ND Medicaid Provider Updates
- Section 1202 of the Affordable Care Act (ACA) requires that Medicaid payment for certain evaluation and management (E&M) services and immunization services furnished in calendar years 2013 and 2014 by a physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine are to be at a rate not less than 100 percent of the payment rate that applies to such services under Medicare. Because North Dakota Medicaid currently reimburses above the Medicare payment rate for E&M codes, the enhanced payment only applies to vaccine administration codes.
In order to be eligible for the increased payment, physicians must be enrolled as family medicine, general internal medicine, pediatric medicine or a sub-specialty thereof; and must self-attest as qualifying either by board certification or show that 60% of all Medicaid services they bill are for the specified E&M and vaccine administration codes. Details of the eligibility requirements may be found at http://www.gpo.gov/fdsys/pkg/FR-2012-11-06/pdf/2012-26507.pdf.
Qualifying physicians interested in receiving the higher payment for vaccination administration for North Dakota Medicaid recipients must submit the completed Self-Attestation form by June 17, 2013 in order to receive retrospective payment consideration back to January 1, 2013. Attestations received on or after June 17, 2013 will result in the enhanced rates on a prospective basis. The Self-Attestation (SFN 1508) can be found below or by visiting http://www.nd.gov/eforms/Doc/sfn01508.pdf.
- Enhanced Payments Overview - Memo dated 5/14/13
- 2013 Changes for Vaccine Administration - Enclosure
- Primary Care Enhanced Payment Increase Self-Attestation - SFN 1508
- Effective 3-1-2012, ND Medicaid will require prior authorization through North Dakota Healthcare Review for CPT 43775 - Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (i.e., sleeve gastrectomy). If approved, ND Medicaid will reimburse this procedure. The ICD-9-CM Volume 3 codes also requiring prior authorization for the sleeve gastrectomy procedures are 43.82 - Laparoscopic vertical (sleeve) gastrectomy and 43.89 - Open and other partial gastrectomy. Prior authorization can be requested through:
ND Healthcare Review, Inc.
3520 North Broadway
Minot, ND 58703
701-838-6009 (Review Fax only)
- The ND Medicaid Coding Guideline for LICSW/LCSW Allowed Services has been updated to reflect the 2013 Psychiatry Code Updates per CPT. The updated Coding Guideline may be viewed on the ND Medicaid Coding Guidelines page.
- The Swing Bed Rate for 2013 has been updated on the Main Provider page.
- An Available Primary Care Provider (PCP) List has been updated, and may be reviewed, on the Medicaid Managed Care page.
- The Dental Provider Manual for North Dakota Medicaid has been updated. Please see the Provider Manuals page for more information.
- Checkwrite dates through June 2013 have been updated on the Medicaid Checkwrite page.
- The most recent Provider Bulletin dated February 2013 has been posted to the Provider Main page.
- Two Completion Guides for Durable Medical Equipment (DME) have been added for providers' reference. Please see the Medicaid DME Provider Web page to access these documents.
- The American Medical Association (AMA) made significant changes to Current Procedural Terminology (CPT) codes for psychiatry and psychotherapy services effective January 1, 2013. North Dakota Medicaid has now implemented these changes with the 2013 Psychiatry CPT codes 90785-90840 effective for dates of service January 1, 2013 and after.
If you have submitted claims with these CPT codes for dates of service January 1, 2013 and after that have been denied due to code implementation, please resubmit those claims to ND Medicaid.
If you have submitted claims with dates of service January 1, 2013 and after using the obsolete psychiatry CPT codes (codes that were effective previous to 01/01/13), you must submit an adjustment to deny the claim in conjunction with the submission of a revised corrected claim using the current psychiatry CPT codes by July 1, 2013. If you do not submit an adjustment by July 2, 2013, ND Medicaid will adjust the claim and deny it for invalid procedure code.
- A new Provider Policy regarding Medical Record Retention has been placed on the Medicaid Provider Policies page. Important information pertaining to medical records formats is included in this policy.
- There is a new version of the Medicaid Program Provider Agreement available for providers to update their enrollment. The retention period of this form has also changed from 5 years to 7 years. The new SFN 615 can found at http://www.nd.gov/eforms/Doc/sfn00615.pdf, or on the Provider Enrollment Web pages.
- The Partial Hospitalization Prior (PHP) Authorization/Continued Stay (SFN 73) form has been updated this month. Please discard all older version of this form and use this most recent version. It may also be found on www.nd.gov/eforms.
- A new informative page regarding the Federal Payment Error Rate Measurement (PERM) audit has been created. You may visit this ND Medicaid PERM page for example letters and general information. This page is also accessible through the main Department of Human Services Providers page (www.nd.gov/dhs/providers).
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