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ND Health Enterprise Medicaid Management Information System (MMIS)

Frequently Asked Questions (FAQs)

The FAQs will be updated as ND Medicaid receives more questions on the ND Health Enterprise MMIS.

Provider Identification

Q. On ND Health Enterprise, do I still bill with a Medicaid ID?

  • No, you will bill using your NPI and taxonomy. Only those providers who do not enroll with an NPI will bill using their new 7-digit Medicaid provider number. Those providers are travel/lodging providers, Developmental Disability (DD) waivered service providers and Qualified Service Providers (QSP).

Q. Will I need to list the NPI and taxonomy on a claim for a rendering provider?

  • Yes, the same requirements apply for a rendering, attending or servicing provider to submit using their NPI and taxonomy.

Q. How is Taxonomy defined?

  • It is defined by provider type and provider specialty. It is not uniquely assigned to an individual.

Q. How do I learn what NPI and taxonomy I enrolled with?

Q. Should I place taxonomy on ND Medicaid paper claims today?

  • No, continue to use your current Medicaid provider number until we launch ND Health Enterprise.

Q. Will Developmental Disability (DD) waivered service providers bill with taxonomy and/or NPI?

  • No, DD providers will not submit taxonomy when billing for waivered services. Taxonomy will be required when billing for ICF/IID services.

Q. Where do I list the taxonomy for a rendering physician on a CMS1500 claim form?

  • The taxonomy for a rendering provider should be listed in Box 24J.

Q. When submitting an electronic claim, do we submit taxonomy for the provider or the facility?

  • You will need to submit taxonomy for both the provider and the facility as supported by the claim form.

Q. After the transition from the Legacy system to ND Health Enterprise, will you use a Medicaid provider number?

  • No, but we will issue you a new 7-digit Medicaid provider number to further identify you as a provider and as another form of validation.

Q. If a hospice provider submits claims for nursing facility room and board, does the provider submit both the nursing facility and hospice taxonomy?

  • You will use the taxonomy of the billing provider, which is the hospice agency.

Q. When do I use an affiliation form?

  • An affiliation form is used when rendering provider needs to be affiliated with a billing provider. A rendering provider does not need to reenroll if they are already enrolled with ND Medicaid. However, Provider Enrollment needs to validate each affiliation.

Q. Who do third party billers contact for taxonomy?

  • Third party billers are not assigned taxonomy. They are not an enrolled provider with ND Medicaid. Only email inquiries will be accepted from the third party biller. Email inquiries will be answered in the order they are received. The third party biller will receive an email response within 7-10 business days.

Q. If we have a current trading partner with ND Legacy MMIS do we need to request a new one with ND Health Enterprise?

  • Yes, you will have to register as a trading partner for ND Health Enterprise. You will also have to complete SFN 109 or SFN 111 in order to receive an 835 electronic remittance advice.

Q. When we filled out our enrollment form, we were using different electronic transaction submission software from what we are currently using. Do we need to change what is on record with ND Health Enterprise?

  • Yes, you should keep your information current. Please call the EDI hotline at 1-844-484-0844 to update your information.

The email address for inquiries is ndmedicaid-thirdpartyinquiries@direct.ndhin.com. Please note that to utilize the email address, third party billers will need to enroll to join the North Dakota Health Information Network (NDHIN). The NDHIN is a secure, online network. Entities can sign up by visiting: www.ndhin.org/services.

Claims Submission

Q. What billing changes will be seen on institutional claims?

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

Q. Will National Correct Coding Initiative (NCCI) edits apply to facilities when ND Health Enterprise is launched?

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

Q. What are the ways I can submit claims to ND Health Enterprise?

  • 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.

Q. Will ND Health Enterprise accept secondary electronic claims?

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

Q. For pharmacy claims in cases where Medicaid is secondary to Medicare, specifically for DME, will these claims continue to auto-transfer to Medicaid?

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

Q. What kind of pharmacy claims do not go through the Point-of-Sale (POS) system?

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

Q. If a claim suspends, what state is it in?

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

Q. Can we expect faster claim processing and payment with the ND Health Enterprise portal?

  • 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.

Q. Will the claim form be auto-populated in ND Health Enterprise like a clearinghouse?

  • No, ND Health Enterprise is not a clearinghouse.

Q. Will ND Medicaid accept either the 2006 or the 2012 ADA claim form?

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

Q. We submit 8-10 claims per month. Can we continue to submit paper?

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

Q. Can we submit ambulance claims electronically?

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

Q. How does a Basic Care facility bill within ND Health Enterprise?

  • 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.

Q. Will Basic Care continue to submit paper claims?

  • 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.

Q. Will Psychiatric Residential/Rehabilitative Treatment Facilities (PRTF) have to change claim billing forms from a CMS1500 to a UB04?

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

Q. How will claim billing for Ambulatory Surgery Centers (ASC) change with ND Health Enterprise?

  • 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.

