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Medicaid Provider Updates

Posted 11-19-2009

  • Provider Memo dated November 19, 2009 (37kb PDF) regarding ND Medicaid providers billing drugs in an outpatient setting. State Medicaid agencies are required to collet the National Drug Code (NDC) whenever drugs are billed.

Posted 10-30-2009

Posted 10-26-2009

  • 2010 ICD-9-CM Updates
    • North Dakota Medicaid follows industry standards and will begin to use the 2010 ICD-9-CM codes as of October 1, 2009. A complete listing of the new, deleted and revised codes can be viewed on the CMS website at: http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp#TopOfPage -- changes include 311 new diagnosis codes, 45 revised diagnosis codes, 23 invalid diagnosis codes, 15 new surgical procedure codes, and 16 revised procedure codes. Provider should use the 2010 ICD-9-CM Official Guidelines for Coding and Reporting as a supplemtn to accompany and complement the office conventions and instructions provided within the ICD-9-CM itself.
  • H1N1 Immunization Administration
    • The H1N1 Vaccine will be available exclusively through the ND Department of Health. You must follow the ND Department of Health's criteria guidelines when determining which patients may receive the H1N1 vaccine. Go to http://www.ndflu.com/Vaccine/VaddineInformation.aspx
    • North Dakota Medicdaid will allow/reimburse the immunization administration for vaccines /toxoids (90465-90474) at our current allowed amount when appropriately billed with the H1N1 vaccine. As with other vaccines/toxoids, you may submit a claim to ND Medicaid with the H1N1 vaccine code (90663-SL) and the appropriate immunization administration code (90465-90474). Please click H1N1 for details on coding/billing.
    • See Medicare guidelines for appropriate billing when Medicare is the primary payer.
  • H1N1 Providers for recipients receiving services through the Primary Care Case Management Program (PCCMP)
    • To the extent that symptoms of suspected or confirmed 2009 H1N1 influenza are sufficiently severe that a prudent layperson might reasonably expect that the absence of immediate treatment could result in imminent harm to health, the PCCM program may not impose prior authorization or referral requirements prior to the assessment, diagnosis and treatment of Medicaid recipiens presenting with such symptions. In cases in which the prudent layperson test is not met, Medicaid recipients with flu-like symptoms may seek these services from their primary care provider (PCP) of obtain any necessary referrals from their PCP. (Centers of Medicare and Medicaid 9-24-2009).
    • Should a Medicaid beneficiary seek care for severe symptoms related to suspected or confirmed 2009 H1N1 influenza, pass the prudent lay person test, and is unable to obtain a referral from the designated PCP, and the claim is submitted and denied; Submit a provider adjustment form and attach related documentation/medical notes to the adjustment for review.
  • Synagis (palivizumab) - 90378 (respiratory syncytial virus immune globulin (RSV-IgIM), for instramuscular use, 50 mg, each)
    • See ND Medicaid Coding Guidelines for updated information: Synagis
    • See Prior Authorization Forms - then Synagis Registration Form for prior authorization at www.hidndmedicaid.com
  • ND Medicaid Pharmacy Manual has been updated.
  • ND Medicaid Managed Care program web site has been updated.

Posted 8-24-2009

  • Revised Synagis (Palivizumab) guidline has been posted
  • New Provider Newsletter Issue 65-July 2009 has been mailed to provider billing addresses and is available on our website.
  • North Dakota Medicaid no longer denies institutional claims at the claims level for NDC reasons. This is for institutional claims only. Edits now apply at the detail line level. Providers may re-submit claims that previously denied with the M19, as timely-filing limits allow.

