Adults and Aging Qualified Service Providers (QSP)

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Enrolling as a Qualified Service Provider

Qualified Service Providers or QSPs are individuals or agencies that provide services to clients who receive services funded by North Dakota Health and Human Services.

People who qualify for home and community-based services can choose among available qualified service providers that offer competitively priced services.

QSPs are independent contractors that have met certain competency standards required to provide services to eligible clients.

The new QSP enrollment portal is here! Visit the portal now to start your enrollment application.

 

Access the QSP Enrollment Portal

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Enrollment Assistance and Resources

Do you need help understanding or completing the enrollment forms or have questions about how to enroll?

The QSP Hub provides support, educational tools, and training opportunities to walk QSPs and QSP agencies through all stages of the QSP process.

Access the QSP Hub

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Posted 10-17-2023

Claims guidance for when members lose and regain Medicaid eligibility 
On April 1, 2023, North Dakota began verifying coverage for regular Medicaid individuals whose coverage was temporarily extended due to the COVID-19 public health emergency.

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, QSPs will have 180 days from the date the member’s eligibility was updated to resubmit claims that were previously denied because of no member eligibility.

QSPs 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); Call (877) 328-7098, Option 1.
  3. Calling the Provider Relations Call Center at (701) 328-7098 or (877) 328-7098.

Posted 6-21-2023

As a QSP you are required to revalidate (renew) your enrollment every five years instead of every two years!

Why revalidate?

Revalidations must be done to maintain QSP enrollment. If you do not revalidate your QSP enrollment, it may result in automatic closure of your QSP enrollment. Payments will be stopped if ND Medicaid does not get your completed revalidation packet by the due date.

How will I know if I need to revalidate?

A notice of revalidation will be sent to you before your QSP enrollment expires. Agency revalidation will be sent by email. All other revalidation information will be sent by mail. It is your responsibility to ensure all forms are correct and returned in a timely manner for processing. 

How do I revalidate?

Revalidations require much of the same paperwork you used for your initial enrollment. You must complete and submit a new forms packet and all required documentation. Some services require additional forms to complete revalidation. Make sure you are using the most current forms version!

Specific changes can be found in the Agency, Individual, Family Home Care and Family Personal Care QSPs handbooks.

Click here for QSP Q&A and other information on COVID-19.

IMPORTANT: QSP drop boxes for paper claims are located to the department's Prairie Hills Plaza building located at 1237 W. Divide Ave. - use Door #2, and the department's main office at the State Capital, 600 E. Boulevard Ave., Judicial Wing - third floor, Bismarck.

NEW: North Dakota QSP Hub - North Dakota’s centralized source of support and information for qualified service providers.

  • Get one-on-one individualized support by email, phone, or video conferencing with enrollment questions, service authorizations, electronic visit verification (Therap), documentation, billing processes, renewals and MORE!

Informational packet for NEW QSPs (330kb pdf) (August 2024)

Billing Instructions

Paper

Online

Claims Questions?

  • When will I get paid?
  • Why didn’t I get paid?
    MMIS Call Center 1-877-328-7098 (When asked for a PIN, select “0”)
     
  • How do I void or replace a claim?
    • Claims billed in MMIS 1-877-328-7098 (When asked for a PIN, select “0”)
    • Claims billed in Therap call 203-596-7553 or email 
       
  • How do I reset my password and/or unlock my account?
    • MMIS account access 1-877-328-7098 (When asked for a PIN, select “0”)
    • For Individual QSP Therap account access call 1-855-462-5465 or email. Self-password reset instructions are here. 
    • The QSP agency's super admin administrative role can reset/unlock user passwords. 
      If the super administrator is locked out:
      • Follow the instructions here.
      • On agency letterhead, the QSP executive director (or equivalent position) must generate and sign a letter requesting a password reset.
      • Attach a copy of the executive director’s driver’s license.
      • Send the form, letter and ID to the Therap email

QSPs / Explanation of QSP Billing Codes

Computer-Based Training

Various Links

Outreach/Educational Material

This application should not be completed unless you have already been in contact with a case manager or your client has already been approved for this service.

Family Home Care Provider (FHC) (September 2024) 

Family Personal Care Provider (June 2023)

When you enroll as a QSP, you choose the services you want to provide. All services have a number called a billing code that is used to submit a claim for payment to Health and Human Services. An explanation of billing codes includes important information about each service, how to document your time and certain requirements for each task. The information also gives you tips for how to bill.

Click here to view the billing codes.