Q. Under the Claims Submission Guidelines for Nursing Facilities, the In-house revenue code is listed as 110, currently we bill with revenue code 120. Is this a change?

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

Q.Will the payments be on one remittance advice or will we receive a remittance advice for each claim individually?

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

Q.Will the member Medicaid eligibility that we see on the web portal be printable to put in a file?

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

Q.What claim form option will a Basic Care Facility use to submit a claim through the web portal?

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

Q.Will the claim template be filled out with member information for a member who resides in a basic care facility?

  • The claim template will not auto populate with member information.

Q.The claims submission guidelines for home health services states that revenue code 0571 must be used to bill for home health aide visits. We currently use revenue code 0572 to bill for home health aide visits. Is there more than one revenue code that exists for home health aide visits?

  • 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.

Q.When creating templates in the system, does all of the red asterisk information need to be filled in?

  • 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.

Q.Will there be a list of changes outside of the companion guide (professional and institutional) that we can review with claims when ND Health Enterprise goes live?

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

Q.What is the EDI payer ID that is effective with ND Health Enterprise go-live?

  • The EDI payer ID is NDDHSMED.

Q.Will we be able to send electronic claim files directly to ND Medicaid through ND Health Enterprise?

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

Transition

Q. Is timely filing going to remain at one year?

  • Yes, the current timely filing policy will apply to ND Health Enterprise processed claims.

Q. Does ND Medicaid plan to pay claims in 30 days?

  • Yes, our goal is to process a clean claim within 30 days.

Q. Will ND Health Enterprise denials match Medicare denial codes?

  • ND Health Enterprise will use the national standard for reason and remark codes.

Q. Will ND Health Enterprise recognize all new modifiers?

  • Yes, ND Health Enterprise will support the submission of modifiers.

Q. How will we submit modifiers for multiple surgical procedures?

  • We will be utilizing the Multiple Procedure Payment Reduction (MPPR) following the same indicators published on the Medicare Fee Schedule (MPFS). Any surgical procedure with an MPPR indicator of “2” will be reduced by 50% of the allowed amount regardless of the utilization of modifier -51.

Q. How should bilateral procedures be submitted in ND Health Enterprise?

  • Bilateral procedures should be reported on one line item with modifier -51.

Q. Will ambulance destination modifiers be utilized when billing in ND Health Enterprise?

  • No, we will not use destination modifiers when processing a claim.

Q. How do I void/replace an Electronic Data Interface (EDI) claim?

  • The voice/replace process for a previously processed claim will be the same regardless of how the original claim was submitted.

Q. When providers receive notice that claims are denied due to the shutdown before go-live, do we resubmit using the void/replacement process once ND Health Enterprise is live?

  • No, because the claim has been denied you can submit a new claim.

Q. If an original claim had errors and was corrected through the void/replacement process, will I be able to see that original claim as well as the void/replace claim?

  • Yes, you will be able to see the original claim and the claim submitted through the void/replace process in the web portal.

Q. Is the void/replace process going to be the same as now whereby we take all dollars back for the entire claim and process the replacement for payment?

  • Yes, the void/replace process voids all lines of the original claim and processes all lines of the replacement claim.

Q. Can we correct claims we submitted in Health Enterprise?

  • You cannot correct a claim. You can use the void/replacement process to correct a previously processed claim.

Q. Will ND Health Enterprise edits align with Medicare?

  • No, not all of our edits will align with Medicare. There are some ND Medicaid specific edits.

Q. Will you require consent for sterilization by paper?

  • Yes, you will need to submit the signed consent form as a claim attachment.

Q. Will we be able to tell if a claim is paper or EDI based on the 1st digit of the TCN, like that of the current ICN?

  • The media source is the 6th position in the TCN. A value of 8 identifies it as a paper claim.
  • tcn fromat

Q. Are there ND Health Enterprise changes for nursing facilities?

  • Yes, nursing facilities must meet the requirements for submitting NPI and taxonomy on the claim. Any UBO4 claim submitted will be edited to ensure that the last digit of the bill type (frequency code) coincides with the patient status. A new line must be submitted when a member's MDS classification period changes during the month, whether or not the MDS RUG IV classification changes.

Q. Will a nursing facility have to use our new Medicaid provider number on our MDS assessments?

  • Yes, you should put your new 7-digit Medicaid provider number on your MDS assessments after ND Health Enterprise is implemented.

Q. What are the changes for Developmental Disability (DD) providers?

  • DD providers will submit a 5-digit local code when billing for DD waivered services. SFN 1731 will be used to bill for these services. The new 7-digit Medicaid provider number is used when billing with this claim form.

Q. Are we able to use the web portal through Legacy MMIS until the new web portal goes live? If so how do we get access to that portal?

  • You will not be able to use the ND Health Enterprise web portal until the system is live.