Posted 7-24-2009

Posted 7-16-2009

Posted 7-10-2009

Posted 4-13-2009

Posted 2-12-2009

Posted 12-01-2008

Posted 10-22-2008

Posted 9-22-2008

Posted 9-08-2008

  • The VERIFY System should now be up and running. ND Medicaid has previously been experiencing problems with the automate eligibility system. As of Friday, September 5th, everything should be working.
  • New Durable Medical Equipment Fee Schedules effective July 1, 2008 have been posted to the web. Go to ND Medicaid DME Purchase Fee Schedule as of 7-1-2008 or ND Medicaid DME Rental Fee Schedule as of 7-1-2008.
  • The General Information for Providers Manual has been updated effective August 2008. The following chapters have been revised:
    • Coordinated Services Program
    • Home Health Private Duty Nursing
    • Managed Care
    • Medicaid Eligibility of Recipient
    • Medicare Coverage, Rural Health Clinics and Federally Qualified Health Centers
    • Surveillance Utilization Review
    • Third-Party Liability

Posted 07-31-2008

Posted 07-11-2008

  • Fee Schedule Update - Effective 7-01-2008
    • In accordance with the legislative mandate to update provider rates with a 5.0% inflationary increase the second year of the 2007-2009 biennium, we have increased provider rates effective for 7-01-2008 dates of service and after. Codes which are priced off a fee schedule will be adjusted with the 5% inflationary increase accordingly.

      Codes which are priced using the Relative Value unit (RVU) methodology have had the conversion factor adjusted. The adjustment in the conversion factor takes into account the implementation of the 2008 RVUs for dates of service on or after July 1, 2008. Based on previous 12 month's claims volume, the new relative value unit adjustments, along with the 5.0% inflationary increase, result in the conversion factor being adjusted to $39.13. The previous conversion factor was $36.68. Based on the changes to the relative value units, some fees will increase while others may stay the same or decrease.

      Please remember that providers participating in the North dakota Medicaid (NDMA) program are required to bill their usual and customary charge for each service provided. "Usual and customary charge" refers to the amount the provider charges the general public in the majority of cases for a specific item or service. Providers should not base their billed amount off the North Dakota Medicaid fee schedule.

      The updated fee schedules will be published as soon as possible.

Posted 06-16-2008

  • Some providers may be experiencing difficulty obtaining information regarding the Primary Care Physician program and the Coordinated Services (Lock-In) program through the Verify and Medi-Fax Lines. If you are unable to obtain information through these methods and required this information, please contact your local county social services office or the ND Medicaid Provider Relations at 701-328-4030 or 701-328-4043.

Posted 05-29-2008

  • The Deficit Reduction Act of 2005 (DRA) included a requirement for state Medicaid agencies to collect NDC's whenever drugs are billed in an outpatient setting. To comply with this Federal Regulation, ND Medicaid will use the following billing guidelines to ensure the system captures the NDC for drugs.
    1. If an electronic claim denies a drug for a description (16/N29) of the drug the provider is required to resubmit the claim electronically with the description of the drug narrative.
    2. If an electronic claim denies a drug for documentation (16/N29) the provider is required to submit an adjustment with the notes attached.
    3. If the NDC is invalid on an electronic claim it will deny with an M119 (invalid NDC).
    4. A paper claim with drugs submitted will be denied with an M117 (required to bill electronically).
    5. Currently the information above affects only drugs billed on a CMS 1500 (837P or paper) claim for for Physician services. Outpatient Hospital services (billed on a UB04) are exempt from the requirments until July 1, 2008.
    • REMINDER -- None of the information above applies to Inpatitent Hospital or Family Planning providers as they are exempt from the NDC requirment of billing drugs.
  • EFFECTIVE JULY 1, 2008 - ND Medicaid is requiring all adjustments be submitted on the current version (rev. 08-2002) of the adjustment form. This form can be found at the following link: http://www.nd.gov/dhs/services/medicalserv/medicaid/online-forms.html
    • Once at the web page, click on the Provider Request For An Adjustment (SFN 639). Adjustments not submitted on the current version of the form will not be processed and will be returned to the provider. This does not apply to entities that submit Pharmacy adjustments.
  • The Durable Medical Equipment (DME) Task Force questions and responses from the April 11, 2008 meeting have been posted to the DME web site. Please click the link above to review.