Individual Service Provider (ISP) Training in Therap - Jan. 29, 2024
QSP Onboarding Training                                                                                                                          
T1020 Attendance Billing Training (February 26, 2024)
ONLINE TRAINING - Fraud, Waste and Abuse

Claiming Your Account and Maintenance Requests  (August 12, 2024)

QSP Maintenance Training  (August 12, 2024)

Connect to Care - Individual QSPs (September 26, 2024)

Connect to Care Overview (September 26, 2024)

Nurse Educator QSP Training Webinar - April 25, 2024, 12:00 PM - 12:45 PM

Aging Services is responsible for licensing Agency Foster Homes for Adults (AFHA). The purpose of an AFHA is to provide a residential setting where four or fewer Medicaid waiver recipients live together and are receiving Residential Habilitation or Community Support services. All referrals to receive Residential Habilitation or Community Support services in an AFHA must go through the Aging & Disability Resource Link (ADRL) intake process by calling phone #855-462-5465, and then be assigned to a  HCBS case manager to determine eligibility for services in this setting.

Providers interested in developing an AFHA should contact the ADRL.  This setting can only be licensed to assist Medicaid eligible individuals. An AFHA cannot accept individuals who private pay for services.

List of providers:

Prairie Home & Health, Mohall ND                                  prairiehomeandhealth@yahoo.com

Prudent Home Care, Bismarck & Mandan, ND              coker2991@gmail.com

Lake Region Corporation, Leeds, ND                               jjacobson@lakeregioncorp.com

Blessed Homes LLC, Jamestown, ND                               georgeblessing24@gmail.com

A Place to Call Home LLC, Fargo, ND                               info@aplacetocallhomecare.com

Ebenezer Agency Foster Home, Horace, ND                  wiltontravers@gmail.com

Shepherd Homes LLC, Horace, ND                                  shepherdhomesmn@gmail.com

Blossom Services Group, West Fargo, ND                      info@blossomservicesgroupllc.com

Home Instead, Bismarck, ND                                           erin.sorensen@homeinstead.com  

Q: What is a Home & Community-Based Services (HCBS) Provider Navigator (PN)?

A: A PN helps HCBS case managers (CM) and Community Service Coordinators (CSCs) find an Individual or Agency Qualified Service Provider (QSP) to provide services to recipients that choose to remain in their own home and community.

Q: How do the PN assist the case manager (CM) and/or CSC?

A: The CM and/or CSC sends a referral(s) to the PN if the recipient that needs in-home services wants help finding a QSP. If the recipient already knows who they would like for a QSP, the CM and/or CSC will not send a referral to the PN. This limits the number of referrals the PN receives and unnecessary emails to QSPs.

Q: What happens when the PN receives a referral from the CM or CSC?

A: The PN:

  • Will review the referral received from the CM and/or CSC for completeness, what services the recipient has been approved for, and if the recipient wants an Agency or Individual QSP.
  • Then will send an email to only the Agency or Individual QSPs that have signed up to provide those services and are located in the community where the recipient lives. If there are no QSPs in the community where the recipient lives, the PN will email QSPs enrolled to provide services in the county and are willing to drive.

Q: What happens when the QSP Individual and/or Agency accepts a referral from the HCBS PN?

A: When a QSP accepts a referral, the PN sends an acknowledgment form that must be filled out by the QSP before officially acquiring the referral. The acknowledgment form is letting the PN, CM  and/or CSC know that you have staff located in that community where the recipient resides and/or have staff willing to drive to provide the needed services.

Q: Why are some QSPs receiving more referrals from the PN than others?

A: The PN has a spreadsheet with all the QSPs listing the counties each QSP chose when they enrolled, the services they are enrolled for and their contact information. The location of where the recipient is located determines the number of QSPs that receive an email from the PN.

  • Example: If the recipient is located in Bowman, ND,  there are a limited number of QSPs that provide services.  The PN sends an email to all QSPs who selected that service area.  If none of the QSPs respond within 24 hours, the PN sends an email to other QSPs willing to travel from another town (located in Dickinson and willing to drive to Bowman).
  • Example: If the recipient is located in Fargo, ND, where there are many QSPS, the PN sends an email to a limited number of QSPs meeting the criteria of the referral, such as:
    • How many units are approved by the CM.
    • What QSPs provide all or the majority of services the recipient needs.
    • Which QSPs have already received a referral.

