Eligibility
To be eligible for enrollment, a provider must:
- Provide services to at least one North Dakota Medicaid eligible recipient.
- Meet the conditions regulating the specific type of provider, program, and/or service.
- Hold a current license, certification, accreditation, or registration according to North Dakota state laws and regulations.
- Providers must pass the enrollment screening process.
Application Information
All providers are required to apply for enrollment electronically on the ND Health Enterprise MMIS portal. The exception is Qualified Service Providers.
ND Health Enterprise MMIS Web Portal
All enrollment documentation submitted must include the application tracking number (ATN) from the online enrollment application.
- Select and fill out the entire packet that applies to your provider type and specialty
- Attach the required documents and
- Sign the signature pages for the packet to be considered complete.
You may also use the MMIS web portal to directly enter claims, upload batch transactions, and get real-time access to member eligibility, claims status, remittance advice, payment status and claims history.
Enrollment
Use the following resources to submit both the online and documentation portions of your application. The documentation portion cannot be attached to the online application, so you must submit them to Noridian by email or fax.
Resources
- How to Enroll (104kb pdf)
- Enrollment Effective Date (132kb pdf)
- Online Application Guide (971kb pdf)
- Online Application Video Walkthroughs
- How to Populate the Taxonomy in an Online Application (64kb pdf)
- National Provider Identifier (NPI) Information
- Individual Provider Application Instructions
- Provider Enrollment Toolkit
- Basic System Navigation User Guide
- Recall an Application User Guide
- Application Status User Guide
- Instructions to complete SFN 1168 (Ownership/Controlling Interest and Conviction Information) (541kb pdf)
Required Documents
- Fax or Email Coversheet
- Individual Provider Form Packets
- Urgent Medicaid Expansion Prescriber Fill out and attach for Medicaid expansion enrollment.
- Licensed Addiction Counselor (LAC) Packet (1,925kb pdf)
- Licensed Associate Professional Counselor (LAPC) Packet (1.951kb pdf)
- LAPC Attestation (for LAPC applications and affiliations)
- Licensed Baccalaureate Social Worker (LBSW) Packet (1.946kb pdf)
- LBSW Attestation (for LBSW applications and affiliations)
- Licensed Master Social Worker Attestation (for Individual Provider Form applications and affiliations)
- Behavior Modification Specialist Attestation (for Individual Provider Form applications and affiliations)
- Mental Health Technician Attestation (for Individual Provider Form applications and affiliations)
- Physical Therapist Packet (1.933kb pdf)
- Registered Nurse Packet (2.27mb pdf)
- Non-Emergent Medical Transportation Checklists (2,194kb pdf)
- Targeted Case Management Checklists and Attestations (2045kb pdf)
- 1915(i) Checklists and Attestations (2.152kb pdf)
Resources
- How to Enroll (104kb pdf)
- Enrollment Effective Date (132kb pdf)
- Online Application Guide (971kb pdf)
- Online Application Video Walkthroughs
- How to Populate the Taxonomy in an Online Application (64kb pdf)
- National Provider Identifier (NPI) Information
- Group Provider Application Instructions
- Provider Enrollment Toolkit
- Basic System Navigation User Guide
- Recall an Application User Guide
- Application Status User Guide
- Instructions to complete SFN 1168 (Ownership/Controlling Interest and Conviction Information) (541kb pdf)
Required Documents
- Fax or Email Coversheet
- Group Provider Checklists (June 2023)
- Urgent Medicaid Expansion Prescriber Fill out and attach for Medicaid expansion enrollment.
- Non-Emergent Medical Transportation Checklists (2mb pdf)
- Targeted Case Management Checklists and Attestations (1mb pdf)
- 1915(i) Checklists and Attestations (1.50mb pdf)
Revalidation Information
Revalidations are required to be done for all provider records, regardless of provider type, at least every five years. Qualified Service Providers are required to revalidate their enrollment every two years.
Qualified Service Provider Revalidation Information
In the event your enrollment is included on the 90-day Provider Revalidation Roster you may submit the applicable revalidation checklist.
