The State of North Dakota Department of Human Services (DHS) is implementing a certifiable Medicaid Management Information System (MMIS), a Pharmacy Point-of-Sale (POS) system, and a Data Warehouse (DSS/DW)/ Decision Support System, which will replace the current Legacy system that supports Medicaid Claims.
The new MMIS will offer providers a user friendly self-service web portal that has many new features and benefits. This MMIS web portal will allow providers to directly enter claims or upload batch transactions and will also offer real time access to member eligibility, claims status, Remittance Advice, payment status and claims history.
The North Dakota MMIS web portal will be implemented in two phases:
- Phase One: Provider Enrollment
- Phase Two: Claims Payment
Phase one, which is limited to enrolling current and new providers in the new MMIS, is scheduled to go live in April 2013 and be completed within 5 months. All providers and trading partners must re-enroll into the new MMIS. Enrollment is required to continue participation in the ND Medicaid program and to capture detailed, up-to-date information as the Department transitions to the new MMIS. During phase one, there will be no change in how providers currently submit Medicaid Claims, this will specifically allow each provider enough time to enroll into the new MMIS.
As part of Phase two, MMIS will allow claims to be submitted electronically, directly through the web portal or using batch (X12) transactions. The Department encourages providers to utilize the web portal which will provide timely submission and inquiry on claims status.
The MMIS Web Portal will support the following claims:
- Institutional - UB04
- Professional - CMS 1500
- Dental - 2006 American Dental Association
- Home and Community Based Services (HCBS) and Developmentally Disabled (DD)
- Travel and Lodging
Providers who submit electronically via the web portal or on paper UB04, CMS 1500 or Dental claim forms will be required to have a NPI and taxonomy code. Providers who do not have an NPI are encouraged to obtain an NPI prior to the new MMIS implementation.Providers using the HCBS/DD and the Travel and Lodging forms are excluded from the National Provider Identifier (NPI) requirement as they do not bill using the UB04, CMS 1500 or Dental forms.
Letter from Medicaid Director
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