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North Dakota Medicaid

Provider Application Information and Forms

All providers are required to apply for enrollment electronically on the ND Health Enterprise MMIS portal. Exceptions are HCBS/QSP and NEMT providers.

The information below is for electronically submitted North Dakota Medicaid applications using ND Health Enterprise MMIS Web Portal. A printable PDF version is linked below for reference/distribution.

Providers:

ND Health Enterprise MMIS offers providers a user-friendly self-service web portal that has new features and benefits. 

  • Use the MMIS web portal now to enroll electronically. This is required for all new and existing providers with the exception of Individual Qualified Service Providers (QSPs) and Developmental Disability Providers.
  • Use the MMIS web portal to directly enter claims, upload batch transactions, and get real-time access to member eligibility, claims status, remittance advice, payment status and claims history.

Need help?

ALL DOCUMENTATION SUBMITTED MUST INCLUDE THE APPLICATION TRACKING NUMBER (ATN) FROM THE ONLINE ENROLLMENT APPLICATION.

Medicaid Providers

Primary Care Providers (PCP)

Options for Submitting Provider Enrollment Documentation

  • Electronically through a secure link - For those providers that wish to send the required documentation via email, you must request access to a secure link by sending an email to dhsenrollment@nd.gov. An email will be sent back to you with a link to a secure site to send your documents to the enrollment application.
  • Fax - Providers may fax the required documentation to (701) 328-1544.
  • Standard mail address - Medicaid Provider Enrollment, ND Dept of Human Services, 600 E Boulevard Ave Dept 325, Bismarck ND 58505-0250

Manual (paper) Provider Enrollment Information


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