nd.gov - The Official Portal for North Dakota State Government
North Dakota: Legendary. Follow the trail of legends
NDDHS logo MMIS logo
 arrowDHS Home arrowContact DHS arrowSkip Navigation
Search:

Providers

The ND MMIS Web Portal is an electronic health care administration system that gives patients, doctors, pharmacists and other users easy, secure and efficient access to health care information.

How is North Dakota MMIS Web Portal accessed?

The general public will be able to access the web portal and view general information about North Dakota's Medical Assistance and other related programs. It is only through entry of a User ID and Password that an individual or a provider is granted access to secured areas within the North Dakota MMIS Web Portal.


Billing changes

New Forms

  • New billing forms for non-emergency transportation and meal/lodging providers will be available.
  • Home and Community Based Services (HCBS) and Developmental Disability (DD) providers will be using a new form to submit claims.
  • The web portal will allow for submission of the new claim forms electronically. Providers are encouraged to use the web portal to submit their claims.

New Remittance Advice (RA)

  • Providers will have an option to receive electronic (835) or paper Remittance Advice (RA).
  • Providers will have the ability to indicate how they want their paper RA sorted. The options include client name, date of service, patient account number, etc. and also if they want to see suspended claims on their RA.
  • Summary pages will indicate financial transaction and grand totals of paid, voided or denied claims. A "year to date" summary will also be included with each RA containing the total number of paid, denied, and in process claims.
  • Payment information made by other insurance will be provided.
  • Providers may see up to five Adjustment Reason codes and ten Remark codes with descriptions of both on the RA.

Claims

  • Claims functions can be accessed online through the web portal.
  • Providers can enter claims online with real time adjudication. Providers will immediately know the status of the claim including co-payments, recipient liability, and the to-be-paid amount. Payment will follow the Department's check-write schedule and will coincide with the RA.
  • Adjustment reason and remark codes can be viewed after submission.
  • If you cannot complete the claim because you are waiting for information from within your organization, the provider will have the ability to save your web entered claim for up to 30 days. This will allow you to make changes to your claim before submitting for processing.
  • Check the status of your claim, whether it is submitted via the web portal, EDI or paper. This includes status of paid, denied and pending claims.
  • View or print a RA.
  • Inquire and print an IRS 1099.
  • Submit EDI transactions through the web portal. Providers, who want to submit electronic claims, will be required to test the transmission with the Department.
  • If a provider uses a trading partner, the trading partner will be required to test with the Department.
  • Upload and retrieve EDI files through an online mailbox.
  • Adjustments in the new system will be referred to as replacements or voids.
  • Providers can easily submit replacements/voids online using the original claim form. If paper replacements/voids are submitted, the claim form that was used to submit your original claim must be used.
  • The provider will not be allowed to replace/void a claim in a suspended status.
  • The Department will discontinue ALL proprietary billing software. This includes the web file transfer for claims.  Providers will use the Web Portal for claims entry and submission.
  • Providers are required to use the original claim forms for paper claims submission. This allows the claim to process through the Optical Character Recognition Scanner (OCR) system.
  • The Department will only support the latest 2006 American Dental Association version paper claim form. All other dental forms will not be processed and will be returned. We encourage the use of the online web portal for claims submission.

Verify Member Eligibility

Providers can check member eligibility via the MMIS web portal or by accessing the Automated Voice Response System (AVRS) which will replace the current Verify system. The information available to Providers will be as follows:

  • Member information
  • Claim Status
  • Claim Payment
  • Service Authorization

Service Authorizations

  • Submit an authorization online.
  • Inquire and edit your service authorization.
  • Check the status of your service authorization, whether it is submitted via electronically or paper. This includes status of approved, denied or pending authorizations.
  • Option to change or save a service authorization before final submission on the web portal for 30 days while waiting for information from within your organization.

Pharmacy Providers

Changes will be minimal for pharmacy providers

  • The location of the NDC drug lookup and pharmacy claim entry web pages will change but the functionality will remain.
  • Enhanced editing with fewer service authorizations.
  • Submit medical claims online (e.g. Medicare crossovers).

Managed Care

Primary Care Case Management (PCCM)

  • Inquire on a member's Primary Care Physician (PCP).
  • The web portal will allow the entry and inquiry of referrals for the PCCM program.
  • Submit a referral online through the web portal. All referrals entered online will eliminate the need to submit a paper claim and attach a referral.

Coordinated Service Program (CSP)

  • The web portal will allow the entry of referrals for the CSP program.
  • Providers will have the ability to inquire on a member's CSP providers.

Automated Voice Response System (AVRS)

  • The AVR system will be replacing the current Verify system
  • Providers will be allowed to access the AVR system for information on members which includes:
  • Member Information
  • Claim Status
  • Claim Payment
  • Service Authorization

 

Return to the top of the page Top of page   Go back to the previous page Back to previous page

 Get Adobe Acrobat Reader Tested for W3C WAI AA Accessibility Tested for W3C Well-Formed XHTML Code Tested for W3C Well Formed Cascading Style Sheet Code