

Posted 7-30-2021

Attention DME providers and practitioners: Please review the ND Medicaid DME Insulin Pump policy, as it has been revised and is effective on Aug. 1, 2021.

Posted 7-27-2021

Effective for dates of service July 1, 2021, the surgical procedure (PCS) codes will no longer require a service authorization from the North Dakota Medicaid QIO vendor Kepro. The list of CPT® codes that require service authorization are listed on a separate tab in the Codes Requiring Service Authorization list under Policies and Guidelines heading located on the Medicaid provider information page.

Posted 7-7-2021

All Providers:  The North Dakota Medicaid Program Integrity Unit provided program updates June 23 and 24, 2021 by video conference.  Access the PowerPoint, Q & A and an audio recording of that presentation on the Medicaid Provider Education and Training webpage

If you were not sent an email invitation to the event and would like to be included in future video conferences, please email Missy Rosales at melrosales@nd.gov.

Posted 7-6-2021

The General Information for Provider Manual has been updated. This manual covers areas regarding provider enrollment and Medicaid covered services. Find it on North Dakota Medicaid's Provider Manuals and Guidelines webpage.

Posted 6-30-2021

Fee Schedule Update – The fee schedules for dates of services July 1, 2021, have been posted to the website. Provider rates will receive a 2.0% inflationary increase for the second year of the biennium in accordance with the legislative mandate.

Codes which are priced off a fee schedule have been adjusted with the 2.0% inflation increase accordingly. Codes which are priced using the Relative Value Unit (RVU) methodology have had the conversion factor adjusted. The adjustment of the conversion factor takes into account the implementation of the 2021 RVUs for dates of service on or after July 1, 2021.

Based on the previous calendar 12 month’s claims volume, the new relative value unit adjustments, and a 2.0% inflationary increase for the first year of the biennium, the resulting conversion factor effective for July 1, 2021 dates of service and after is $34.9990. The previous conversion factor was $36.9758. Based on the changes to the relative value units, some fees will increase while others may stay the same or decrease. In the aggregate, the providers whose claims are priced off the RVU methodology will see a 2.0% increase in their reimbursement.

The Ambulatory Surgical Center (ASC) conversion factor effective for July 1, 2021 dates of service and after is $29.29 based on the 2.0% inflation increase.

The Anesthesia conversion factor effective for July 1, 2021 dates of service and after is $24.45 based on the 2.0% inflation increase.

Posted 6-29-2021

Attention Providers:  The latest edition of the North Dakota Medicaid Provider e-newsletter is now available. A PDF version is also available.

In the June 2021 edition, learn about the state’s new contract for Medicaid Expansion managed care services, legislative changes to North Dakota Medicaid, initiative to expand access to a program helping older adults remain in their homes and more.

We welcome your feedback by email to dhsmed@nd.gov. Thank you for being a North Dakota Medicaid provider and serving North Dakota Medicaid members.

Posted 6-28-2021

Attention Providers: There have been several changes to the CPT® codes that require service authorization from the North Dakota Medicaid QIO vendor Kepro effective for dates of service on or after July 1, 2021. Please refer to Codes Requiring Service Authorization list under Policies and Guidelines heading located on the Medicaid Provider Information page.

Posted 6-7-2021

Effective June 1, all DME service authorization request for HCPC code S1040 pediatric cranial remolding orthosis must be submitted via Kepro’s Atrezzo Provider Portal.

Posted 5-27-2021

Revised Enrollment Forms - Medicaid Enrollment team members have updated a large number of forms to include the applicable contact information for Noridian, as well as including some minor changes. Always refer to our website and scroll down the page to see the most recent version of a form to submit. Previous versions of forms are allowed for 30 days from the date the revised forms post.

Forms impacted include:

  • SFN 1330 - Request to Add an Affiliation,
  • SFN 1302 - Request to Add/Change Taxonomy,
  • SFN 509 - Out of State/Out of Network Enrollment Clarification,
  • SFN 661 - Electronic Funds Transfer,
  • SFN 1299 - Group Address Update and
  • SFN 1331 - Provider Termination.

Posted 5-24-2021

Payment Error Rate Measurement (PERM) RY2022

The PERM program measures improper payments in Medicaid and CHIP and produces error rates for each program.  The error rates are based on reviews of the fee-for-service (FFS), managed care, and eligibility components of Medicaid and CHIP in the fiscal year (FY) under review.  It is important to note the error rate is not a “fraud rate” but simply a measurement of payments made that did not meet statutory, regulatory or administrative requirements.