QSPs have 24 hours to respond back to the PN. If no responses are received in 24 hours, the PN sends an email to additional QSPs. If multiple QSPs respond with a "yes" in the 24 hours that they accept the referral and have not received one from the PN, the PN sends all the “yes” responses to the CM/CSC. The CM/CSC then contacts the recipient that will be receiving in-home services to discuss all the QSPs to provide all the options. This allows the recipient to choose who they would like to accept as their provider.

Q: How does the PN make sure referrals are spread fairly when there are a lot of Agency QSPs in one area?

A: The PN track all counties; counties with a lot of Agency QSPs have additional tracking measures to make sure no Agency QSPs are favored over another one. We check for things like:

  • Which QSP was sent an email from the PN.
  • Which QSP responded back stating "no" they were unable to accept the referral.
  • Which QSP has already received a referral.
  • Which QSP responded back stating “yes” they could accept the referral but did not get the referral if it went to another agency.

The PN puts Agency QSPs on a rotation to receive emails; varying the number of Agency QSPs  enrolled in a specific community. Example: Fargo as of August 1, 2024, had 80 Agency QSPs, so there will be a rotation of 10 Agency QSPs at a time.

Q: What hours do the PN work?

A: Hours of operation are Monday – Friday; 8 a.m. – 5 p.m. The PN are full-time State employees and are not available when State offices are closed during the recognized State approved 10 holidays.

Q: How do I reach a PN?

A: The PN can be reach via email at qspnavigator@nd.gov.

Q: Why can’t I open my email that came from the HCBS PN?

A: All emails sent by the PN are secure as they contain protected health information (PHI). As a QSP, it is your responsibility to make sure you have the technology capable to open the email.  Here are the instructions to open a secure email:
1.   Click on “Read the message”
2.   Click on “Sign in with a one-time password”
3.   A one-time password with be sent to the same email the “Securemail” message was sent.
4.   Enter passcode in “One-time passcode.
5.   Click on continue
6.   Message should appear, if not, you may need to try a different browser.

Q: Why did another QSP receive an email with a referral from the PN and I did not?

A: If you didn’t receive an email from the PN with a possible referral, it may be because:

  • The recipient is looking for a certain provider.
  • The recipient does not care for their current provider.
  • You as a QSP do not offer the services that the recipient needs.

Emails that are only sent specific QSPs by the PN cannot be shared with other QSPs. All emails are confidential and by sharing them, you as the QSP are violating HIPPA rules.  

Q: I am a QSP Agency, why don’t we get referrals for a recipient that needs a lot of services so I can keep my employees busy and at one location?

A: It is the responsibility of the QSP Agency to manage their employees’ schedules to keep them busy.  There is no guarantee of what the recipient needs for in-homes services which means there are not a lot of referrals that have large number of units attached.

Q: Do you as a QSP provide services in all the counties in North Dakota?

A: If a QSP only provides services in a certain county, it is important that you only select the county in when you enroll. Selecting counties where you do not plan to provide services, could put you at risk for:

  • Receiving a lot of emails from the PN that are not relevant. 
  • Overlooking important emails because you receive so many referrals.

If the QSP only selects the counties where they actually plan to provide services, they may see an increase in emails with possible referrals because the PN may have a better understanding of exactly where you have staff and are willing to provide services.

Q: How do I change what counties I provide services in?

A: If you would like to add or remove counties from your service area, email the QSP Hub info@ndqsphub.org for assistance.

Q: Is a QSP guaranteed a referral from the PN?

A: No. The PN cannot guarantee a QSP will receive referrals from the State.  The recipient chooses who they would like as a provider. It is important that you as a QSP also promote your services to private pay recipients as part of your business model.  

Q: What is Recipient Liability (RL)/Client Share?

A: Amount a client must pay for the cost of services. This amount is deducted from the QSPs payment before payment is issued. The QSP must collect payment due from the individual.  For more information, refer to ND Medicaid’s frequently asked questions webpage.

Q: What are Service Payments for the Elderly and Disable (SPED) fees?

A: This is the amount a recipient is required to pay toward the cost of their services.

Q: Who is responsible for collecting the RL, SPED fee or any other fees?

A: It is the responsibility of the QSP to collect the RL, SPED fee or any other fees from the recipient. The State will not collect the RL, SPED fee or any other fees from the recipient on your behalf in order to receive the in-home services.

Q: How does the QSP know if the recipient has an RL or other fees?

A: The QSP is notified right away in the email sent by the PN if the recipient has an RL or other fees. The RL and other fees are written in the service authorization provided to the QSP by the CM.

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