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2008 Medicaid Provider Updates

Posted 12-01-2008

Posted 10-22-2008

Posted 9-22-2008

Posted 9-08-2008

  • The VERIFY System should now be up and running. ND Medicaid has previously been experiencing problems with the automate eligibility system. As of Friday, September 5th, everything should be working.
  • New Durable Medical Equipment Fee Schedules effective July 1, 2008 have been posted to the web. Go to ND Medicaid DME Purchase Fee Schedule as of 7-1-2008 or ND Medicaid DME Rental Fee Schedule as of 7-1-2008.
  • The General Information for Providers Manual has been updated effective August 2008. The following chapters have been revised:
    • Coordinated Services Program
    • Home Health Private Duty Nursing
    • Managed Care
    • Medicaid Eligibility of Recipient
    • Medicare Coverage, Rural Health Clinics and Federally Qualified Health Centers
    • Surveillance Utilization Review
    • Third-Party Liability

Posted 07-31-2008

Posted 07-11-2008

  • Fee Schedule Update - Effective 7-01-2008
    • In accordance with the legislative mandate to update provider rates with a 5.0% inflationary increase the second year of the 2007-2009 biennium, we have increased provider rates effective for 7-01-2008 dates of service and after. Codes which are priced off a fee schedule will be adjusted with the 5% inflationary increase accordingly.

      Codes which are priced using the Relative Value unit (RVU) methodology have had the conversion factor adjusted. The adjustment in the conversion factor takes into account the implementation of the 2008 RVUs for dates of service on or after July 1, 2008. Based on previous 12 month's claims volume, the new relative value unit adjustments, along with the 5.0% inflationary increase, result in the conversion factor being adjusted to $39.13. The previous conversion factor was $36.68. Based on the changes to the relative value units, some fees will increase while others may stay the same or decrease.

      Please remember that providers participating in the North dakota Medicaid (NDMA) program are required to bill their usual and customary charge for each service provided. "Usual and customary charge" refers to the amount the provider charges the general public in the majority of cases for a specific item or service. Providers should not base their billed amount off the North Dakota Medicaid fee schedule.

      The updated fee schedules will be published as soon as possible.

Posted 06-16-2008

  • Some providers may be experiencing difficulty obtaining information regarding the Primary Care Physician program and the Coordinated Services (Lock-In) program through the Verify and Medi-Fax Lines. If you are unable to obtain information through these methods and required this information, please contact your local county social services office or the ND Medicaid Provider Relations at 701-328-4030 or 701-328-4043.

Posted 05-29-2008

  • The Deficit Reduction Act of 2005 (DRA) included a requirement for state Medicaid agencies to collect NDC's whenever drugs are billed in an outpatient setting. To comply with this Federal Regulation, ND Medicaid will use the following billing guidelines to ensure the system captures the NDC for drugs.
    1. If an electronic claim denies a drug for a description (16/N29) of the drug the provider is required to resubmit the claim electronically with the description of the drug narrative.
    2. If an electronic claim denies a drug for documentation (16/N29) the provider is required to submit an adjustment with the notes attached.
    3. If the NDC is invalid on an electronic claim it will deny with an M119 (invalid NDC).
    4. A paper claim with drugs submitted will be denied with an M117 (required to bill electronically).
    5. Currently the information above affects only drugs billed on a CMS 1500 (837P or paper) claim for for Physician services. Outpatient Hospital services (billed on a UB04) are exempt from the requirments until July 1, 2008.
    • REMINDER -- None of the information above applies to Inpatitent Hospital or Family Planning providers as they are exempt from the NDC requirment of billing drugs.
  • EFFECTIVE JULY 1, 2008 - ND Medicaid is requiring all adjustments be submitted on the current version (rev. 08-2002) of the adjustment form. This form can be found at the following link: http://www.nd.gov/dhs/services/medicalserv/medicaid/online-forms.html
    • Once at the web page, click on the Provider Request For An Adjustment (SFN 639). Adjustments not submitted on the current version of the form will not be processed and will be returned to the provider. This does not apply to entities that submit Pharmacy adjustments.
  • The Durable Medical Equipment (DME) Task Force questions and responses from the April 11, 2008 meeting have been posted to the DME web site. Please click the link above to review.

Posted 05-06-2008

Posted 04-28-2008

Posted 04-23-2008

Posted 03-28-2008


Posted 01-15-2008


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