The PERM audit is important to all Medicaid providers because the Centers for Medicare and Medicaid Services (CMS) and the review contractor NCI Information Systems (NCI) will be sending letters to various Medicaid providers requesting medical records to validate that the service was ordered, provided, documented and billed appropriately.  Please make sure that your Release of Information departments are aware and responding to the records requests in a timely manner. 

UPDATE: NCI started sending medical record request letters to providers on May 17, 2021.  Record requests will come in an envelopeClick on link to see what the envelope looks like.

  • NCI makes initial calls to providers to verify provider contact information. 
  • NCI establishes a point of contact with providers and sends record requests.
    • Providers have 75 days to submit documentation.
  • NCI makes reminder calls and sends reminder letters on day 30, 45, and 60 until the medical records are received.
    • If the provider does not respond, NCI sends a non-response letter on day 75 to the State PERM representative.
    • If submitted documentation is incomplete, NCI requests additional documentation.
    • The provider has 14 days to submit additional documentation.
    • A reminder call is made, and a letter is sent on day 7.
    • If the provider does not respond, NCI sends a 15 day non-response letter.

Failure to submit documentation, or if the submitted documentation is incomplete, the claim will be considered an error and subject to recoupment.

When submitting records, we highly recommend the use of the corresponding medical review (MR) cover sheet with each submission for quick and accurate processing of record submissions. The MR cover sheet is included with your PERM letter packet.

For more detailed information and to see a template of the actual medical request letter and MR fax cover sheet being sent to providers, visit the ND Medicaid Program Integrity PERM webpage.

Questions may be directed to:

Steven McNichols, PT
Medicaid Program Integrity Audit Coordinator
ND Department of Health and Human Services, Medical Services Division
600 E. Boulevard Ave., Dept. 325
Bismarck, ND 58505-0250
Phone: (701) 328-4831
Email: auditresponse@nd.gov

Posted 4-30-2021

The state has discovered that enrollment documents faxed to the former Provider Enrollment fax line, (701) 328-4030, are not forwarding correctly to Noridian HealthCare Solutions (Noridian). Providers should discontinue use of the (701) 328-4030 number and fax enrollment documents to (701) 433-5956. Noridian's email address is NDMedicaidEnrollment@Noridian.com. Please either fax or email your enrollment or revalidation documents to Noridian.

If you have faxed documents to the (701) 328-4030 number since March 1, 2021, it is advised that you re-send them by either fax or email to Noridian.

Posted 3-30-2021

The General Information for Provider Manual has been updated. This manual covers areas regarding provider enrollment and Medicaid covered services. Click here to see the updated manual.

Posted 3-26-2021

Provider enrollment revalidation activities are beginning again for both past due and current revalidation due dates. The email notices will originate from either a PE-NDM or NDMedicaidEnrollment@Noridian.com email address. For revalidation documents previously submitted but not reviewed by state staff, Noridian staff will be reviewing to ensure that all the necessary documentation was provided.

In the event a form has been updated and the most current version was not submitted with the revalidation documentation, the newest version will be requested and required to complete the revalidation process. If a complete revalidation application is not received within 30 days of the date of the revalidation notice, the enrollment may be terminated.

Once you receive an email revalidation notification, it is a best practice to submit your revalidation as soon as possible, so if any corrections are needed, you can complete them before the due date. All required documents are due within 30 days of the email notification and no extensions will be given if no documents are submitted or if partial information was received. Please check the revalidation website for the most current list of providers that are due for revalidation within the next 90 days and be mindful of the past due notices that you may be receiving as well.

It is the provider’s responsibility to ensure updated email addresses are on file, so the revalidation notification is not sent to an invalid email address. If you do not receive your email revalidation notification, you are still responsible to complete your revalidation by the due date. Please contact the enrollment vendor at NDMedicaidEnrollment@noridian.com if you do not receive your revalidation notification within 30 days of revalidation due date (*not including past due revalidations). Records that have been terminated for no revalidation will not receive priority status for reactivations. Reactivations will be processed in the order they are received.