Posted 05-06-2008

Posted 04-28-2008

Posted 04-23-2008

Posted 03-28-2008

 

Posted 01-15-2008

Posted 11-23-2007

Posted 10-23-2007

Posted 10-22-2007

Posted 9-7-2007

  • DME August 2007 Questions
  • Medical Nutritional Therapy Guidelines
  • Providers Billing Date of Placement - A revision has been made to the policy that previously stated providers are to bill for certain items using date the item is ordered rather than the date of placement. For items ordered on or after May 1, 2007, the revised policy states providers are allowed to bill either the date of placement or the date ordered for services, for example: dentures, prosthetics, glasses. Please be reminded the following policies still apply - i.e. eligibility for the receipient, receiving glasses froman NDMA contractor, or appropriate prior authorizations.
  • Maintenance and Servicing (DME Claims)
    • Capped Rental Items - Maintenance/Servicing or repairs is not allowed on rental items during the rental period. Once the recipient owns the capped rental item, Medicaid will cover reasonable and necessary repairs and labor.
    • Oxygen and Ventilator Equipment - Payment may be made for maintenance/servicing every six months starting six months after the recipient owns the equipment. Maintenance/servicing payment will be paid in 15 minute intervals and shall not exceed 30 minutes. Medicaid will cover reasonable and necessary repairs when medically necessary. Medicaid will allow one month of rental of replacement equipment when patient owned equipment needs to be sent to the manufacturer for repairs.

      Maintenance and Servicing requires the Provider to submit prior authorization with the HCPCS code of E1340 indicating the number of units or with the base HCPCS code for the oxygen or ventilator equipment and the MS modifier for maintenance and servicing for oxygen equipment. If the MS modifier is missing the prior authorization will be denied.
    • Maintenance and Servicing (T-Codes for Incontinence Products )
      • T-Codes for Incontinence Products - Effective 8-17-07, provider's request for consideration of T-codes to be added to the DME fee schedule has been denied at this time. Providers are required to use:
        • A4520 - Incontinence garment, anytype, (e.g., brief, diaper), each Prior Authorization is required and is limited to 180 diapers/pullups per month.
        • A4554-Disposable underpads, all sizes (e.g., Chux's) does not require prior authorization and is limited to 70 underpads per month.
  • Updated Fee Schedules as of July 1, 2007
  • Pharmacy Quantity Limits updated as of 9-5-07


Posted 8-9-2007

  • Provider Memo date 7-25-07 - to Providers that bill J-codes and the Deficit Reduction Act of 2005 (DRA) implications.
  • Provider Memo 7-19-07 to Medicaid enrolled Physicians, Clinics, Hospitals, Prescribers (NP's, PA's, etc.) and enrolled Pharmacies- regarding Tamper Resistant Prescription Drug Pads.
  • Provider Memo 7-20-07 to ND Medicaid Pharmacy Providers rgarding AMP - New Federal Upper Limits.
  • HCPC Codes added to the DME Fee Schedule - they are: S8189, E2215, L3702, L1831, and E1392.
  • A new UB04 has been posted to our web site.
  • The Pharmacy Manual has been updated.

Posted 7-27-2007

  • Fee Schedule Update – Effective 07/01/2007

In accordance with the legislative mandate to update provider rates with a 4.0% inflationary increase the first year of the 07-09 biennium, we have increased provider rates effective for 7-1-2007 dates of service and after. Codes which are priced off a fee schedule will be adjusted with the 4% inflationary increase accordingly.

Codes which are priced using the Relative Value Unit (RVU) methodology have had the conversion factor adjusted. The adjustment in the conversion factor takes into account the implementation of the 2007 RVUs for dates of service on or after July 1, 2007. Based on previous 12 month’s claims volume, the new relative value unit adjustments along with the 4.0% inflationary increase result in the conversion factor being adjusted to $36.68. The previous conversion factor was $34.99. Based on the changes to the relative value units, some fees will increase while others may stay the same or decrease.

