General Medicaid Provider Enrollment Information
PROVIDER ENROLLMENT INFORMATION:
- In-State and Border UB-04 or CMS/HCFA 1500 Billing For Services
- Any billable service by a licensed individual requires a separate enrollment from that of the facility enrolled. This includes hospital ER Physician fees and those practicing as a sole-proprietor, LLC, Partners, etc.
- Providers within the 50-mile radius of the ND border
- Physicians billing Independently
- Physicians affiliated with the enrolled border facility
All NEW CMS/HCFA 1500 facilities billing for services must include a list of their medical professional personnel and their Medicaid numbers to link to the billing facility if already enrolled. If medical professional personnel are not enrolled this requires a separate enrollment application.
- Out-of-State UB-04 or CMS/HCFA 1500 Billing for Services
- ND Medicaid enrolls the facility as a group and requires the attending medical professional personnel(s) license
- ND Medicaid does not separately enroll out-of-state physicians practicing at a facility
- ND Medicaid enrolls Physicians billing Independently
"Out-of-State Provider" means a provider who provides a service to a North Dakota Medicaid Eligible Recipient at a site located within a state other than North Dakota, 51 or more miles from the border.
All out-of-state services require prior authorization, unelss the services provided in response to an emergency service.
An out-of-state provider may apply for retroactive enrollment as a provider effective on the date of service to a North Dakota Medicaid Eligible Recipient. However, North Dakota Medicaid has a one-year timely filing limit. This means you have one year from the date of service to become an enrolled provider and bill for your services.
- Dental Providers
- Any licensed and practicing dentist must be enrolled with North Dakota Medicaid to see Medicaid recipients
- Services billable by a licensed individual would require a separate enrollment from that of the facility enrolled. This includes those practicing as a sole-proprietor, LLC, Partners, etc.
- Separate application(s) are required for billing dental services versus medical services.
Medicaid Provider Enrollment Application Forms
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