If your revalidation was due prior to March 1, 2021, your notification will be sent soon. You will have 30 days to submit your completed revalidation. If no response is received within 30 days, your enrollment may be terminated.

If you have already submitted your revalidation packet, but enrollment information is no longer up to date, please submit your updates as soon as possible.

Additionally, providers are strongly encouraged to enroll in electronic funds transfer (EFT) versus receiving a check payment if you haven’t already enrolled with EFT. For State Form Number 661 Electronic Funds Transfer (EFT) click here. You will need to submit the form along with a voided check or a deposit slip or a letter from the financial institution that includes the applicable routing and account numbers.

Posted 3-22-2021

Attention Providers:  The latest edition of the North Dakota Medicaid Provider e-newsletter is available by clicking here. A PDF version is also available.

In the March 2021 edition, learn about the new electronic visit verification system, the state’s new contract for utilization management, enrollment to become a Medicaid 1915(i) service provider and more.

We welcome your feedback by email to dhsmed@nd.gov.  

Thank you for being a North Dakota Medicaid provider and serving North Dakota Medicaid members.

Posted 3-17-2021

Attention Ambulance Providers: Effective for claims processed on and after April 1, 2021 please submit CPT modifier 76 with ambulance transports (HCPCS codes A0425-A0999) to indicate when a second trip occurred on the same date of service.     

Posted 3-9-2021

CMS newly created HCPCS code G2212 is to be used for billing Medicaid for prolonged Evaluation and Management (E/M) services which exceed the maximum time for a level five (99205, 99215) office/outpatient E/M visit by at least 15 minutes on the date of service. CPT codes 99417,  99358 and 99359 will not be accepted  with 99202 - 99215 codes for dates of service on and after Jan. 1, 2021. Please see MLN Matters MM12071 for further information.

Posted 3-8-2021

Attention Dialysis Providers: Effective for dates of service on or after March 1, 2021, HCPCS code A4657 – Syringe, with or without needle, each will be not be paid separately and considered incidental to the dialysis service performed on that day. 

Posted 3-5-2021

All Providers - The North Dakota Medicaid Program Integrity Unit provided program updates Feb. 24 and 25, 2021 via video conference.  Click here to access the PowerPoint, Q & A and an audio recording of that presentation.  If you were not sent an email invitation to the event and would like to be included in future video conferences, please email Missy Rosales at melrosales@nd.gov.

Posted 3-2-2021

Kepro is contracted with the North Dakota Department of Human Services to perform retrospective reviews of certain hospital admission requests for North Dakota Medicaid members effective January 1, 2021.

Reviews will occur on a rolling quarterly basis beginning in March 2021 with claims with dates of service between July 1, 2019 to Sept. 30, 2019. Click here to learn more.

Posted 3-1-2021

The Medical Services Division (Division) has contracted with Noridian Healthcare Solutions (Noridian) to provide Medicaid provider enrollment services.

Noridian will be responsible for all work associated with provider enrollments to include processing applications, updating enrollment information and enrollment revalidations. The division is not transitioning provider enrollment services for Qualified Service Providers (QSPs) at this time.

We appreciate everyone’s patience as we transition those responsibilities to Noridian. Noridian’s phone number is (701) 277-6999, fax (701) 433-5956 and email is NDMedicaidEnrollment@noridian.com. Any enrollment or revalidation documents received by the state will be forwarded to Noridian for processing.

Posted 2-11-2021

Durable Medical Equipment (DME) Claims Billing Guidance

The ND Health Enterprise Medicaid Management Information System (MMIS) was updated in December 2020 to properly reimburse required laterality modifiers right (RT) and left (LT) units. For claims that were denied, those can now be resubmitted. For claims that were partially paid, those can be adjusted. Please keep in mind that RT/LT modifiers will be required to be billed on two separate lines.

Example:
Line 1:  L3912 NU RT 1 unit
Line 2:  L3912 NU LT 1 unit

DME HCPC codes that require a service authorization the claims submittal process will continue to require it to be submitted on one line to match the approved request.

Posted 1-26-2021

North Dakota Department of Human Services (DHS) Medical Services Division has contracted with Noridian Healthcare Solutions (Noridian) to provide Medicaid Provider Enrollment services.

State staff are currently working on the transition plan with Noridian, and Noridian is expected to be fully operational in March.  

