2006 Medicaid Provider Updates
Posted 12-22-2006
- HCPCS have been changed/added to the DME Purchase and Rental Fee Schedules. Click on Changes Made to view and/or print the list of changes/additions only.
Click Purchase Fee Schedule or Rental Fee Schedule to view and/or print the complete list(s)
Posted 12-14-2006
- A new list of the Pharmacy Provider ID Numbers has been generated as of December 1, 2006. Please click the link to view.
Posted 12-01-2006
- The 2006 ND DRG Relative Weights has been posted. It is available in Excel and PDF file formats.
- The Nursing Facility MEDICAID PAYMENT ALERT form has been revised. Please click to print the latest version of this form.
- The Dental Manual was missing the fee information for code D2953. The manual has been updated and reposted to this web site.
Posted 10-30-2006
- Updates have been made to the provider Dental Manual and the provider Optometric Manual
- Dental Manual was revised on October 23, 2006
- Optometric Manual was revised on October 23, 2006
- There was an error was found to the date of the Technical Component Fee Schedule file that was posted to the web.
- The date has been fixed, and the revised fee schedule has been posted to the Fee Schedule web page.
Posted 9-22-2006
- Durable Medical Equipment (DME) Updates
- An updated DME Purchase Fee Scheduled is available as of 8-31-06.
- A new forms link was added to the DME Forms web page. This link is for SFN785 - Hospital Beds.
- The DME Manual was updated on 8-31-06 adding links to the state's e-forms web site for SFN 785. These Certificate of Medical Necessity forms are located in the manual on pages 17 & 18.
- The minutes from the DME meeting on 9-6-06 have been posted to the web, including an update that occurred on 9-15-06 relating to the 9-6-06 meeting.
- An updated DME Purchase Fee Scheduled is available as of 8-31-06.
- Updated to Medicaid Coding Guidelines
- An update has been added to the Medicaid Coding Guidelines for Gardasil-HPV vaccine, effective 9-26-06.
- An update has been added to the Medicaid Coding Guidelines for Gardasil-HPV vaccine, effective 9-26-06.
Posted 8-28-2006
- New Provider Bulletin
- Issue 59 - August 2006 Provider Bulletin is going out this week. Look for it in your mailboxes. You can also access the downloadable version by clicking the link provided.
- The DME Certificate of Medical Necessity forms have been posted to the DME forms web page. Click the link provided to access these fillable forms online.
- General Information for Provider Manual has two new chapters. They are Indian Health Services (IHS) and North Dakota Health Tracks Early Periodic Screening, Diagnosis and Treatment (EPSDT).
- Issue 59 - August 2006 Provider Bulletin is going out this week. Look for it in your mailboxes. You can also access the downloadable version by clicking the link provided.
Posted 8-24-2006
- Providers that had claims incorrectly denied with a "62"
- Providers that had claims incorrectly denied with a '62' (Payment denied/reduced for absence of, or exceeded, pre-certification/authorization) on the 08/15/06 Remittance Advice will see Department created adjustments in the next few weeks. The claims will be identifiable through the Internal Control Number on the Remittance Advice. An example ICN for an adjustment is 100xxxx714xxx. The internal adjustments will have 716 in the eighth position of the ICN, for example 100xxxx716xxx.
Posted 8-18-2006
- New Durable Medical Equipment Fee Schedules effective July 1, 2006 have been posted to the web
- Go to the DME Provider web page to view and/or print the DME Purchase Fee Schedule, or the DME Rental Fee Schedule.
- The Durable Medical Equipment Provider Manual has been revised as of 8-15-06. Click the link to view and/or print.
Posted 8-11-2006
- Attention DME Audiology Providers -
Effective July 1, 2006 all repairs to hearing aids require prior authorization.
- Home Rehab Service - Intensive In-Home; Family Therapy Crosswalk Update
- Attention DME Providers that dispense incontinence garments or incontinence supplies (catheters) - it is vital that the quantity ordered by the physician is documented on the attached prescription. The July 2006 DME Provider Manual will assist providers as to what is required on a physician prescription. Prior Authorizations (PAs) will be returned if this information in not included with the request.
- A correction was made to the Nursing Facility Rate Manual regarding a error relating to Part D supplies. The corrected version has now been posted to our web site.
