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ND Medicaid Provider Updates

Posted 6-22-2015

The Qualified Service Provider educational conference call has been cancelled for Tuesday, June 23, 2015, from 3 to 4 p.m. (CT).

All other Medicaid providers - Wednesday, June 24, 2015, 3 to 4 p.m. (CT). Agenda.

Posted 6-16-2015

Agendas for this week's educational conference calls for Qualified Service Providers and other Medicaid providers.

Qualified Service Providers - Tuesday, June 16, 2015, 3 to 4 p.m. (CT). Agenda

All other Medicaid providers - Wednesday, June 17, 2015, 3 to 4 p.m. (CT). Agenda

Posted 6-8-2015

Agendas for this week's educational conference calls for Qualified Service Providers and other Medicaid providers.

Qualified Service Providers - Tuesday, June 9, 2015, 3 to 4 p.m. (CT). Agenda

All other Medicaid providers - Wednesday, June 10, 2015, 3 to 4 p.m. (CT). Agenda

Posted 6-1-2015

Agendas for this week's educational conference calls for Qualified Service Providers and other Medicaid providers.

Qualified Service Providers - Tuesday, June 2, 2015, 3 to 4 p.m. (CT). Agenda

All other Medicaid providers - Wednesday, June 3, 2015, 3 to 4 p.m. (CT). Agenda

Posted 5-29-2015

835 Electronic Remittance Advice (ERA) Enrollment – ND Medicaid will offer Health Care Claim Payment/Advice (835) Transactions when the new ND Health Enterprise MMIS goes live. Providers who wish to receive an 835 transaction will be REQUIRED to complete one of two forms.

SFN 109 authorizes a Clearing House or Billing Agent to retrieve a provider’s 835 Electronic Remittance Advice (ERA) transactions.

SFN 111 is for providers who have the capability of retrieving their own 835 Electronic Remittance Advice (ERA) transactions.

These forms can be found at www.nd.gov/eforms/ or by clicking on the links above. If you have any questions, contact the ND EDI Help Desk at 1-844-848-0844 or ndmmisedi@nd.gov

Posted 5-21-2015

The educational conference calls will continue the week of May 26 for Qualified Service Providers and other Medicaid providers.

Qualified Service Providers - Tuesday, May 26, 2015, 3 to 4 p.m. (CT). Agenda

All other Medicaid providers - Wednesday, May 27, 2015, 3 to 4 p.m. (CT). Agenda

Posted 5-18-2015

The weekly educational conference calls for Qualified Service Providers and other Medicaid providers start this week.

Qualified Service Providers - Tuesday, May 19, 2015, 3 to 4 p.m. (CT). Agenda

All other Medicaid providers - Wednesday, May 20, 2015, 3 to 4 p.m. (CT). Agenda

Posted 4-30-2015

All providers are encouraged to take advantage of ND Health Enterprise MMIS provider training, which begins May 11, 2015. Please enroll at http://ndmmis.learnercommunity.com. For more information on the trainings, visit www.nd.gov/dhs/info/mmis.html.

Posted 3-31-2015

The Department will continue to accept claims adjustments until further notice.

Posted 3-31-2015

For electronic claims (excluding Qualified Service Provider claims), the ND Health Enterprise MMIS requires the provider’s taxonomy code for all providers on the claim. Providers should begin submitting their taxonomy codes on current electronic claims. Individual and group providers can learn more about valid taxonomy codes under the Additional Enrollment Resources heading.

Continue to visit this webpage for important updates.

Posted 2-6-2015

Attention Hearing Aids Providers: Please read the follow below as it is related to the Hearing Aid meeting in 2014.

In response to the requested changes to the current hearing aid policy and its review process, the Department has issued the following.

1. The current hearing loss criteria for both children and adults will remain unchanged.
2. The intent of NDMA is to assist with one adult hearing aid and will continue monaural coverage using current policies’ criteria.
3. Consideration for unilateral hearing loss in pediatrics will require supporting documentation which must accompany the request for consideration.
4. The review process will allow a replacement hearing aid after 5 years regardless if current hearing is currently meeting the recipient’s hearing needs or not.
5. Due to the implementation of the new MMIS going live in June and the transition time afterwards hearing aid repair costs of $200 or more will need to temporarily remain unchanged. Once the new system has been operating the policy will be changed to reflect the increase to $250 or more for hearing aid repairs and will require a prior authorization. Providers will be notified of this change via this site.
6. Implementation of the above response is effective 1-22-15.

Posted 1-9-2015

Effective January 1, 2015 ND Medicaid requires, as specified in CFR 42 441.18 (a)(7) that providers performing and billing for Targeted Case Management (T1017) maintain records that document for following criteria to support services billed:

  • The name of the individual.
  • The dates of the case management services.
  • The name of the provider agency (if relevant) and the person providing the case management service.
  • The nature, content, units (total time) of the case management services received and whether goals specified in the care plan have been achieved.
  • Whether the individual has declined services in the care plan.
  • The need for and occurrences of coordination with other case managers.
  • A timeline for obtaining needed services.
  • A timeline for reevaluation of the plan.

N.D. Medicaid may conduct pre or post payment documentation review to ensure that the above criteria are met. Failure to comply with above criteria will result in claim denial or recoupment of payment.

 

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