Posted 7-27-2007

Posted 6-19-2007

  • DEPO PROVERA Reimbursement Update -- ND Medicaid has increased the reimbursement for J1055 (injection, medroxyprogesterone acetate for contraceptive use, 150 mg. {Depo-Provera}) to $47.00 for dates of service July 1, 2006 and after. Adjustments can be submitted if payment was made before the increase.

  • False Claims Education PROVIDER NOTICE -- Selected North Dakota Medicaid Participaing Providers are mandated under Section 6032 of the Deficit Reduction Act of 2005 (Pub. L. 109-171) that any provider or provider entity that receives payments, in any federal fiscal year, of at least $5,000,000 from any state Medicaid program, must have written policies for all employees, including management, and for all employees of any contractor or agent. Please click the Provider Notice link to view the notice mailed to select North Dakota Medicaid providers. The False Claims Education Certification form referenced in the Provider Notice is available at www.nd.gov/e-forms.

Posted 6-11-2007

  • DME UPDATES -- The DME Purchase Fee Schedule has been updated. Click this link for added and deleted codes.
  • Please reference the example claims forms for the new CMS 1500 and UB04. The new CMS 1500 claim forms are required starting June 1, 2007 for dates of service April 1, 2007 and forward. The UB04 claim forms are required starting July 1, 2007. Please note the yellow highlights on the UB04 which indicate the most significant changes.

Posted 5-25-2007

Posted 5-23-2007

  • NPI Contingency Plan - In order to assist North Dakota Medicaid Providers in processing their claims after the May 23, 2007 NPI implementation date, North Dakota Medicaid has developed an NPI Contingency Plan effective 5-23-2007. If this plan is not followed for HIPAA covered electronic transactions providers risk denial of claims.

Posted 5-15-2007

  • UPDATE ON MEDICARE CROSSOVERS-- The system changes necessary to process batch files are now complete and ND Medicaid is currently processing electronic Medicare Crossover claims that were held in our system due to unforeseen issues. Because of the high volume of claims, ND Medicaid will need to process the claims already submitted, in increments that will result in additional checkwrites.

    The additional checkwrites will take place between May 9, 2007 and June 15, 2007. After June 15, 2007, we encourage providers to verify the status of electronic crossover claims with Remittance Advices or status check calls to Provider Relations to determine whether or not you will need to submit a hard copy claim as the electronic claim has not been processed.

    North Dakota Medicaid does not want to hinder the claims process and adjudication of the electronic crossover claims. We are asking providers to continue to hold hard copy claims until you are able to verify if an electronic claims has been processed. ND Medicaid will notify all providers when we will begin accepting duplicated hard copy crossover claims that you have been asked to hold.

Posted 5-14-2007

  • ATTENTION DME PROVIDERS -- Effective July 1, 2007, DME providers are required to use the current PRIOR AUTHORIZATION REQUEST form SFN 1115 (7-2006). If outdated versions are submitted for review after 7-1-2007, the request will be returned to the provider for resubmission on the current form. The current form is available at www.nd.gov/eforms.

Posted 5-8-2007

  • MEDICARE CROSSOVER CLAIMS UPDATE -- The NDMA's system changes needed to alleviate the issues we were experiencing with Medicare Crossover Claims are nearing completion. Processing of electronic files which have been rejected in the past will occur during May and early June. Until the process is completed and the payment or status of an electronic claim is known, we continue to ask that providers not submit duplicate paper claims.
  • An updated Pharmacy Provider File has been added to the Pharmacy web site.

Posted 4-27-2007

  • Issue 61 - March 2007 -- The new Provider Bulletin (Your Reimbursement News Source) has been posted to the web.

Posted 3-30-2007

Posted 3-14-2007

  • New Swing Bed Rates - The new Swing Bed Rates (effective April 1, 2007 through March 31, 2008) have been posted.