Posted 7-25-2006
- Medifax Eligibility Change [This same information is also available as a pdf file: Medifax Eligibility Change (14kb pdf)]
- Please NOTE: You will no longer be able to check Medicaid recipient
eligibility via Medifax or the HIPAA 270/271 transactions using a range of dates. North Dakota Medicaid will only
support recipient eligibility requests using a single date of service. Due to the eligibility process involved with
determining and authorizing Medicaid recipient eligibility on a month-by-month basis, at this time using a date range
span to check eligibility is not yielding consistently accurate results. We hope in the future to have this problem
resolved. Again, you WILL be able to continue using Medifax or the HIPAA 270/271 transactions to check Medicaid
recipient eligibility; however only for for a single date of service.
- Please NOTE: You will no longer be able to check Medicaid recipient
eligibility via Medifax or the HIPAA 270/271 transactions using a range of dates. North Dakota Medicaid will only
support recipient eligibility requests using a single date of service. Due to the eligibility process involved with
determining and authorizing Medicaid recipient eligibility on a month-by-month basis, at this time using a date range
span to check eligibility is not yielding consistently accurate results. We hope in the future to have this problem
resolved. Again, you WILL be able to continue using Medifax or the HIPAA 270/271 transactions to check Medicaid
recipient eligibility; however only for for a single date of service.
- Durable Medical Equipment (DME) Provider Manual has been updated
- The Durable Medical Equipment Manual (620kb pdf) has been updated effective 7-21-06.
Posted 7-20-2006
- New Fee Schedules effective July 1, 2006 have been posted to the web
- Go to the Provider Fee Schedules web page to view and/or print.
- Go to the Provider Fee Schedules web page to view and/or print.
- Durable Medical Equipment (DME) Task Force Meeting
The next Durable Medical Equipment Task Force meeting will be held September 6, 2006 from 1:30pm to 3:00pm. This meeting will be held at the North Dakota Department of Human Services in the Children & Family Services Conference Room D. See you all then!
Posted 7-12-2006
- Newly updated Durable Medical Equipment Manual (620kb
pdf)
The Durable Medical Equipment Manual (DME) and all of its contents/criteria ha been implemented with dates of service July 1, 2006. Please make this manual available to all support staff involved with ordering and billing DME.
- 2.65% Provider Increase Update - Effective July 1, 2006
In accordance with the legislative mandate to update provider rates with a 2.6% inflationary increase each biennium for providers of services under the various grant (assistance) programs, we have increased provider rates effective for 7-1-2006 dates of service and after. Codes which are priced using the Relative value Units (RVUs) methodology have had the conversion factor adjusted to $34.99. The previous conversion factor as of 01-01-2006 was $34.09. Codes which are priced off a fee schedule will be adjusted accordingly.
- Updated Nursing Facility Rate Manual (300kb pdf)
has been posted. Revisions are effective July 2006.
- New list of medications requiring prior authorization has been posted.
Go to Medications Requiring Prior Authorization web link to view the list as of May 2006. (16kb pdf)
Posted 6-13-2006
- Update to the Ambulatory Behavioral Health
Care for Children and Adolescents (194kb pdf) manual
Appendix C of this manual was updated to reflect the correct Chemical Dependency-Hospital Based information and level of care.
- Update to the Pharmacy Manual (315kb pdf)
The Long Term Care Credit information was updated to comply with federal regulations.
Posted 6-5-2006
- Durable Medical Equipment (DME) Providers
An updated Durable medical Equipment Manual is available in DRAFT format only. It has been posted to allow providers time to review and make note of any changes that they may need to make within their institution. DO NOT make copies of this manual, as the content may change before implementation. Medical Services Division will notify providers via the website Update for Providers as to the final version and effective date. This will be dependent upon the impact study that is currently taking place. DME Manual-DRAFT June 2006 (362kb pdf)
Posted 6-1-2006
- National Provider Identifier (NPI) -- FYI TO ALL PROVIDERS
EVERY provider completing electronic transactions MUST use only the NPI (National Provider Identifier) in standard transactions by May 23, 2007. Providers need to prepare themselves, and their staff, for the upcoming NPI compliance date. Careful preparation for, and use of, the NPI will help minimize Prior Authorization Requests (PAR) for DME providers and/or claim errors and delays in payment. ND Medicaid will alert providers when they can start using their NPI. Please watch our website or your remittance advice for this notification. As of May 23, 2007 only the NPI will be accepted, except for those small health plans that are exempt until May 23, 2008. Those providers that are exempt can submit a PAR and/or claim with just the UPIN number up until that time. If the NPI is not present on the PAR, the PAR will be returned to the provider for complete information. ND Medicaid will be updating the current Prior Authorization Request form (SFN 1115) to accommodate the NPI. When completed, the form will be made available on the provider website.
- New Quantity Limits (57kb pdf) on medications is
available. Please click on the link to review.
