Trading partner enrollment is an essential step to begin EDI transaction exchanges with ND Medicaid. Any entity that directly submits or receives EDI data from ND Medicaid must complete an online application to enroll as a trading partner.
Trading partner enrollment is different than completing enrollment as a Medicaid provider. Enrolling as a trading partner only creates an approved data partner relationship with ND Medicaid for the purpose of exchanging data.
Upon approval of the trading partner application, the department issues a “Trading Partner Identification Number” or TPID. This is like a fingerprint that identifies the entity sending or receiving data and is found in every EDI transmission.
ND Medicaid has a process to verify the TPID before accepting any data file. If we do not find the supplied TPID in the system, we will not accept or process the data file transactions.
Note: If you are using a clearinghouse, you do not need to complete a trading partner application; you will need to confirm that the clearinghouse you plan on using is enrolled with ND Medicaid as an “approved” trading partner.
To complete an online Trading Partner Agreement click here.
The EDI 835 transaction set is called Health Care Claim Payment and Remittance Advice. It has been specified by HIPAA 5010 requirements for the electronic transmission of healthcare payment and benefit information.
The EDI 835 is used primarily by health care insurance plans to make payments to health care providers, to provide Explanations of Benefits (EOBs), or both. When a health care service provider submits an 837 Health Care Claim, the insurance plan uses the 835 to detail the payment to that claim, including:
- What charges were paid, reduced or denied
- Whether there was a deductible, co-insurance, co-pay, etc.
ND Medicaid offers Health Care Claim Payment/Advice (835) Transactions with ND Health Enterprise MMIS.
Billing providers who wish to receive an 835 transaction will be REQUIRED to complete ND Medicaid Electronic Remittance Advice (835) Enrollment form (SFN 583).
- NOTE: SFN 583 is an e-form and requires Adobe Acrobat Reader. If you do not currently have this installed, you may download a free copy.
NOTE: Individual/Service Only Providers do not receive 835/Remits only the Billing NPI will receive Payments/Remits)
If you have any questions, contact the ND EDI Help Desk toll-free (844) 848-0844 or email@example.com.
Companion Guides for North Dakota trading partners are to be used in conjunction with the Accredited Standards Committee (ASC) X12 Technical Report Type 3 (TR3) Guides, including all related errata documents.
The Companion Guides define state-specific requirements in electronic transactions, remaining within the framework and code sets as defined in the TR3s, which support rules as defined by the Health Insurance Portability and Accountability Act (HIPAA).
Updated May 2023
- ND Companion Guide 270/271 - Health Care Eligibility Benefit Inquiry and Response
- ND Companion Guide 276/277 - Health Care Claim Status Request and Response
- ND Companion Guide 277CA - Health Care Claim Acknowledgment
- ND Companion Guide 278 - Health Care Services Review – Request for Review and Response
- ND Companion Guide 820 - Payroll Deducted and Other Group Premium Payment for Insurance Products
- ND Companion Guide 834 - Benefit and Enrollment Maintenance
- ND Companion Guide 835 - Health Care Claim Payment/Advice
- ND Companion Guide 837D - Health Care Claim: Dental
- ND Companion Guide 837I - Health Care Claim: Institutional
- ND Companion Guide 837P - Health Care Claim: Professional
Managed Care Organizations (MCO) - Encounter Claims
Updated May 2023
- ND Companion Guide 837D Encounter - Health Care Claim: Dental
- ND Companion Guide 837I Encounter - Health Care Claim: Institutional
- ND Companion Guide 837P Encounter - Health Care Claim: Professional
- ND MCO Encounter Adjustment Processing Guidelines - Health Care Encounter Adjustment Processing Guidance
Updated May 2023
- ND MCO Encounter Claims FAQ - Health Care Encounter Claim FAQ
Updated Jan. 2021
- ND MCO Procedures Requiring NDC Codes - Procedures Requiring NDC Codes
Taxonomy codes are national codes used by providers to indicate the type of services and products they deliver. Claims must be submitted with both your National Provider Identifier (NPI) and your Taxonomy code combination. Without the NPI and Taxonomy combination your claims will deny. Please make sure you are using the taxonomy code that was assigned during the enrollment process.
The Taxonomy Code associated with your enrollment record is available for lookup by NPI
The table below outlines the Taxonomy Code requirements for claim submission: Please ensure the required Taxonomy Codes are included in the fields specified below for each claim type. Please work with your billing software/clearing house to make sure that the Taxonomy Code is being sent in the appropriate Loop/Segment to avoid denials.
|Provider Type||837 P Professional Electronic Claims||837 I Institutional Electronic Claims||
837 D Dental
|Billing Provider||2000A *PRV||2000A * PRV||2000A * PRV|
|Rendering Provider||2310B * PRV (Header)||2310B * PRV (Header)|
|Rendering Provider||2420A * PRV (Line)||2420A * PRV (Line)|
|Attending Provider||2310A * PRV|