- Select and fill out the entire packet that applies to your provider type and specialty
- Attach the required documents and
- Sign the signature pages for the packet to be considered complete.
- Provider Revalidation Roster
- Provider Past Due Revalidation Roster
- Individual Revalidation Checklist (2,161kb pdf)
- Group Revalidation Checklist (1,612kb pdf)
- Sole Proprietor (billing under SSN) Revalidation Checklist (2,068kb pdf)
Taxonomy Codes
Taxonomy codes identify a health care provider by the service they provide and area of specialty https://www.cms.gov/Medicare/Provider-Enrollment-and Certification/MedicareProviderSupEnroll/Taxonomy.
Providers are required to submit taxonomy codes when submitting paper or electronic claims to ND Medicaid. This excludes Qualified Service Providers (HCBS claims), transportation claims, and claims submitted by other atypical provider types.
If you are adding or updating a taxonomy use the SFN 1302 Request to Add/Change Taxonomy
There are two separate taxonomy code sets, one for individual providers, and one for group providers. Individual taxonomies cannot be used for group enrollments, just as group taxonomies cannot be used for individuals.
Determine the taxonomy you are going to be billing by searching the following lists to see which specialty and provider type corresponds to that taxonomy.
- ND Medicaid Valid Values for Individual and Group Providers
- Provider Type Codes and Provider Specialty Codes
How to Search
- Open the document
- Hold the Control Key and press F
- A search box will be displayed in the upper right of the screen
- Enter your search criteria (NPI number)
- Click the NEXT button in the search box to locate the NPI number you are inquiring on
Instructions to validate your taxonomy code(s) in Enterprise MMIS
Taxonomy codes are:
- Maintained on the provider's record and will be verified based on licenses and certifications
- Submitted to North Dakota on claims and other items such as service authorizations
- Used during adjudication
- Required on paper and electronic claims. Claims without the required taxonomy code will be denied.
Taxonomy codes listed on a claim MUST match the taxonomy codes on a provider's record or the claims will be denied.
Questions about taxonomy codes, changing taxonomy codes or other enrollment information should be emailed to NDMedicaidEnrollment@Noridian.com.
Search for Enrolled Providers
Use this search before completing an application. If a provider is enrolled, do not submit a new application.
Search by Name - Web Portal (1.32mb pdf)
Note:
- If a new affiliation is needed, submit the Affiliation Form (SFN 1330)
- If a new taxonomy is needed, submit the Add Taxomony Form (SFN 1302)
- If the provider is inactive, submit a Reactivation Form Packet
Options for Submitting Provider Enrollment Documentation
Electronic Secure Link:
For those providers that wish to send the required documentation via email, you must request access to a secure link by sending an email to NDMedicaidEnrollment@noridian.com. An email will be sent back to you with a link to a secure site to send your documents to the enrollment application.
Fax:
Providers may fax the required documentation to (701) 433-5956
ATTN: NDM Provider Enrollment
Mail:
Noridian Healthcare Solutions
Attn: ND Medicaid Provider Enrollment
PO Box 6055
Fargo, ND 58108-6055
Phone: (701) 277-6999
Additional Information and Resources
Instructions: How to Update Contact Information in MMIS Web Portal
Add Affiliation (583kb pdf)
Sample Affiliation Form (121kb pdf)
Terminate Affiliation (no longer providing services) (562kb pdf)
The department only needs to add service location requests specific to Physical Therapists and Group enrollment.
Required for all primary care providers.
Contract to Provide Primary Care Case Management Services (SFN 1296)
Provider Enrollment FAQ (1.60mb pdf)
Questions? Need Help?
Noridian Healthcare Solutions
Attn: ND Medicaid Provider Enrollment
PO Box 6055
Fargo, ND 58108-6055
Email: NDMedicaidEnrollment@noridian.com
Phone: (701) 277-6999
Fax: (701) 433-5956
Developmental Disability Providers
Phone: (701) 328-8935
Toll-Free: (800) 755-8529
Qualified Service Providers
Phone: (701) 328-4602
Toll-Free: (800) 755-2604 - to enroll
Enrolling as a Qualified Service Provider