We could use your help! Our North Dakota Medicaid Quality Provider Outreach team is now partnering with clinics. If you would like to learn more about partnering with us, please e-mail your clinical contact information to us at dhsmedicaidquality@nd.gov.
Together we can ensure that every eligible North Dakota child gets the healthy start they deserve. We look forward to a partnership with your practice and improving wellness visit rates across North Dakota.
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ND Medicaid has extended coverage for eligible new moms from 60 days to 12 months to help address maternal health needs after birth. Learn more here: ND Medicaid extended coverage for new moms
Wellness Visit (EPSDT) Benefits
North Dakota wellness visits, also known as the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program, is a preventative health care benefit for newborns, children and young adults through age 20 who are enrolled in Medicaid. To see if you are eligible for North Dakota Medicaid see income guidelines.
The intent of the ND Wellness visit benefit is to focus on early prevention and treatment, assure the availability and accessibility of required health care resources and help members and their parents or guardians effectively use services.
Member/Provider Relationship
It is the patient’s choice where to establish care with a primary care provider for:
- a regular and familiar source of health care
- well and sick care visits
- right care at the right time in the right place
The federal guidelines for EPSDT are available at www.medicaid.gov.
The Wellness Visit (EPSDT) Benefit Must Include:
- Comprehensive health and developmental history including assessment of both physical and mental health development
- Comprehensive unclothed physical exam
- Appropriate immunizations
- Laboratory tests (including Lead Toxicity screening) and
- Health education/anticipatory guidance
- Vision services including evaluation and treatment for defects in vision
- Dental Services including fluoride varnish, sealants, relief of pain and infections, restoration of teeth and maintenance of oral health. May include an orthodontia screening
- Hearing Services including evaluation and treatment for defects in hearing, including hearing aids.
- Other necessary health care services to diagnose and treat physical and behavioral health illnesses, defects and conditions discovered through a check-up.
Additional Services Such As:
- Orthodontia Screening
- Dental examinations
- Transportation and scheduling assistance
- Follow up care with Specialists
Recommended EPSDT Periodicity Schedule:
- Newborn
- 3-5 days
- 1 months
- 2 months
- 4 months
- 6 months
- 9 months
- 12 months
- 15 months
- 18 months
- 24 months
- 30 months
- Age 3 through age 20, annually
Consult the Bright Futures Well Child Periodicity Schedule for details of age-appropriate visits. Visit the provider guidelines and manuals webpage to see the EPSDT policy.
Wellness Visits Provider Toolkit
Resources for Provider
Questions or Concerns? Contact Us
If you are a Medicaid provider with Wellness visit questions, please contact the Quality Outreach Team by emailing dhsmedicaidquality@nd.gov or calling (701) 328-2014 (then press 2) to connect to our team.
For questions about member eligibility, payments, denials or general claims questions:
Call (701) 328-7098, toll-free (877) 328-7098 or email inquiries to mmisinfo@nd.gov.
Send written inquiries to:
ND Medicaid Provider Enrollment
Noridian Healthcare Solutions
PO Box 6055
Fargo, ND 58108-6055
Email inquiries to NDMedicaidEnrollment@noridian.com
Call: (701) 277-6999
Fax: (701) 433-5956
Medicaid Contacts
Medical Services Division
North Dakota Health and Human Services
600 E. Boulevard Ave., Dept. 325
Bismarck, ND 58505-0250
Phone: (701) 328-7068
Toll-Free: (800) 755-2604
Fax: (701) 328-1544
E-mail: dhsmed@nd.gov
711 (TTY)