- Crosswalk Codes - Speech
Therapy - Swallowing Dysfunction 92526 (63kb pdf) - Swallowing Dysfunction 92526 - new coding information
has been posted. Please click on the link to review.
- A new chapter has been added to the General Information For Providers Manual (1Mb pdf). The chapter on Coordinated Services Program (CSP) is new information.
Posted 5-17-06
- Provider Enrollment is now available at our web site. Please click the link to find information, instructions to become a provider, and forms.
Posted 05-05-06
- Notice to DME Providers (28kb pdf) - Update to Provider Bulletin (Issue 58, April 2006)
Posted 04-28-06
- National Provider Identifier Information (44kb pdf)
Posted 04-27-06
- Provider Bulletin (624kb pdf) - Issue 58, April 2006
- Printing Error Correction - On the last page of the bulletin, it has been noted that a
printing error occurred. "ATTENTION PROVIDER/DME SUPPLIER" should read:
- Prior Approval for service(s) by the North Dakota Department of Human Services does not guarantee eligibility nor
ensure payment for the services(s). Eligibility is established by the appropriate county social service office on a
monthly basis, and payment is contingent upon the eligibility of an individual at the time the services approved are
rendered. Eligibility for dates of service may be verified by calling 1-800-428-4140 or 701-328-2891. All providers are
responsible for submitting prior authorizations and claims with the appropriate CPT/HCPC codes. Non-covered codes will
be reviewed on an ongoing basis and may be paid if added to the fee schedule or allowed as an exception. Please do not
resubmit another request if the original was sent in the past three weeks. North Dakota Medicaid will not fax or resend
approval notices. It is the provider’s responsibility to work with their organization to secure the originally
sent authorization or approval The website for guidelines, provider bulletins, manuals and fee schedule is located at http://www.nd.gov/dhs/services/medicalserv/medicaid/ Any applicable third parties
must be billed prior to billing Medicaid and all third party requirements must be followed. The recipient may be
responsible for any recipient liability before payment is made by the Department.
- Prior Approval for service(s) by the North Dakota Department of Human Services does not guarantee eligibility nor
ensure payment for the services(s). Eligibility is established by the appropriate county social service office on a
monthly basis, and payment is contingent upon the eligibility of an individual at the time the services approved are
rendered. Eligibility for dates of service may be verified by calling 1-800-428-4140 or 701-328-2891. All providers are
responsible for submitting prior authorizations and claims with the appropriate CPT/HCPC codes. Non-covered codes will
be reviewed on an ongoing basis and may be paid if added to the fee schedule or allowed as an exception. Please do not
resubmit another request if the original was sent in the past three weeks. North Dakota Medicaid will not fax or resend
approval notices. It is the provider’s responsibility to work with their organization to secure the originally
sent authorization or approval The website for guidelines, provider bulletins, manuals and fee schedule is located at http://www.nd.gov/dhs/services/medicalserv/medicaid/ Any applicable third parties
must be billed prior to billing Medicaid and all third party requirements must be followed. The recipient may be
responsible for any recipient liability before payment is made by the Department.
- DME Excerpts (32kb pdf) from April 2006 Provider Bulletin - Important information for DME & Pharmacy DME suppliers, please read!
- Update to the General Information for Providers Manual (1.14Mb pdf) - three chapters have been added: Physical Therapy, Occupational Therapy, and Speech-Language Pathology.
Posted 04-03-2006
- Billing Notice
- Self-administered drugs in any outpatient observation setting will be DENIED AS NON-COVERED. Please bill the patient or drug insurance regarding Medicare Part D.
Posted 03-22-2006
- Updated Swing Bed Rates (12kb pdf)
- Payment Error Rate Measurement (PERM) program (24kb
pdf)
- Updated the Medicaid Income Levels which become effective 4-1-2006
Posted 03-03-2006
- New form added to online forms page SFN332 - Nursing Facility Satisfaction Survey Grant Application (32kb pdf)
Posted 02-08-2006
- Three new chapters added to the General Information for Providers Manual (1.41Mb pdf) (Lab, Radiological, and Diagnostic Services, Medicare Coverage, Third-Party Liability)
Posted 02-03-2006
- Risperdal Consta (risperidone, LA) (19kb pdf)
- Synagis (Palivizumab) (20kb pdf)
Posted 01-10-2006
- Psychiatric Billing & Code Changes 2006 (66 kb
pdf)
- LICSW-LCSW Allowed Services - CPT Code(s) (updated 12-20-05) (24 kb pdf)
Posted 01-01-2006
- RVU and Laboratory Fee Schedule Update (35 kb PDF)
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