2009 Medicaid Provider Updates
- An updated billing and coding guidelines regarding consultations is effective January 1, 2010.
- The General Information for Providers Manual was updated in December 2009. Chapters updated were Coordinated Services Program, Managed Care Program, and Surveillance Utilization Review and Third Party Liability.
- The Medicaid Basic Fee Schedule for July 1, 2008 has been updated.
- The Medicaid Base Fee Schedule for July 1, 2009 has been updated.
- Effective December 1, 2009 Nurse Practitioners can enroll as Primary Care Providers (PCPs). Please click to view the letter recently mailed.
- North Dakota Medicaid Policy and Procedure regarding reuse of durable medical equipment. (129 kb pdf)
- Provider Memo dated November 19, 2009 (37kb PDF) regarding ND Medicaid providers billing drugs in an outpatient setting. State Medicaid agencies are required to collet the National Drug Code (NDC) whenever drugs are billed.
- Guidance relating to provider billing for H1N1 that was recently posted at the Centers for Medicare and Medicaid Services (CMS) website. Go to H1N1 Fact Sheet for Medicaid/CHIP Provider Billing.
- 2010 ICD-9-CM Updates
- North Dakota Medicaid follows industry standards and will begin to use the 2010 ICD-9-CM codes as of October 1, 2009. A complete listing of the new, deleted and revised codes can be viewed on the CMS website at: http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp#TopOfPage -- changes include 311 new diagnosis codes, 45 revised diagnosis codes, 23 invalid diagnosis codes, 15 new surgical procedure codes, and 16 revised procedure codes. Provider should use the 2010 ICD-9-CM Official Guidelines for Coding and Reporting as a supplemtn to accompany and complement the office conventions and instructions provided within the ICD-9-CM itself.
- H1N1 Immunization Administration
- The H1N1 Vaccine will be available exclusively through the ND Department of Health. You must follow the ND Department of Health's criteria guidelines when determining which patients may receive the H1N1 vaccine. Go to http://www.ndflu.com/Vaccine/VaddineInformation.aspx
- North Dakota Medicdaid will allow/reimburse the immunization administration for vaccines /toxoids (90465-90474) at our current allowed amount when appropriately billed with the H1N1 vaccine. As with other vaccines/toxoids, you may submit a claim to ND Medicaid with the H1N1 vaccine code (90663-SL) and the appropriate immunization administration code (90465-90474). Please click H1N1 for details on coding/billing.
- See Medicare guidelines for appropriate billing when Medicare is the primary payer.
- H1N1 Providers for recipients receiving services through the Primary Care Case Management Program (PCCMP)
- To the extent that symptoms of suspected or confirmed 2009 H1N1 influenza are sufficiently severe that a prudent layperson might reasonably expect that the absence of immediate treatment could result in imminent harm to health, the PCCM program may not impose prior authorization or referral requirements prior to the assessment, diagnosis and treatment of Medicaid recipiens presenting with such symptions. In cases in which the prudent layperson test is not met, Medicaid recipients with flu-like symptoms may seek these services from their primary care provider (PCP) of obtain any necessary referrals from their PCP. (Centers of Medicare and Medicaid 9-24-2009).
- Should a Medicaid beneficiary seek care for severe symptoms related to suspected or confirmed 2009 H1N1 influenza, pass the prudent lay person test, and is unable to obtain a referral from the designated PCP, and the claim is submitted and denied; Submit a provider adjustment form and attach related documentation/medical notes to the adjustment for review.
- Synagis (palivizumab) - 90378 (respiratory syncytial virus immune globulin (RSV-IgIM), for instramuscular use, 50 mg, each)
- ND Medicaid Pharmacy Manual has been updated.
- ND Medicaid Managed Care program web site has been updated.
- Revised Synagis (Palivizumab) guidline has been posted
- New Provider Newsletter Issue 65-July 2009 has been mailed to provider billing addresses and is available on our website.
- North Dakota Medicaid no longer denies institutional claims at the claims level for NDC reasons. This is for institutional claims only. Edits now apply at the detail line level. Providers may re-submit claims that previously denied with the M19, as timely-filing limits allow.
- ND Medicaid ASC Group Rates (11.6 kb pdf)
- DME Task Form Questions and Responses for June 2009 have been posted to the DME web page.
- ND Medicaid BASIC Fee Schedule as of 7-1-2009 (1.5 MB pdf)
- ND Medicaid Dental CHILD Fee Schedule as of 7-1-2009 (51kb pdf)
- ND Medicaid Dental ADULT Fee Schedule as of 71-1-2009 (39kb pdf)
- ND DME Fee Schedules
- ND Medicaid Professional Component Fee Schedule as of 7-1-2009 (224kb pdf)
- ND Medicaid Technical Component Fee Schedule as of 71-2009 (113kb pdf)
- Added and Deleted codes to the DME Purchase and Rental fee schedules effective 2-27-09
- Swing Bed Rates for 2009
- Updated CPT guideline for Routine Foot Care has been posted to the CPT Coding Guidelines web page.
- Updated ND Medicaid Basic Fee Schedule has been posted to the Fee Schedules web page.
- Updated CPT guideline for Synagis (Palivizumab) has been posted to the CPT Coding Guidelines web page.
- Web links have been updated in the Dental Manual for Providers.