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ND Medicaid Provider Updates

Posted 10-19-2021

Attention all providers:  The SFN 615 Medicaid Provider Agreement was updated this month and providers should be using the most recent version when submitting paperwork. As of Nov. 1, the previous version will not be accepted.

Posted 10-19-2021

Medical Services' Program Integrity Unit will host a provider update Oct. 27 and Oct. 28, 2021.  The agenda is here.

Posted 10-11-2021

Attention All Providers: Effective at 12:00 p.m. today, Oct. 11, 2021, incoming PERM faxes to NCI will not be accepted for processing. NCI will resume acceptance of incoming faxes on Tuesday, Oct. 12, 2021 at 7 a.m. Thank you.

Posted 10-4-2021

The General Information for Provider Manual has been updated. This manual covers areas regarding provider enrollment and Medicaid covered services.

Posted 9-23-2021

Attention Providers:  The latest edition of the North Dakota Medicaid Provider e-newsletter is now available.

In the September 2021 edition, learn about the return of provider revalidations, resources for using Kepro’s Atrezzo online provider portal for prior authorizations, the Payment Error Rate Measurement review year for 2022 and more.

If you have trouble viewing the e-newsletter, cut and paste the URL into another web browser – Chrome, Firefox or Internet Explorer or Safari for Mac users.

A PDF version is also available. We welcome your feedback by email to dhsmed@nd.gov.  

Thank you for being a North Dakota Medicaid provider and serving North Dakota Medicaid members.

Posted 9-2-2021

All Providers:  The COVID-19 Vaccine policy has been updated to reflect the reimbursement rates effective July 1, 2021, as well as the new CPT codes for the administration of the third dose of Pfizer and Moderna vaccine. 

Posted 8-10-2021

The North Dakota Department of Human Services is working to expand in-home and community-based long-term care and support services, including PACE services.

PACE provides coordinated care for older adults living in the community who have significant support needs. Services include preventive and primary health care, and short-term and long-term care services.

Individuals interested in learning more about PACE and how to expand direct services to older adults by becoming a PACE provider can attend an upcoming meeting in Bismarck, Grand Forks, Fargo or Watford City. See meeting flyer for details.

Posted 7-30-2021

Attention DME providers and practitioners: Please review the ND Medicaid DME Insulin Pump policy, as it has been revised and is effective on Aug. 1, 2021.

Posted 7-27-2021

Effective for dates of service July 1, 2021, the surgical procedure (PCS) codes will no longer require a service authorization from the North Dakota Medicaid QIO vendor Kepro. The list of CPT® codes that require service authorization are listed on a separate tab in the Codes Requiring Service Authorization list under Policies and Guidelines heading located on the Medicaid provider information page.

Posted 7-7-2021

All Providers:  The North Dakota Medicaid Program Integrity Unit provided program updates June 23 and 24, 2021 by video conference.  Access the PowerPoint, Q & A and an audio recording of that presentation on the Medicaid Provider Education and Training webpage

If you were not sent an email invitation to the event and would like to be included in future video conferences, please email Missy Rosales at melrosales@nd.gov.

Posted 7-6-2021

The General Information for Provider Manual has been updated. This manual covers areas regarding provider enrollment and Medicaid covered services. Find it on North Dakota Medicaid's Provider Manuals and Guidelines webpage.

Posted 6-30-2021

Fee Schedule Update – The fee schedules for dates of services July 1, 2021, have been posted to the website. Provider rates will receive a 2.0% inflationary increase for the second year of the biennium in accordance with the legislative mandate.

Codes which are priced off a fee schedule have been adjusted with the 2.0% inflation increase accordingly. Codes which are priced using the Relative Value Unit (RVU) methodology have had the conversion factor adjusted. The adjustment of the conversion factor takes into account the implementation of the 2021 RVUs for dates of service on or after July 1, 2021.