During this transition, there may be delays in responding to provider inquiries, updating enrollments and processing applications. Please be patient with us as we navigate through this process which we anticipate will result in quicker processing times for providers.

As we approach the completion of the transition an updated phone number and group mailbox address will be provided. DHS is excited to partner with Noridian to provide the best customer service possible for our Medicaid providers and provider applicants. Noridian currently operates the North Dakota Medicaid Call Center and this expanded service should bring familiarity to both providers and Noridian.

Posted 1-11-2021

DME Fee Schedules effective January 1, 2021 have been posted. The fee schedules can be found here.

Posted 1-8-2021

The General Information for Provider Manual has been updated. This manual covers areas regarding provider enrollment and Medicaid covered services.

Accordion Section Title
2020 Provider Updates

Posted 12-29-2020

The North Dakota Medicaid Dental Manual has been updated to include the addition of new 2021 ADA dental codes and updates to coding descriptions.

Posted 12-29-2020

Attention North Dakota Medicaid Providers: Emails that come from the audit response inbox will no longer have an attachment letter for you to open/read. The State of North Dakota will have a link inside the email that will take you to the letter the state is sending you.

You may need to check your junk folder for the audit response email. If you receive an email from the audit response inbox and are unsure about its origin, contact either Steve McNichols at smcnichols@nd.gov or Christina Altringer at caltringer@nd.gov.                  

Posted 12-28-2020

North Dakota received approval from the Centers of Medicare and Medicaid Services for a waiver specific to the Medicaid program. That waiver allows provider enrollment staff to enroll providers who are working in North Dakota to use a valid license(s) from another state or territory. Providers are reminded that it is their responsibility to ensure that the Department has updated licensing information associated with their enrollment records. Enrollments that have expired licenses on file will be closed and any claims paid after the expired license date will be recovered.  See the approved waiver by clicking here.

Posted 12-23-2020

North Dakota Medicaid has contracted with a new quality improvement organization (QIO) to perform service authorization reviews of certain requests for services and supplies for Medicaid Members effective Jan. 1, 2021.

Kepro, the new QIO, will be hosting a series of provider trainings on the Atrezzo provider portal. Four trainings will be held between Dec. 29, 2020 and Jan. 6, 2021. Learn more here. See codes requiring authorization by Kepro here.

Posted 12-16-2020

North Dakota Medicaid has posted a revised policy for coverage of medication assisted treatment (MAT) services through a bundled rate effective October 1, 2020. The Covered Services and Billing Guidelines sections were revised. The Weekly Rate for MAT Intake and MAT Established were revised also.

Posted 12-10-2020

Fee Schedule Update – Updated Dental Services Fee Schedules effective July 1, 2020 have been posted. The rates for various codes have been revised. Click here for updated fee schedules.

Attention Providers - North Dakota Medicaid has issued a policy on the COVID-19 vaccine. See it here.

Posted 11-2-2020

All Providers:  The North Dakota Medicaid Program Integrity Unit provided program updates Oct. 28 and 29, 2020 via video conference.  Click here to access the PowerPoint, Q & A and an audio recording of that presentation.  If you were not sent an email invitation to the event and would like to be included in future video conferences, please email Missy Rosales at melrosales@nd.gov.

Posted 10-20-2020

North Dakota Medicaid has posted a revised policy for coverage of medication assisted treatment (MAT) services through a bundled rate effective October 1, 2020. The policy was revised to add a statement that the codes may not be billed by FQHCs.

Posted 10-9-2020

North Dakota Medicaid has posted a revised policy for coverage of medication assisted treatment (MAT) services through a bundled rate effective October 1, 2020. The policy was revised to add clarification of when the weekly bundled rate may be billed.

Posted 10-2-2020

The North Dakota Department of Human Services is increasing access to behavioral health services for North Dakota citizens by adding withdrawal management as a Medicaid covered service! Click here to learn more.

Posted 9-30-2020

North Dakota Medicaid will cover medication assisted treatment (MAT) services through a bundled rate effective October 1, 2020. The policy is located Under the Provider Manuals and Guidelines.

Posted 9-30-2020

Effective Oct. 1, 2020, service authorization requests previously submitted to Quality Health Associates should now be submitted via fax using SFN Form 511 and be sent to 701-328-1544.