Q. Will we be able to save a month (such as April 1, 2015 to April 30, 2015) of remittance advices at one time as one file or will we have to save them individually?

  • You will receive a separate remittance advice for each checkwrite. The checkwrite is typically run once a week.

Q. Are the remittance advices going to have the member's name on them or just their member ID numbers?

  • The member's name will be displayed on the remittance advice.

Q. Is Medicaid Provider ID number our older 5 digit number? When it says "Medicaid ID" what is this referring to?

  • Your Legacy Medicaid provider number is 5 digits in length. Your ND Health Enterprise Medicaid provider number will be 7 digits in length.

Q. Is Medicaid Provider ID number our older 5 digit number? When it says "Medicaid ID" what is this referring to?

  • Your Legacy Medicaid provider number is 5 digits in length. Your ND Health Enterprise Medicaid provider number will be 7 digits in length.

Q. Our dietician recently got her own NPI number and we will be billing for her services. Does she need to be enrolled as a provider in ND Medicaid or can we bill under our NPI number?

  • Any provider who participates in the services being billed must be identified on the claim. The provider must also be enrolled with ND Medicaid.

Q. What is the purpose of requesting a Service Authorization online?

  • Not all services provided to a member require a service authorization. If you provide services which require a service authorization, the web portal is one of the options to submit the service authorization.

Security/Organization Administration

Q. What occurs if the organization administrator we previously designated has left the organization?

  • You will still be able to utilize the user id/password mailed to you to log in and appoint another individual.

Q. What occurs if we do not recall if we designated an individual as the organization administrator?

  • If you did NOT complete the Security section of the on-line re-enrollment Application you will not receive a PIN/Password Letter in mid-September. However, you will still be able to designate an individual(s) on or after October 5, 2015 by clicking on the "Register" link located in the Provider Registration section of the ND MMIS Health Enterprise Home Page. The name used on the re-enrollment will be the default organization administrator. When the letters are mailed the user ID and password provided will be for an account that will have both the Org Admin and the Primary Account Holder roles. In this way each provider can manage their own organizations in whichever way they choose. If someone re-enrolled and registered for web access they will receive an ID and password that will be for an account that has Org Admin privileges.

Q. How do I register for web portal access?

  • You can register by clicking on the "Register" link located in the Provider Registration section of the ND MMIS Health Enterprise Home Page. The user ID and password will be mailed in separate provider letters. Following that step, additional Organization Administrator accounts and other user accounts can be established.

Q. Is it important to establish more than one organization administrator?

  • It is strongly recommended that a back-up organization administrator is appointed in the event the primary organization administrator is not available.

Q. Does the organization administrator need to be from an information technology department?

  • Not necessarily. Provider organizations may want to appoint individual(s) who are familiar with business roles performed by various staff.

Q. What occurs if a staff member forgets their password?

  • The organization administrator(s) is/are able to self-manage your security and can re-set staff passwords.

Q. As the organization administrator, do I use the organization provider number for the web access registration process?

  • You will use your new 7-digit ND Medicaid provider number.

Q. I am an office manager and will be the organization administrator. Will I receive passwords and logins for all staff or just myself?

  • As part of the self-management process, you as the organization administrator will receive a user id/password. The organization administrator will set up all other users with user ids and passwords. This account can be used to add more accounts and to assign and change roles for other staff.

Q. The main contact person has retired or left the organization. What steps should we take to ensure access to ND Health Enterprise MMIS? When we receive our new ID's and passwords, can this information be changed at login or does it need to be done beforehand?

  • You need to designate a new organization administrator who can use the departed person's account to create a new account for themselves with the correct roles, and then deactivate the departed person's account.

Q. We have 6 locations. Do I have to sign out and sign back in to move from facility to facility?

  • If there are different ND Medicaid IDís, yes, you will be required to create unique Accounts and sign in to that particular providers account.

Q. Will an actual physician use Enterprise?

  • Generally the provider support staff will use Enterprise.

Q. What action is taken if our organization administrator loses their password?

  • You will need to call the ND Health Enterprise MMIS Call Center at 1-877-328-7098.

Q. What if our organization administrator is on vacation or a leave of absence?

  • Prior to these events, the Organization Administrator may set expanded roles and permissions for some users. We do recommend organizations designate and configure, at a minimum, both a Primary and a Backup Organization Administrator for expressly this purpose.

Q. What do we do if our organization administrator leaves the organization?

  • If a back-up organization administrator is not designated, users can call the Health Enterprise MMIS Call Center to assist in de-activating the old account and establishing the new organization administrator account.

Q. Is Enterprise security training available?

  • Yes. For more information about the Organization Administrator role within Health Enterprise, please view the Computer-Based Training Modules (CBT) at: http://ndmmis.learnercommunity.com.

Contact

N.D. Department of Human Services
Medical Services
600 East Boulevard Avenue, Dept. 325
Bismarck, N.D. 58505-0250
Phone: (800) 755-2604

 

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