Based on the previous calendar 12 month’s claims volume, the new relative value unit adjustments, and a 2.0% inflationary increase for the first year of the biennium, the resulting conversion factor effective for July 1, 2021 dates of service and after is $34.9990. The previous conversion factor was $36.9758. Based on the changes to the relative value units, some fees will increase while others may stay the same or decrease. In the aggregate, the providers whose claims are priced off the RVU methodology will see a 2.0% increase in their reimbursement.

The Ambulatory Surgical Center (ASC) conversion factor effective for July 1, 2021 dates of service and after is $29.29 based on the 2.0% inflation increase.

The Anesthesia conversion factor effective for July 1, 2021 dates of service and after is $24.45 based on the 2.0% inflation increase.

Posted 6-29-2021

Attention Providers:  The latest edition of the North Dakota Medicaid Provider e-newsletter is now available. A PDF version is also available.

In the June 2021 edition, learn about the state’s new contract for Medicaid Expansion managed care services, legislative changes to North Dakota Medicaid, initiative to expand access to a program helping older adults remain in their homes and more.

We welcome your feedback by email to dhsmed@nd.gov. Thank you for being a North Dakota Medicaid provider and serving North Dakota Medicaid members.

Posted 6-28-2021

Attention Providers: There have been several changes to the CPT® codes that require service authorization from the North Dakota Medicaid QIO vendor Kepro effective for dates of service on or after July 1, 2021. Please refer to Codes Requiring Service Authorization list under Policies and Guidelines heading located on the Medicaid Provider Information page.

Posted 6-15-2021

The Medical Services’ Program Integrity Unit will host a provider update June 23 and June 24, 2021.  The agenda is here.

Posted 6-7-2021

Effective June 1, all DME service authorization request for HCPC code S1040 pediatric cranial remolding orthosis must be submitted via Kepro’s Atrezzo Provider Portal.

Posted 5-27-2021

Revised Enrollment Forms - Medicaid Enrollment team members have updated a large number of forms to include the applicable contact information for Noridian, as well as including some minor changes. Always refer to our website and scroll down the page to see the most recent version of a form to submit. Previous versions of forms are allowed for 30 days from the date the revised forms post.

Forms impacted include:

  • SFN 1330 - Request to Add an Affiliation,
  • SFN 1302 - Request to Add/Change Taxonomy,
  • SFN 509 - Out of State/Out of Network Enrollment Clarification,
  • SFN 661 - Electronic Funds Transfer,
  • SFN 1299 - Group Address Update and
  • SFN 1331 - Provider Termination.

Posted 5-24-2021

Payment Error Rate Measurement (PERM) RY2022

The PERM program measures improper payments in Medicaid and CHIP and produces error rates for each program.  The error rates are based on reviews of the fee-for-service (FFS), managed care, and eligibility components of Medicaid and CHIP in the fiscal year (FY) under review.  It is important to note the error rate is not a “fraud rate” but simply a measurement of payments made that did not meet statutory, regulatory or administrative requirements.

The PERM audit is important to all Medicaid providers because the Centers for Medicare and Medicaid Services (CMS) and the review contractor NCI Information Systems (NCI) will be sending letters to various Medicaid providers requesting medical records to validate that the service was ordered, provided, documented and billed appropriately.  Please make sure that your Release of Information departments are aware and responding to the records requests in a timely manner. 

UPDATE: NCI started sending medical record request letters to providers on May 17, 2021.  Record requests will come in an envelope. Click on link to see what the envelope looks like.

  • NCI makes initial calls to providers to verify provider contact information. 
  • NCI establishes a point of contact with providers and sends record requests.
    • Providers have 75 days to submit documentation.
  • NCI makes reminder calls and sends reminder letters on day 30, 45, and 60 until the medical records are received.
    • If the provider does not respond, NCI sends a non-response letter on day 75 to the State PERM representative.
    • If submitted documentation is incomplete, NCI requests additional documentation.
    • The provider has 14 days to submit additional documentation.
    • A reminder call is made, and a letter is sent on day 7.
    • If the provider does not respond, NCI sends a 15 day non-response letter.

Failure to submit documentation, or if the submitted documentation is incomplete, the claim will be considered an error and subject to recoupment.