Posted 3-8-2007

  • Attention DME Providers - please click the link (DME Update 2-13-07) for information regarding current policy and recent changes to current policy.

Posted 2-7-2007

Posted 2-1-2007

  • Laboratory Fee Schedule Update
    • The Department has revised our Laboratory Fee Schedule using the 2007 Medicare Clinical Diagnostic Fee Schedule amounts for dates of service on or after January 1, 2007.
  • PERM Update - Medical Review Request Letters Sent:
    • The Centers for Medicare and Medicaid Services (CMS) Payment Error Rate Measurement (PERM) program documentation/database contractor, Livanta LLC, has begun the process of contacting providers beginning in January 2007. If a claim has been selected for a service that you rendered as part of the sample, Livanta LLC will contact you to request a copy of your medical records to support the medical review of the claim. Medical records are needed to support medical reviews on claims to determine if the claims were correctly paid. It is critical that providers supply information on sampled claims in a complete and timely matter. Non-compliance will result in a claim adjustment against the provider’s claim with the monies being recovered by ND Medicaid. Failure to submit the requested medical information could also result in State errors.
    • We recognize providers are concerned with maintaining the privacy of patient information. However, providers are required by Section 1902(a)(27) of the Social Security Act to retain records necessary to disclose the extent of services provided to individuals receiving assistance and provide CMS (through Livanta) with information about any payments claimed by the provider for rendering services. Providing information includes medical records. Also, the collection and review of protected health information contained in individual-level medical records for payment review purposes is allowed by the Health Insurance Portability and Accountability Act (HIPAA) and implementing regulations at 45 Code of Federal Regulations, parts 160 and 164. This permits the collection and review of protected health information to meet the CMS PERM requirements. The records do not need to be de-identified.
  • Relative Value Unit Fee Schedule Update
    • Historically, the Department has implemented the latest relative value units (RVUs) on the first of each year. This year, the Department will implement the 2007 RVUs for dates of service on or after July 1, 2007.
    • Updating the RVUs effective July 1 allows us to do one update in unison with any provider increases granted by the legislature. Due to the limitations of our current system (MMIS), updating a fee effective date once per year, versus twice per year, is much more effective and ensures we are processing claims more efficiently and appropriately. Updating the fees on July 1 also provides more consistency with fees and aligns with the State Fiscal Year.

Posted 1-12-2007

Posted 12-22-2006

Posted 12-14-2006

Posted 12-01-2006

  • The 2006 ND DRG Relative Weights has been posted. It is available in Excel and PDF file formats.
  • The Nursing Facility MEDICAID PAYMENT ALERT form has been revised. Please click to print the latest version of this form.
  • The Dental Manual was missing the fee information for code D2953. The manual has been updated and reposted to this web site.

Posted 10-30-2006

  • Updates have been made to the provider Dental Manual and the provider Optometric Manual
  • There was an error was found to the date of the Technical Component Fee Schedule file that was posted to the web.
    • The date has been fixed, and the revised fee schedule has been posted to the Fee Schedule web page.

Posted 9-22-2006

  • Durable Medical Equipment (DME) Updates
    • An updated DME Purchase Fee Scheduled is available as of 8-31-06.
    • A new forms link was added to the DME Forms web page. This link is for SFN785 - Hospital Beds.
    • The DME Manual was updated on 8-31-06 adding links to the state's e-forms web site for SFN 785. These Certificate of Medical Necessity forms are located in the manual on pages 17 & 18.
    • The minutes from the DME meeting on 9-6-06 have been posted to the web, including an update that occurred on 9-15-06 relating to the 9-6-06 meeting.
  • Updated to Medicaid Coding Guidelines
    • An update has been added to the Medicaid Coding Guidelines for Gardasil-HPV vaccine, effective 9-26-06.