Posted 9-17-2020

Attention Providers:  The latest edition of the North Dakota Medicaid Provider newsletter is available by clicking here. A PDF version is also available here

In the September 2020 edition, learn about Medicaid turning 55, new provider enrollment video tutorials, managed care organization re-procurement timelines, claims-related training opportunities for providers and more.

We welcome your feedback by email at dhsmed@nd.gov.

If you have trouble viewing the e-newsletter, cut and paste the URL into another web browser – Chrome, Firefox or Internet Explorer or Safari for Mac users.

Thank you for being a North Dakota Medicaid provider and serving North Dakota Medicaid members.

Posted 9-17-2020

Payment Error Rate Measurement (PERM) RY2022

The PERM program measures and reports an unbiased estimate of the true improper payments in Medicaid and CHIP and produces error rates for each program.  The error rates are based on reviews of the fee-for-service (FFS), managed care and eligibility components of Medicaid and CHIP in the fiscal year (FY) under review.  It is important to note the error rate is not a “fraud rate” but simply a measurement of payments made that did not meet statutory, regulatory or administrative requirements.

  • Review Period: The PERM review period is payments made from July through June to align with state fiscal years and to provide additional time to complete the cycle before reporting improper payment rates. The upcoming cycle will review Medicaid and CHIP payments made in Reporting Year (RY) 2022 for July 1, 2020 through June 30, 2021.
  • Statistical Contractor (SC) – The Lewin Group (Lewin): The SC will be collecting state’s claims and payment data, processing the data to ensure completeness and compliance with PERM requirements, and selecting samples. The SC may have questions regarding data differences and changes from last cycle, payment methodologies, and identifying Medicaid versus CHIP matched payments. The SC is also responsible for national and state improper payment rate calculations that are provided to states at the end of each cycle.
  • Eligibility Review Contractor (ERC) – Booz Allen Hamilton (Booz Allen): The ERC will be performing eligibility reviews on the samples selected by the SC to inform the resulting improper payment rate. The ERC may have questions regarding topics such as state eligibility policies, eligibility systems, eligibility processes, and eligibility case documentation.
  • Review Contractor (RC) – NCI Information Systems, Inc. (NCI): The RC will be performing data processing and medical reviews on the samples selected by the SC to inform the resulting improper payment rate. The RC may have questions regarding topics such as state claims adjudication systems; managed care programs; vendors; third-party administrators, like Pharmacy Benefit Managers (PBMs); fee schedules; special programs (e.g., waivers); and claim submission policies.

The PERM audit is important to all Medicaid providers because CMS and the review contractor NCI will be sending letters to various Medicaid providers requesting medical records to validate that the service was ordered, provided, documented and billed appropriately.  Please make sure that your release of information/compliance/audit departments are aware and responding to the records requests in a timely manner.  Providers should start receiving the letters sometime in late March or April 2021.

  • NCI makes initial calls to providers to verify provider contact information. 
  • NCI establishes a point of contact with providers and sends record requests.
    • Providers have 75 days to submit documentation
  • NCI makes reminder calls and sends reminder letters on day 30, 45, and 60 until the medical records are received.
    • If the provider does not respond, NCI sends a non-response letter on day 75 to the State PERM representative.
    • If submitted documentation is incomplete, NCI requests additional documentation.
    • The provider has 14 days to submit additional documentation.
    • A reminder call is made, and a letter is sent on day 7.
    • If the provider does not respond, NCI sends a 15-day non-response letter.

Failure to submit documentation or if the submitted documentation is incomplete, the claim(s) will be considered an error and subject to recoupment.

Questions may be directed to:
Steve McNichols, PT
Medicaid Audit Coordinator
ND Department of Human Services
Medical Services
600 E. Boulevard Ave., Dept. 325
Bismarck, ND 58505-0250
Phone: (701) 328-4831
Email: auditresponse@nd.gov

Posted 9-17-2020

ND Medicaid would like to make providers aware that the Centers for Medicare & Medicaid Services (CMS) has selected Qlarant (formerly Health Integrity, LLC) as a Unified Program Integrity Contractor (UPIC). Qlarant has a strong history of quality improvement, program integrity and technology-based solutions. The UPIC will work with ND Medicaid to detect, prevent, and proactively deter fraud, waste, and abuse in its programs.

