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ND Medicaid Provider Updates

Posted 8-4-2015

Fee Schedule Update - Effective July 1, 2015 - In accordance with the legislative mandate to update provider rates with a 3.0% inflationary increase the first year of the biennium, we have increased provider rates effective for 7/1/2015 dates of service and after.

Codes which are priced off a fee schedule have been adjusted with the 3.0% 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 2015 RVUs for dates of service on or after July 1, 2015.

Based on previous calendar 12 month’s claims volume, the new relative value unit adjustments, and a 3.0% inflationary increase for the first year of the biennium, the resulting conversion factor effective for 07/01/2015 dates of service and after is $52.93. The previous conversion factor was $51.56. 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 3.0% increase in their reimbursement.

Posted 8-3-2015

In preparation for the new ND Health Enterprise MMIS, we are now instructing providers to include their taxonomy code on electronic claims submitted for processing with our current Legacy MMIS system to begin adjustment to the new requirements.

Posted 7-15-2015

ND Medical Services is inviting all ND Medicaid-enrolled DME providers, DME department managers, and compliance officers to the 2015 Annual DME Task Force Meeting. Meeting will be held at:

                        ND State Capital – Judicial Wing-Room 210/212
                        Wednesday, August 26, 2015 - 1 to 3 p.m.

This year due to the implementation of the new ND Health Enterprise MMIS, the Department will be presenting a power point presentation on service authorization.  Also there will be discussion on current policy and the opportunity for providers to bring recommendations for Medical Services to take into consideration.

RSVP by August 21, 2015, to tamholm@nd.gov. Please include the names and titles of staff who will be attending. Space is limited.

To insure as many DME providers can attend this special meeting as possible it will be available from your computer, tablet or smartphone.

https://global.gotomeeting.com/join/292495085

You can also dial in using your phone.
United States+1 (646) 749-3131
Access Code: 292-495-085

Providers are asked to submit all questions to Tammy Holm at tamholm@nd.gov  by August 14, 2015.  The questions will be compiled and will be utilized in developing the agenda. The list of questions will then be posted on the DME Provider web page for review at http://www.nd.gov/dhs/services/medicalserv/medicaid/provider-durable.html.  As a reminder, please do not submit questions pertaining to individual cases, or previously denied cases, or RAC as this is not the appropriate forum.

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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