General Medicaid Provider Enrollment Information

 

PROVIDER ENROLLMENT INFORMATION:

• In-State and Border UB-92 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-92 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 health service to a North Dakota Medicaid Eligible Recipient at a site located in a state other than North Dakota.

  All out-of-state services require prior authorization (except in the local trade area within 50 miles of the North Dakota border or 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 General Provider Enrollment Application

Pharmacy Provider Enrollment Application

Basic Care Provider Enrollment Application

Transportation, Meals, & Lodging Provider Enrollment Application

 

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