Under CMS or ND Medicaid direction, Qlarant will work in conjunction with or separately from ND Medicaid to deter targeted risks to the integrity of Medicaid programs. These vulnerabilities may result from billing approaches, program changes, or other improper practice applications. The goal is to achieve enhanced FWA detection and prevention across Medicaid programs. The UPICs are required to perform their work in compliance with all federal and state laws and regulations, CMS requirements, and Medicare and Medicaid manuals.

In the coming weeks and months your office may be contacted by Qlarant seeking information for one of their processes. We encourage you and your staff to work with Qlarant directly but feel free to reach out to ND Medicaid should you have any questions or concerns. You can reach out to Steve McNichols at smcnichols@nd.gov at any point in your dealing with Qlarant. Thank you for all that you do for the citizens of the State of North Dakota.

Posted 7-7-2020

The Medicaid Provider Enrollment Unit is resuming provider revalidation work. The revalidation roster was not updated the past two months due to the focus being on processing applications for enrollments due to COVID-19. Those enrollments have slowed down considerably, and staff will have more time to focus on revalidating enrollments.

Click here for an updated revalidation roster and be prepared to submit the applicable revalidation paperwork.

Posted 7-2-2020

The General Information for Provider Manual has been updated. This manual covers areas regarding provider enrollment and Medicaid covered services.

Posted 6-30-2020

The North Dakota Medicaid Dental Manual has been updated to include clarifying language in the orthodontic section and the addition of a few codes and descriptions that Medicaid was covering prior but not published in the manual.

Posted 6-30-2020

Fee Schedule Update – The fee schedules for dates of services July 1, 2020, have been posted to the website. Provider rates will receive a 2.5% inflationary increase for the second year of the biennium in accordance with the legislative mandate.

Codes which are priced off a fee schedule have been adjusted with the 2.5% inflation increase accordingly. Codes which are priced using the Relative Value Unit (RVU) methodology have had the conversion factor adjusted. The adjustment of the conversion factor takes into account the implementation of the 2020 RVUs for dates of service on or after July 1, 2020.

Based on the previous calendar 12 month’s claims volume, the new relative value unit adjustments, and a 2.5% inflationary increase for the first year of the biennium, the resulting conversion factor effective for July 1, 2020 dates of service and after is $36.9758. The previous conversion factor was $36.1558. Based on the changes to the relative value units, some fees will increase while others may stay the same or decrease. In the aggregate, the providers whose claims are priced off the RVU methodology will see a 2.5% increase in their reimbursement.
The Ambulatory Surgical Center (ASC) conversion factor effective for July 1, 2020 dates of service and after is $28.72 based on the 2.5% inflation increase.

The Anesthesia conversion factor effective for July 1, 2020 dates of service and after is $23.97 based on the 2.5% inflation increase.

Posted 6-22-2020

The latest edition of the North Dakota Medicaid Provider newsletter is online here.

In the June 2020 edition, learn about:

  • Available COVID-19 pandemic online resources
  • Medicaid 1915(i) to expand home and community-based behavioral health services
  • Online monthly Medicaid claims payment information
  • Understanding denial, adjustment reason codes and other claims-related information
  • New members of the Medicaid Medical Advisory Committee, and more

We welcome your feedback by email to dhsmed@nd.govClick here for a PDF of the newsletter.

If you have trouble viewing the e-newsletter, cut and paste the URL into another web browser – Chrome, Firefox or Internet Explorer or Safari for Mac users.

Thank you for being a North Dakota Medicaid provider serving North Dakota Medicaid members.

Posted 6-12-2020

Medicaid Partners: The federal Department of Health and Human Services is targeting providers who depend on Medicaid reimbursement with COVID-19 provider relief payments. These payments are specifically for Medicaid providers and providers must apply for them on their own – the state Medicaid agency is not able to apply on behalf of providers.

More information and the application for the Provider Relief Fund is here. Note: the website gives a deadline of June 3, but we have been told that providers are able to apply after the stated deadline.

We believe that the sooner a provider applies, the more likely they are to be approved for funds. Feel free to share this information with your networks.

Thank you for your service to our members.

Posted 6-11-2020

The Department of Human Services is preparing to issue a request for proposals (RFP) for a managed care organization(s) (MCO) to administer the North Dakota Medicaid Expansion group health care coverage. In 2021, the state’s contract with the current MCO expires and there are no additional extension options so by law, North Dakota Medicaid must reprocure this contract.

