MMIS FAQs - Claims Submission

The last digit of the bill type (frequency code) must coincide with the patient's status.

Yes, we will be applying NCCI edits to outpatient facility claims.

There are three ways to submit a claim. You can submit a claim through an X12 (837) transaction, using a paper claim form, or online through the ND Health Enterprise portal.

Yes, we accept electronic secondary claims today in our Legacy system. We will continue to accept them in ND Health Enterprise.

Yes, claims where ND Medicaid is secondary will continue to crossover as they do today.

All pharmacy claims can be submitted in POS. Durable medical equipment (DME) and immunization claims will be submitted through ND Health Enterprise.

If a claim is in suspense within ND Health Enterprise, it is either under review or we are waiting for attachments from the provider.

Yes, if you submit a claim using the web portal the claim will be adjudicated once you hit the Submit button. If the claim requires additional review or attachments the claim will be suspended.

No, ND Health Enterprise is not a clearinghouse.

Yes, these are the only two ADA claim forms we will accept in ND Health Enterprise.

Yes, you can continue to submit paper claims. The claims will need to be scanned before they are adjudicated by ND Health Enterprise.

Yes, you can submit the claims electronically. You will need to submit any required attachments through fax or mail.

The turnaround document will not be used in ND Health Enterprise. ND Medicaid will no longer mail out preprinted forms. The claim must be submitted with the NPI and taxonomy of the basic care facility using a UB04 claim form. Separate lines for personal care and room and board must be submitted on the same claim form.

Paper claims will continue to be accepted in ND Health Enterprise. However, basic care claims can be submitted through an X12 (837) transaction or through the ND Health Enterprise web portal.

Yes, a PRTF will bill on a UB04 claim form using revenues codes to bill for services.

A freestanding ASC will bill on a CMS1500. The claim will need to be billed with the ASC taxonomy and proper place of service. The SG modifier will no longer be required.

Yes, you should submit the appropriate revenue code to identify the type of room the resident is in.

All of the claims processed in the checkwrite will be on one remittance advice.

You can print the web portal page with the results of a member's eligibility inquiry using the Print option in your web browser.

To submit a basic care claim through the web portal, select the institutional claim form option.

The claim template will not auto populate with member information.

The National Uniform Billing Committee (NUBC) guidelines identify revenue code 0571 as a home health aide visit. Revenue code 0572 is a home health aide hourly charge and is not an appropriate revenue code to bill for a visit.

You must name your claim template. This is the only requirement to save a claim template. However, you may want to fill in basic information that will be consistent on your claims.

No, there is not a separate list of changes outside of the companion guides.

The EDI payer ID is NDDHSMED.

Yes, once you have registered as a trading partner with ND Health Enterprise you will be able to send electronic claim files.