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ND Health Enterprise Medicaid Management Information System (MMIS)

How to Read the ND Health Enterprise MMIS Remittance Advice

Enterprise Remittance Advice (RA) notices are produced as the final step of the weekly (or as otherwise scheduled) payment cycle. RAs are available as a PDF accessed via the provider web portal, EDI 835 transaction file routed to authorized trading partners, or paper documents printed and mailed on a very limited exception basis.

The RA includes detailed information on finalized claims (paid or denied); including the total amount of provider payment for all finalized claims within the financial cycle period. Providers may elect to receive information on suspended claims also, if desired. Itemized information reported on the remittance advice for each claim detail and claim total assist the provider in tracking adjudication decisions necessary for patient account update and claim resubmission as appropriate.

The RA report includes detailed information on adjustments made to previously finalized claims, as adjustments can happen at line, claim or provider level.

Accessing a Remittance Advice

Payment Cycle Dates

Changing RA Delivery Method

Although the information that the two formats provide is alike, the electronic format offers administrative efficiencies not available in a paper format. Submit a request, including your 7-digit Medicaid ID(s) to dhsenrollment@nd.gov to change your preference.

Reason/Remark Codes Used by ND Medicaid

Adjustment Group Codes
Claim Adjustment Reason Codes
Remittance Advice Remark Codes

General Remittance Advice Information

Claim Status Category Codes
Common Details for all RAs
Understanding In Process/Suspended Claims

Understanding Unique Remittance Advice by Claim Type

The materials below provide field level descriptions of a remittance advice, by claim type.

ASC CMS1500 Hospice Outpatient Crossover
Dental Inpatient Outpatient
Financial Lab / X-ray Pharmacy
Fiscal Pend Long Term Care Physician
HCBS / Developmental Disability Medical Supply Transportation
HIPP Claims Medicare Part A Travel and Lodging
Home Health Medicare Part B  

 

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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