The department is looking for feedback from partners and providers that will inform the design of the RFP and subsequent MCO(s) contract. Please complete the survey on the top of the page by July 15, 2020 and return to dhsmed@nd.gov.

Use your discretion as to how many surveys your organization should complete. For example, if you have multiple service lines, it would be appropriate to fill out multiple surveys.

Posted 6-4-2020

The Medicaid Coding Guideline for Medical Nutrition Therapy has been updated to reflect the following changes: Effective April 1, 2020, the limit for Medical Nutrition Therapy changed from four (4) visits per year to four (4) hours per year as well as two additional HCPCS codes have been added.    

Posted 5-8-2020

The North Dakota Department of Human Services continues its effort to increase transparency. North Dakota Medicaid is sharing operational monthly outcome data as it relates to claims processing. This data provides taxpayers, Medicaid providers and members and other stakeholders better insight into the department’s work.

Click here for North Dakota Medicaid claims processing data.

Posted 5-6-2020

The requirement for use of the CR modifier for CPT 99441-99443 has been removed from the Temporary Telemedicine Policy. Click here for the Temporary Telemedicine Policy.

Posted 5-6-2020

Primary Care Case Management (PCCM) Program update: Effective May 1, 2020, for North Dakota Medicaid members enrolled in the Primary Care Case Management Program, a Primary Care Provider (PCP) referral will no longer be required for inpatient services provided in a hospital. 

North Dakota Medicaid has implemented system changes so that inpatient services provided in a hospital will no longer require a PCP referral.  These changes were made to support our members by making navigating the program requirements for inpatient hospital services easier while also decreasing the administrative burden of hospitals and PCP providers. 

The department encourages hospitals and members to keep PCP providers informed of inpatient services so the PCP remains aware of all health concerns the member is dealing with. 

Posted 4-23-2020

North Dakota Medicaid will host a webinar on April 24 from 1 to 2 p.m. CT to provide an update to providers, partners and other stakeholders on its response to the pandemic and answer any Medicaid-related questions pertaining to medical services and COVID-19.

The webinar will be available through Microsoft Teams at https://bit.ly/2VuRo8B or by phone at 701-328-0950, conference ID code 429118138#. Attendees can join from any computer or mobile device. The webinar will be recorded and available for later viewing on the department’s website at www.nd.gov/dhs/info/covid-19/program-policy.html. See press release for more information.

Posted 4-21-2020

Medicaid Providers and Partners: You are invited you to sign up for email updates about North Dakota Medicaid-related news and information, including provider newsletters and press releases. Sign up today!

Posted 4-8-2020

A Coding Guideline for HIV screenings (HCPCS Codes G0432, G0433, G0435, G0475 and CPT code 80081) effective for dates of service on or after April 1, 2020 has been added to the Medicaid Coding Guidelines webpage.  

Posted 4-2-2020

Attention Medicaid Providers: ND Medicaid is not actively revalidating provider enrollments or soliciting revalidation documentation.

Providers may continue to submit revalidation documentation, however staff are processing applications and application updates as a priority. 

The revalidation roster will continue to get updated monthly for providers who wish to submit revalidation paperwork. Enrollments with past due revalidations will not be end dated, at this time. Any changes to this practice will be posted on this webpage.

Posted 4-2-2020

Medicaid Partners - ND Medicaid is requesting your assistance completing this brief survey https://www.surveymonkey.com/r/NDMedicaid_COVID19.

The survey will be used to determine the short-term impact COVID-19 has on ND Medicaid’s enrolled providers. We want to monitor the situation as closely as possible to ensure that we are meeting your needs. Please share the survey with your contacts who serve ND Medicaid members.

Please complete this quick survey by April 10, 2020.

NOTE: The department's Behavioral Health Division (BHD) has sent out a separate survey for behavioral health providers. Behavioral health providers are being asked to complete the BHD survey rather than the ND Medicaid survey. That survey can be found at https://www.surveymonkey.com/r/BHservices_COVID-19.   

Thank you for your participation!

Posted 4-2-2020

ND Medicaid will host a LIVE webinar on April 3 from 1 to 2 p.m. CT to share information on Medicaid Services and COVID-19.

The webinar will be available through Skype video conference at https://bit.ly/39DEQPT. It will be recorded and available for later viewing at www.nd.gov/dhs/info/covid-19/program-policy.html.