When submitting records, we highly recommend the use of the corresponding medical review (MR) cover sheet with each submission for quick and accurate processing of record submissions. The MR cover sheet is included with your PERM letter packet.

For more detailed information and to see a template of the actual medical request letter and MR fax cover sheet being sent to providers, visit the ND Medicaid Program Integrity PERM webpage.

Questions may be directed to:

Steven McNichols, PT
Medicaid Program Integrity Audit Coordinator
ND Department of Health and Human Services, Medical Services Division
600 E. Boulevard Ave., Dept. 325
Bismarck, ND 58505-0250
Phone: (701) 328-4831
Email: auditresponse@nd.gov

Posted 4-30-2021

The state has discovered that enrollment documents faxed to the former Provider Enrollment fax line, (701) 328-4030, are not forwarding correctly to Noridian HealthCare Solutions (Noridian). Providers should discontinue use of the (701) 328-4030 number and fax enrollment documents to (701) 433-5956. Noridian's email address is NDMedicaidEnrollment@Noridian.com. Please either fax or email your enrollment or revalidation documents to Noridian.

If you have faxed documents to the (701) 328-4030 number since March 1, 2021, it is advised that you re-send them by either fax or email to Noridian.

Posted 3-30-2021

The General Information for Provider Manual has been updated. This manual covers areas regarding provider enrollment and Medicaid covered services. Click here to see the updated manual.

Posted 3-26-2021

Provider enrollment revalidation activities are beginning again for both past due and current revalidation due dates. The email notices will originate from either a PE-NDM or NDMedicaidEnrollment@Noridian.com email address. For revalidation documents previously submitted but not reviewed by state staff, Noridian staff will be reviewing to ensure that all the necessary documentation was provided.

In the event a form has been updated and the most current version was not submitted with the revalidation documentation, the newest version will be requested and required to complete the revalidation process. If a complete revalidation application is not received within 30 days of the date of the revalidation notice, the enrollment may be terminated.

Once you receive an email revalidation notification, it is a best practice to submit your revalidation as soon as possible, so if any corrections are needed, you can complete them before the due date. All required documents are due within 30 days of the email notification and no extensions will be given if no documents are submitted or if partial information was received. Please check the revalidation website for the most current list of providers that are due for revalidation within the next 90 days and be mindful of the past due notices that you may be receiving as well.

It is the provider’s responsibility to ensure updated email addresses are on file, so the revalidation notification is not sent to an invalid email address. If you do not receive your email revalidation notification, you are still responsible to complete your revalidation by the due date. Please contact the enrollment vendor at NDMedicaidEnrollment@noridian.com if you do not receive your revalidation notification within 30 days of revalidation due date (*not including past due revalidations). Records that have been terminated for no revalidation will not receive priority status for reactivations. Reactivations will be processed in the order they are received.

If your revalidation was due prior to March 1, 2021, your notification will be sent soon. You will have 30 days to submit your completed revalidation. If no response is received within 30 days, your enrollment may be terminated.

If you have already submitted your revalidation packet, but enrollment information is no longer up to date, please submit your updates as soon as possible.

Additionally, providers are strongly encouraged to enroll in electronic funds transfer (EFT) versus receiving a check payment if you haven’t already enrolled with EFT. For State Form Number 661 Electronic Funds Transfer (EFT) click here. You will need to submit the form along with a voided check or a deposit slip or a letter from the financial institution that includes the applicable routing and account numbers.

Posted 3-22-2021

Attention Providers:  The latest edition of the North Dakota Medicaid Provider e-newsletter is available by clicking here. A PDF version is also available.

In the March 2021 edition, learn about the new electronic visit verification system, the state’s new contract for utilization management, enrollment to become a Medicaid 1915(i) service provider and more.

We welcome your feedback by email to dhsmed@nd.gov.  

Thank you for being a North Dakota Medicaid provider and serving North Dakota Medicaid members.

