Terms and Meanings
Some terms that we use in this chapter may not be familiar. These terms and their meanings are listed below.
- Appeal: Asking for Medicaid to review a decision they made about a service you want covered.
- Approved/Authorized: The decision Medicaid makes to pay for a service.
- Facility: A health care building or practice.
- Services: Care, treatments, testing, checkups, equipment, supplies, and other ways your health care providers help you stay healthy.
- Transportation: Being given a ride.
- TTY: The number you can call to connect with someone when you have a hearing impairment.
Getting Serices in Another State
Sometimes your provider may need to send you for medical services that are not in North Dakota. Care from providers or facilities within the United States, more than 50 miles outside of North Dakota are considered out-of-state services.
You must see an in-state Medicaid provider before going to an out-of-state provider. This helps reduce the cost of your health care and travel expenses. Seeing an in-state provider may also help you maintain a continuous relationship with your provider.
Out-of-state non-emergency medical travel by an enrolled non-emergency ambulance is a service that may be covered if used when medically needed and traveling between two long-term care facilities, between two hospitals, or between hospital and long-term care facility. The Customer Support Call Center can tell you if your travel expenses will be covered.
Before you get services outside of North Dakota, Medicaid needs to approve your medical services before you are treated, unless the services are given in an emergency. The service should be requested at least two weeks before the date of service. You need to have approval every time you go out of state for services. Your North Dakota provider will help you get your out-of-state services requested.
Medicaid can help you with travel costs, if needed. You can contact the Out-of-State Services program for help requesting services:
- Call: 1-701-328-2159
Emergency Out-of-State Services
Services may be covered for emergencies that occur while a member is out of state. Medicaid can only pay the out-of-state provider if they are enrolled with ND Medicaid. Your out-of-state situation must be a true emergency for services to be covered by ND Medicaid.
Using an ambulance while out of state is a covered service when the ambulance is needed in a true emergency. Air ambulances are another form of emergency transportation that is covered when used where regular ambulance travel is not sufficient or medically appropriate.
You can learn more about the difference between needing to see a provider and experiencing a true emergency in the Emergency Health Care chapter of this handbook.
Getting a Denial for Out-of-State Services
Requests for out-of-state services may be denied for different reasons. Your denial letter will share the reason why your out-of-state services were denied. Reasons why services could be denied may be because the service you are requesting is already offered within North Dakota boundaries or the supporting documentation from your North Dakota provider doesn’t show a need to get the services out of state instead of within North Dakota.
Your North Dakota provider can request that Medicaid reconsider the decision to deny your request. Your provider will need to submit a request for reconsideration and include new documentation to support the request for out-of-state services within 30 days of the denial letter date. This date will be printed on your denial letter.
You can also file an appeal to the denial with our Legal unit. Your denial letter will include information on how to file an appeal. You will need to submit your appeal within 30 days of the denial letter date. You can learn more about appeals in the Your Rights chapter of this handbook.
Planning Your Travel
You may need help planning your travel for out-of-state services. We can help you plan your travel, including help finding a ride, meals, or lodging if your out-of-state services are approved. You can learn more about travel, meals, and lodging reimbursement in the Non-Emergency Transportation chapter of this handbook.
For help planning your travel, you can contact our Customer Support Center.
Contact Information Mentioned in this Chapter
- Customer Support Center
- Toll-Free: 1-866-614-6005
- Local: 1-701-328-1000
- TTY: 711
- Free translation available upon request
- Email: applyforhelp@nd.gov
- Mail: PO Box 5562, Bismarck, ND 58506
- Fax: 1-701-382-1006