Posted 8-28-2006

  • New Provider Bulletin
    • Issue 59 - August 2006 Provider Bulletin is going out this week. Look for it in your mailboxes. You can also access the downloadable version by clicking the link provided.
    • The DME Certificate of Medical Necessity forms have been posted to the DME forms web page. Click the link provided to access these fillable forms online.
    • General Information for Provider Manual has two new chapters. They are Indian Health Services (IHS) and North Dakota Health Tracks Early Periodic Screening, Diagnosis and Treatment (EPSDT).

Posted 8-24-2006

  • Providers that had claims incorrectly denied with a "62"
    • Providers that had claims incorrectly denied with a '62' (Payment denied/reduced for absence of, or exceeded, pre-certification/authorization) on the 08/15/06 Remittance Advice will see Department created adjustments in the next few weeks. The claims will be identifiable through the Internal Control Number on the Remittance Advice. An example ICN for an adjustment is 100xxxx714xxx. The internal adjustments will have 716 in the eighth position of the ICN, for example 100xxxx716xxx.

Posted 8-18-2006

  • New Durable Medical Equipment Fee Schedules effective July 1, 2006 have been posted to the web
    • Go to the DME Provider web page to view and/or print the DME Purchase Fee Schedule, or the DME Rental Fee Schedule.

 

Posted 8-11-2006

  • Attention DME Providers that dispense incontinence garments or incontinence supplies (catheters) - it is vital that the quantity ordered by the physician is documented on the attached prescription. The July 2006 DME Provider Manual will assist providers as to what is required on a physician prescription. Prior Authorizations (PAs) will be returned if this information in not included with the request.
  • A correction was made to the Nursing Facility Rate Manual regarding a error relating to Part D supplies. The corrected version has now been posted to our web site.

 

Posted 7-25-2006

  • Medifax Eligibility Change [This same information is also available as a pdf file: Medifax Eligibility Change (14kb pdf)]
    • Please NOTE: You will no longer be able to check Medicaid recipient eligibility via Medifax or the HIPAA 270/271 transactions using a range of dates. North Dakota Medicaid will only support recipient eligibility requests using a single date of service. Due to the eligibility process involved with determining and authorizing Medicaid recipient eligibility on a month-by-month basis, at this time using a date range span to check eligibility is not yielding consistently accurate results. We hope in the future to have this problem resolved. Again, you WILL be able to continue using Medifax or the HIPAA 270/271 transactions to check Medicaid recipient eligibility; however only for for a single date of service.

  • Durable Medical Equipment (DME) Provider Manual has been updated

Posted 7-20-2006

  • New Fee Schedules effective July 1, 2006 have been posted to the web
  • Durable Medical Equipment (DME) Task Force Meeting
    The next Durable Medical Equipment Task Force meeting will be held September 6, 2006 from 1:30pm to 3:00pm. This meeting will be held at the North Dakota Department of Human Services in the Children & Family Services Conference Room D. See you all then!

Posted 7-12-2006

  • Newly updated Durable Medical Equipment Manual (620kb pdf)
    The Durable Medical Equipment Manual (DME) and all of its contents/criteria ha been implemented with dates of service July 1, 2006. Please make this manual available to all support staff involved with ordering and billing DME.

  • 2.65% Provider Increase Update - Effective July 1, 2006
    In accordance with the legislative mandate to update provider rates with a 2.6% inflationary increase each biennium for providers of services under the various grant (assistance) programs, we have increased provider rates effective for 7-1-2006 dates of service and after. Codes which are priced using the Relative value Units (RVUs) methodology have had the conversion factor adjusted to $34.99. The previous conversion factor as of 01-01-2006 was $34.09. Codes which are priced off a fee schedule will be adjusted accordingly.

  • Updated Nursing Facility Rate Manual (300kb pdf) has been posted. Revisions are effective July 2006.