Click here for topics that will be covered during the webinar.

Posted 3-30-2020

Attention Dentists:  The department is no longer requiring documentation to be sent for Dental procedure code D0140 – limited oral evaluation – problem focused. 

Posted 3-27-2020

ND Medicaid held its second presentation on Medicaid services and COVID-10 on March 27.  Topics covered included the state’s federal 1135 waiver approved by CMS on March 24 and Appendix K to the state’s existing Medicaid 1915(c) waivers.  Watch here (presentation starts 1 min. into clip). PowerPoint slides.

Posted 3-26-2020

Attention providers who submit paper claims: Effective April 15, 2020, North Dakota Medicaid will no longer accept paper claims submissions. For policy information and web portal claims submission information click here and scroll down to Electronic Claims Submission Policies heading.

Posted 3-25-2020

Effective March 1, 2020, North Dakota Medicaid will cover codes G0248, G0249 and G0250, per the Medicare definition, for Home Prothrombin Time/International Normalized Ration (PT/INR) Monitoring for Anticoagulation Monitoring.

Posted 3-23-2020

North Dakota Medicaid providers are invited to watch a one-hour recording of the March 20 informational presentation on COVID-19.

Providers can also find resources on the department's website, including Provider FAQs, program and policy changes and other important COVID-19 information. 

Posted 3-17-2020

North Dakota Medicaid has created a Frequently Asked Questions (FAQs) regarding COVID-19 and its impact on North Dakota Medicaid members and providers. Please share widely. If you have any questions, contact the ND Medicaid Call Center toll-free at 877-328-7098, 711 (TTY) or mmisinfo@nd.gov.

Posted 3-12-2020

North Dakota Medicaid is hosting its third informational presentation on primary care management reform. The state is considering a new primary care management model as an alternative to it Primary Care Case Management Program.

The next presentation is March 19 from 3 to 4:30 p.m. Central Time. Topic is Connecticut Medicaid's self-insured managed fee for service model. Press release.

Earlier this year, South Dakota Medicaid shared information about its Health Home program, and Alabama Medicaid presented on its Coordinated Health Networks program. Recordings of the presentations are on the Medicaid Provider Information webpage.

Posted 3-12-2020

Codes Requiring Service Authorization have been added to the Medicaid Provider Information webpage under the Policies and Guidelines section.

Posted 2-27-2020

North Dakota Medicaid hosted an informational presentation on Alabama Medicaid’s Coordinated Health Networks. North Dakota is considering a new primary care management model as an alternative to it Primary Care Case Management Program. This was the second of three presentations planned this winter to learn from other state Medicaid programs that have implemented care management models.

The presentation was recorded and is available online at www.nd.gov/dhs/services/medicalserv/medicaid/provider.html.  (Recorded Feb. 19, 2020)

The next presentation is March 19 from 3 to 4:30 p.m. Central Time. Topic is Connecticut Medicaid's self-insured managed fee for service model.

Posted 1-16-2020

North Dakota Medicaid is hosting informational presentations on primary care management reform. The state is considering a new primary care management model as an alternative to it Primary Care Case Management Program. Several presentations are planned this year to learn from other state Medicaid programs that have implemented care management models.

Learn about South Dakota Medicaid's Health Homes. One-hour video presentation and presentation slides. (Recorded Jan. 16, 2020)

Next Presentation is Feb. 19 at Noon CT. Topic is Alabama's Coordinated Health Networks. Check back here for more details.

Posted 1-15-2020

Attention Durable Medical Equipment (DME) Providers - Effective Jan. 1, 2020, the department will no longer require Durable Medical Equipment, Prosthetics/Orthotics and Supplies (DMEPOS) providers to submit service authorizations (which include prior authorizations, additional documentation not required by Medicare, or additional prescription requirements of durable medical equipment and supplies) for Medicaid-eligible members who are also eligible for Medicare, if an item is paid for by Medicare. If Medicare does not cover an item, DMEPOS providers will still be required to follow Medicaid’s requirements for the item.

Posted 1-9-2020

The North Dakota Medicaid Dental Manual has been updated to include new 2020 ADA codes and updated descriptions of current codes per the ADA and updates to the Prosthodontics policy effective January 1, 2020.

The General Information for Provider Manual (January 2020) has been posted. This manual covers areas regarding provider enrollment and Medicaid covered services.