Adults and Aging Qualified Service Providers (QSP)

• QSP Rates (October 2022)

• QSP Rural Differential Rates (July 1, 2022)

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!

• Individual Provider (1mb pdf) Forms Packet (2.95mb pdf) (June 2022)
• Agency Provider (1.04mb pdf) Form Packet (3.06mb pdf) (June 2022)
• Adult Foster Care Provider (AFC) (1mb pdf) Form Packet (2.50mb pdf) (April 2022)
• Agency Foster Home for Adults Provider (AFHA) (914kb pdf) Form Packet (2.94mb pdf) (April 2022)

Informational packet for NEW QSPs (330kb pdf) (March 24, 2020)

Billing Instructions

Paper

• SFN 1730 Paper Billing Instructions - Paper Billing Example
• SFN 1730 Paper Claim Correction Void and Replacement Instructions - Void and Replacement Example
• SFN 1730 HCBS Billing Form (blank)

Online

• MMIS Web Portal Professional Claim Form Submission Instructions (694 kb pdf)
• MMIS Web Portal HCBS/DD QSP Billing Instructions
• FACT SHEET: Internet Browser Compatibility
• MMIS Web Portal HCBS/DD QSP Void and Replacement Instructions
• Benefits of Online Billing - February 2017
• Pay Dates

Claims Questions?

• Claims payments
• Claims submissions
• Prior Authorizations

Documentation Guidelines for Individual Providers

• Procedure codes: 00010, T1019, T1020, S5135

Computer-Based Training

• SFN 1730 HCBS/DD QSP Billing Form - View Computer-Based Training

Contact

Noridian Healthcare Solutions

• Toll-Free: (877) 328-7098, 711 (TTY)
• Phone: (701) 328-7098
• Email: mmisinfo@nd.gov

• WEBINAR Recording: Service Authorizations and Professional Billing in Therap for QSPs Providing Services Not Subject to EVV (Posted Nov. 18, 2020)
• Frequently Asked Questions about EVV (updated Nov. 16, 2020)
• WEBINAR Recording: Electronic Visit Verification System for Aging Services Qualified Service Providers (Fall 2020)
• Therap Electronic Visit Verification System in North Dakota (Website Link)
• PRESENTATION: Electronic Visit Verification System Public Input Meetings (Fall 2019)
• PRESENTATION: Electronic Visit Verification System Public Input Meetings (Spring 2018)

• Instructions on how to get a NPI number (1.90mb pdf) (Posted Dec. 9, 2020)
• Fact Sheet (778 kb pdf)
• Video: Go on-the-job to learn about being a Qualified Service Provider by watching an 18-minute video called "A Realistic Job Preview." (112 MB .wmv)
• QSP Toolkit
• ONLINE TRAINING - Fraud, Waste and Abuse

Newsletters

• Qualified Service Provider Newsletter - March 2019
• Qualified Service Provider Newsletter - March 2018

Various Links

• MMIS Web Portal (submit claims for payment)
• Learn more about the ND Health Enterprise Medicaid Management Information System (MMIS) Web Portal
• Human Service Zone Offices

Outreach/Educational Material

• Print Ad (487kb pdf)
• Poster (4.76Mb pdf)
• Television Ad (5.8Mb mov)

• Critical Incident Reporting Module (ADDED Jan. 10, 2022)
• Critical Incident Reporting Recorded Webinar
• Instructions for reporting a critical incident (Jan. 10, 2022)
• Therap General Event Reporting Forms

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) (609kb pdf) Form Packet (1.88mb pdf) (April 2022)