  • New list of medications requiring prior authorization has been posted.
    Go to Medications Requiring Prior Authorization web link to view the list as of May 2006. (16kb pdf)

Posted 6-13-2006

Posted 6-5-2006

  • Durable Medical Equipment (DME) Providers
    An updated Durable medical Equipment Manual is available in DRAFT format only. It has been posted to allow providers time to review and make note of any changes that they may need to make within their institution. DO NOT make copies of this manual, as the content may change before implementation. Medical Services Division will notify providers via the website Update for Providers as to the final version and effective date. This will be dependent upon the impact study that is currently taking place. DME Manual-DRAFT June 2006 (362kb pdf)

Posted 6-1-2006

  • National Provider Identifier (NPI) -- FYI TO ALL PROVIDERS
    EVERY provider completing electronic transactions MUST use only the NPI (National Provider Identifier) in standard transactions by May 23, 2007. Providers need to prepare themselves, and their staff, for the upcoming NPI compliance date. Careful preparation for, and use of, the NPI will help minimize Prior Authorization Requests (PAR) for DME providers and/or claim errors and delays in payment. ND Medicaid will alert providers when they can start using their NPI. Please watch our website or your remittance advice for this notification. As of May 23, 2007 only the NPI will be accepted, except for those small health plans that are exempt until May 23, 2008. Those providers that are exempt can submit a PAR and/or claim with just the UPIN number up until that time. If the NPI is not present on the PAR, the PAR will be returned to the provider for complete information. ND Medicaid will be updating the current Prior Authorization Request form (SFN 1115) to accommodate the NPI. When completed, the form will be made available on the provider website.

  • New Quantity Limits (57kb pdf) on medications is available. Please click on the link to review.

  • Crosswalk Codes - Speech Therapy - Swallowing Dysfunction 92526 (63kb pdf) - Swallowing Dysfunction 92526 - new coding information has been posted. Please click on the link to review.

  • A new chapter has been added to the General Information For Providers Manual (1Mb pdf). The chapter on Coordinated Services Program (CSP) is new information.

Posted 5-17-06

  • Provider Enrollment is now available at our web site. Please click the link to find information, instructions to become a provider, and forms.

Posted 05-05-06

Posted 04-28-06

Posted 04-27-06

  • Provider Bulletin (624kb pdf) - Issue 58, April 2006

  • Printing Error Correction - On the last page of the bulletin, it has been noted that a printing error occurred. "ATTENTION PROVIDER/DME SUPPLIER" should read:
    • Prior Approval for service(s) by the North Dakota Department of Human Services does not guarantee eligibility nor ensure payment for the services(s). Eligibility is established by the appropriate county social service office on a monthly basis, and payment is contingent upon the eligibility of an individual at the time the services approved are rendered. Eligibility for dates of service may be verified by calling 1-800-428-4140 or 701-328-2891. All providers are responsible for submitting prior authorizations and claims with the appropriate CPT/HCPC codes. Non-covered codes will be reviewed on an ongoing basis and may be paid if added to the fee schedule or allowed as an exception. Please do not resubmit another request if the original was sent in the past three weeks. North Dakota Medicaid will not fax or resend approval notices. It is the provider’s responsibility to work with their organization to secure the originally sent authorization or approval The website for guidelines, provider bulletins, manuals and fee schedule is located at http://www.nd.gov/dhs/services/medicalserv/medicaid/ Any applicable third parties must be billed prior to billing Medicaid and all third party requirements must be followed. The recipient may be responsible for any recipient liability before payment is made by the Department.

  • DME Excerpts (32kb pdf) from April 2006 Provider Bulletin - Important information for DME & Pharmacy DME suppliers, please read!

  • Update to the General Information for Providers Manual (1.14Mb pdf) - three chapters have been added: Physical Therapy, Occupational Therapy, and Speech-Language Pathology.

Posted 04-03-2006

  • Billing Notice

  • Self-administered drugs in any outpatient observation setting will be DENIED AS NON-COVERED. Please bill the patient or drug insurance regarding Medicare Part D.

Posted 03-22-2006

Posted 03-03-2006

Posted 02-08-2006

Posted 02-03-2006

Posted 01-10-2006

Posted 01-01-2006

 

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