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ND Medicaid Provider Updates

Posted 6-19-2018

Attention Pharmacy Providers: The ND Medicaid Medication Therapy Management (MTM) Manual has been updated and is available for review.

Posted 6-1-2018

Attention all Medicaid Providers: Effective for dates of service on and after July 1, 2018, ND Medicaid will be implementing medical necessity editing utilizing Local Coverage Determination (LCD) L36094 – Flow Cytometry as well as Local Coverage Article A54668 – Positron Emission Tomography Scan.

Posted 5-30-2018

Attention all DME Providers: The DME Purchase fee schedule is posted with rates set for E2378 and E2515. Effective date for E2512 is 7-1-2016 and E2378 is 1-1-2018

Posted 5-24-2018

ND Medicaid has increased the psych testing limits to 10 hours per calendar year effective April 1, 2018.

Service authorization is required after the 10 hours per year limit has been met or exceeded. This applies to CPT codes 96101-96125.

Posted 5-24-2018

Attention all Medicaid Providers: The ND Medicaid Coverage Guideline for Telemedicine has been updated effective for dates of service on or after June 1, 2018.

Posted 5-22-2018

Attention all Durable Medical Equipment (DME) Hearing Aid Providers: Guidance on the Service Authorization (SA) submittal process and the Hearing Aid policy is now available online.

Posted 5-2-2018

ND Medicaid has updated the SFN 511 Form – Medical Procedure/Device Service Authorization Request and added a new form specific to Genetic Testing Service Authorization Request – SFN 527. The compliance date for use of these forms is June 1, 2018.

Posted 4-26-2018

Attention Dental Providers: The ND Medicaid Dental Manual has been updated and is available for review.

Posted 4-25-2018

Attention Dental Providers: Effective 5-1-18, new dental policies are available for review for Silver Diamine Fluoride and Documentation Requirements for Periodontal Services.

Posted 4-4-2018

Local Coverage Determination (LCD) Activation - Effective for dates of service on and after May 1, 2018, ND Medicaid will implement medical necessity editing for Intravenous Immune Globulin (IVIg) utilizing the criteria published by Noridian in LCD L34074 – Immune Globulin Intravenous (IVIg) for both professional and outpatient institutional claims. View complete LCD.

Posted 3-21-2018

Attention all Medical Providers: The Medicaid Provider Bulletin has been posted and is available for review.

Posted 3-16-2018

Attention all Medical Providers: The North Dakota Payment Error Rate Measurement (PERM) webpage has been updated and is available for review.

Attention Pharmacy Providers: The ND Medicaid Pharmacy Manual has been updated and is available for review.

Posted 3-7-2018

Attention Dental Providers: The ND Medicaid Dental Manual has been updated and is available for review.

Posted 3-2-2018

Attention all Medical Providers: The Medicaid Coverage Guideline for Health Tracks Early Periodic Screening, Diagnosis and Treatment has been updated and is available for review.

Posted 2-1-2018

Attention PT, OT and Speech Providers - CORRECTION: A misprint in the provider update published 1-5-2017 has been brought to the attention of the Department.

Inadvertently, evaluations were included as not requiring prior authorization for ND Medicaid recipients under the age of 21. The correction to the wording will apply to all dates of service.

Currently, ND Medicaid recipients are allowed 1 evaluation per calendar year, any additional evaluations and all re-evaluations require a prior authorization. Providers have 90 days from the date of service to request a retro authorization. Effective for dates of service on or after January 1, 2017, service limits will not apply for physical, occupational and speech therapy visits for ND Medicaid recipients under the age of 21.

All services submitted to ND Medicaid for payment must continue to be supported by medical records and documentation of medical necessity.

Posted 1-24-2018

Attention Dental Providers: Effective Jan. 1, 2018, paper claim and service authorization submissions will be required to be submitted using only the 2012 ADA Dental Form. All other form versions will be returned.

The diagnosis code is not currently required for claims payment, therefore Box 29a and 34a can be left blank.

The following HCPC codes have been deleted from the provider price file.

B9000
K0901

K0902

The following HCPC codes have been added to the provider price file.

A4224
A4225

Narrative changes have been made to the following codes.

B9002
E0627
E0629
E0967
E0995
E2206
E2220
E2221
E2222
K0045
K0019
K0037
K0042
K0043
K0044
K0069
K0046
K0047
K0050
K0051
K0052
L1906
K0071
K0072
K0077
K0098
K0552

More detailed information on these changes can be found in the 2017 Narrative Changes Summary.


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