2010 Medicaid Provider Updates
- New Durable Medical Equipment Fee Schedules effective July 1, 2010 have been posted to the Web. These documents may be veiwed and printed on the Provider DME page.
- Ambulatory Behavioral Health Care Rates effective July 1, 2010 were added to the Provider Fee Schedules page.
- The Non-Emergency Transportation Billing Codes document has been updated on the Provider Billing page with the current rates effective July 1, 2010.
- There were multiple updates on the Medicaid Provider Manuals page. The General Information for Providers manual was updated this month regarding Health Tracks EPSDT. Under the Nursing Facilitiy Providers heading, the Nursing Facility Rate Manual was updated, as well as an addition of the North Dakota Nursing Facility Payment System (DN 141) booklet that was not previously available on the Web.
- Copayment Information Update
- Please note that due to recent Federal changes from the amneded section 5006(a) of the American Recovery and Reinvestment Act of 2009 (the Recovery Act), effective July 1, 2010, Medicaid copyament changes include the elimination of copayments for Medicaid clients receiving services through the medicaid Women's Way and Medicaid Hospice programs. This copayment elimination affects any type of medical services received, including physician visits, prescription, etc.
It should be noted that all the copyaments changes above do not pertain to recipient liability. Also, these changes do not bypass the Primary Care Provider program (PCP) or the Coordinated Services Program (CSP) rules.
- A Letter to Providers was sent out dated September 28, 2010 regarding Section 6507 of the Patient Protection and Affordable Care Act (ACA) of 2009 requiring incorporation of methodologies from the National Correct Coding Initiative. Additional information can be accessed at http://www.cms.gov/MedicaidNCCICoding.
- A new form is now required with Provider Enrollment. The Ownership/Controlling Interest and Conviction Information (SFN 1168) form must be included in all enrollment packets. Also, ND Medicaid is now only accepting Medicaid Program Provider Agreement (SFN 615) forms that have a revision date of the year 2010. Any SFN 615 received that is an older version of this form will not be processed. The current versions of these forms are also located within the Provider Enrollment Web pages.
- DME Task Force Questions and Responses from the September meeting were posted onto the Durable Medical Equipment Provider - Meetings page.
- Two new Medical Policies have been posted regarding Hysteroscopic Tubal Occlusion (Essure® Sterilization) and Positron Emission Tomography (PET) Scans Coverage. A new Web page designated for Medicaid Medical Policy was created where these two policies were also placed. Additionally, this page can be accessed in the future through the main Medicaid Provider Information page.
- A new page was added to the Medicaid Web site regarding the Provider Incentive Payment Program for Electronic Health Records (EHR). It can be accessed through the main Medicaid Provider Information Web page, or using the URL http://www.nd.gov/dhs/services/medicalserv/medicaid/provider-ehr.html.
- A handbook with Instructions for Completing Lodging and Meals Claims has been posted on the Billing Manuals page.
- The March 2010 Medicaid Provider Bulletin is now available.
- The Provider Fee Schedules page has been updated with the most current figures effective July 1, 2010.
- Beginning September 2, 2010, there will be a change of procedure in acquiring payment for Out-of-State providers rendering services within North Dakota. More information is available in this Letter to Providers. (PDF 52 kb)
- The General Information for Providers Manual has been updated on the Provider Manuals page. Women's Way Program verbiage and information regarding the ages served were updated. (PDF 2.17 MB)
- Fee Schedule Update - Effective 07/01/2010
- In accordance with the legislative mandate to update the provider rates with a 6.0% inflationary increase the second year of the 09-11 biennium, we have increased provider rates effective for 7/1/2010 dates of service and after. Codes which are priced off a fee schedule will be adjusted with the 6% 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 2010 RVUs for dates of service on or after July 1, 2010. Based on previous calendar 12 month's claims volume, the new relative value unit adjustments, along with the 6.0% inflationary increase, result in the conversion factor being adjusted to $53.35. The previous conversation factor was $53.31. Based on the changes to the relative value units, some fees will increase while others may stay the same or decrease.
- An updated List of Licensed Assisted Living Facilities has been posted. It also viewable on the Assisted Living Web page.
- The Fee Schedule for Non-Emergency Transportation Providers has been updated effective July 1, 2010. Specific fee schedules can be viewed on the Medicaid Provider Information - Fee Schedules Web page.
- There is new information regarding reimbursement for a Phototherapy Light or Blanket (E0202) effective July 1, 2010.
- The General Information for Providers Manual has been updated. The Copayment Table (pp. 48-49) has been changed. (PDF 2.17 MB)
- The Ambulatory Surgical Center Payment Groups, Rates and Codes effective July 1, 2010 are available. (PDF 427 kb)
- The Electronic Funds Transfer form has been updated. It can be found on our Electronic Data Interchange (EDI) page.
- Provider Report Documents have been updated on the following pages: Basic Care, Residential Child Care Facilities, Psychiatric Residential Treatment Facilities, and Nursing Facilities.
- MIC Article
- North Dakota Medicaid Provider Memo regarding Contract Health referrals and copays (dated 6/1/2010) (PDF 124 kb)
- The Dental Provider Manual has been updated throughout the entire manual. Multiple changes have been made. (PDF 1.37 MB)
- North Dakota Medicaid Provider Memo regarding Copayment Amounts charged for Non-Emergency Services furnished in a Hospital Emergency Room. (dated 5-20-2010) (PDF 47 kb)
- A new Medicaid Payment Alert form is available for use by the nursing facilities.
- The Pharmacy Manual has been updated.
- The Swing Bed Rate effective April 1, 2010 is available.
- Updates were made to page 22 of the Durable Medical Equipment Provider Manual; in addition, links were updates throughout the manual.
- Medicaid Coding Guideline update for Chiropractor Codes
- The Medicaid Basic Fee Schedule for effective dates 7-1-2009 and later was updated in March 2010.
- PET Scan coding guideline has been added to the Coding Guidelines web page.
- The General Information for Providers manual has been updated with changes to the Managed Care chapters.
- New Durable Medical Equipment (DME) Fee Schedules effective July 1, 2009 have been posted. A new Added and Deleted Codes list has also been posted on this web page.
- The Managed Care State Plan has been amended. Please click the link to view the updated Managed Care State Plan.
- A revised Gardasil HVP vaccine coding guideline is effective December 31, 2009.
- The December 2009 Provider Bulletin is now available.