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2006 Medicaid Provider Updates

Posted 12-22-2006

Posted 12-14-2006

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
  • 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.
  • Updated to Medicaid Coding Guidelines
    • 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).

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.


Posted 8-11-2006

  • Attention DME Audiology Providers - Effective July 1, 2006 all repairs to hearing aids require prior authorization.
  • 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.

  • Durable Medical Equipment (DME) Provider Manual has been updated

Posted 7-20-2006

  • New Fee Schedules effective July 1, 2006 have been posted to the web
  • 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

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.

  • 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

Posted 04-28-06

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.

  • 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

Posted 03-03-2006

Posted 02-08-2006

Posted 02-03-2006

Posted 01-10-2006

Posted 01-01-2006


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