Medicaid Provider Enrollment

 

TO BE ELIGIBLE FOR ENROLLMENT, A PROVIDER MUST:

• PROVIDE SERVICES TO AT LEAST ONE NORTH DAKOTA MEDICAID ELIGIBLE RECIPIENT.
  
• MEET THE CONDITIONS REGULATING THE SPECIFIC TYPE OF PROVIDER, PROGRAM, AND/OR SERVICE. (Information available in the General Information for Providers Manual)
  
• HOLD A CURRENT LICENSE, CERTIFICATION, ACCREDITATION OR REGISTRATION ACCORDING TO NORTH DAKOTA STATE LAWS AND REGULATIONS.

All completed applications should be mailed to:

ND Dept of Human Services
Medicaid Provider Enrollment
600 E Boulevard Ave Dept 325
Bismarck ND 58505-0250

 

If you have any questions on enrollment call:

ND Medicaid Provider Enrollment
1-800-755-2604 or 701-328-4033
Monday through Friday
8:00 a.m. to 4:30 p.m. (CST)

General Medicaid Provider Application

Medicaid Provider Enrollment Applications

 

 

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