Posted 3-17-2021

Attention Ambulance Providers: Effective for claims processed on and after April 1, 2021 please submit CPT modifier 76 with ambulance transports (HCPCS codes A0425-A0999) to indicate when a second trip occurred on the same date of service.     

Posted 3-9-2021

CMS newly created HCPCS code G2212 is to be used for billing Medicaid for prolonged Evaluation and Management (E/M) services which exceed the maximum time for a level five (99205, 99215) office/outpatient E/M visit by at least 15 minutes on the date of service. CPT codes 99417,  99358 and 99359 will not be accepted  with 99202 - 99215 codes for dates of service on and after Jan. 1, 2021. Please see MLN Matters MM12071 for further information.

Posted 3-8-2021

Attention Dialysis Providers: Effective for dates of service on or after March 1, 2021, HCPCS code A4657 – Syringe, with or without needle, each will be not be paid separately and considered incidental to the dialysis service performed on that day. 

Posted 3-5-2021

All Providers - The North Dakota Medicaid Program Integrity Unit provided program updates Feb. 24 and 25, 2021 via video conference.  Click here to access the PowerPoint, Q & A and an audio recording of that presentation.  If you were not sent an email invitation to the event and would like to be included in future video conferences, please email Missy Rosales at melrosales@nd.gov.

Posted 3-2-2021

Kepro is contracted with the North Dakota Department of Human Services to perform retrospective reviews of certain hospital admission requests for North Dakota Medicaid members effective January 1, 2021.

Reviews will occur on a rolling quarterly basis beginning in March 2021 with claims with dates of service between July 1, 2019 to Sept. 30, 2019. Click here to learn more.

Posted 3-1-2021

The Medical Services Division (Division) has contracted with Noridian Healthcare Solutions (Noridian) to provide Medicaid provider enrollment services.

Noridian will be responsible for all work associated with provider enrollments to include processing applications, updating enrollment information and enrollment revalidations. The division is not transitioning provider enrollment services for Qualified Service Providers (QSPs) at this time.

We appreciate everyone’s patience as we transition those responsibilities to Noridian. Noridian’s phone number is (701) 277-6999, fax (701) 433-5956 and email is NDMedicaidEnrollment@noridian.com. Any enrollment or revalidation documents received by the state will be forwarded to Noridian for processing.

Posted 2-11-2021

The Medical Services’ Program Integrity Unit will host a provider update on Feb. 24 and Feb. 25, 2021.  The agenda is here.

Posted 2-11-2021

Durable Medical Equipment (DME) Claims Billing Guidance

The ND Health Enterprise Medicaid Management Information System (MMIS) was updated in December 2020 to properly reimburse required laterality modifiers right (RT) and left (LT) units. For claims that were denied, those can now be resubmitted. For claims that were partially paid, those can be adjusted. Please keep in mind that RT/LT modifiers will be required to be billed on two separate lines.

Example:
Line 1:  L3912 NU RT 1 unit
Line 2:  L3912 NU LT 1 unit

DME HCPC codes that require a service authorization the claims submittal process will continue to require it to be submitted on one line to match the approved request.

Posted 1-26-2021

North Dakota Department of Human Services (DHS) Medical Services Division has contracted with Noridian Healthcare Solutions (Noridian) to provide Medicaid Provider Enrollment services.

State staff are currently working on the transition plan with Noridian, and Noridian is expected to be fully operational in March.  

During this transition, there may be delays in responding to provider inquiries, updating enrollments and processing applications. Please be patient with us as we navigate through this process which we anticipate will result in quicker processing times for providers.

As we approach the completion of the transition an updated phone number and group mailbox address will be provided. DHS is excited to partner with Noridian to provide the best customer service possible for our Medicaid providers and provider applicants. Noridian currently operates the North Dakota Medicaid Call Center and this expanded service should bring familiarity to both providers and Noridian.

Posted 1-11-2021

DME Fee Schedules effective January 1, 2021 have been posted. The fee schedules can be found here.

Posted 1-8-2021

The General Information for Provider Manual has been updated. This manual covers areas regarding provider enrollment and Medicaid covered services.


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