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ND Medicaid Provider Updates

Posted 1-27-2016

Attention all DME Providers. The following HCPCS codes have been deleted from the DME Fee Schedule effective 1-1-2016:

  • E0450 - Volume control ventilator, without pressure support mode, may include pressure control mode, used with invasive interface (E.G., tracheostomy tube)
  • E0460 - Negative pressure ventilator; portable or stationary
  • E0461 - Volume control ventilator, without pressure support mode, may include pressure control mode, used with non-invasive interface (E.G., mask)
  • E0463 - Press support ventilator with volume control mode, may include pressure control mode, used with invasive interface (E.G. tracheostomy tube)
  • E0464 - Press support ventilator with volume control mode, may include pressure control mode, used with non-invasive interface (E.G. mask)

Effective for claims with DOS on or after January 1, 2016, all products classified as ventilators must be billed using one of the following HCPCS codes:

  • E0465 - Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube)
  • E0466 - Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell)

Products previously assigned to HCPCS codes E0450 and E0463 must use HCPCS code E0465. Products previously assigned to HCPCS codes E0460, E0461 and E0464 must use HCPCS code E0466. New rental and purchase rates are listed below.

Code Fee
E0465 (RR)
$1,134.37
E0466 (RR)
$1,134.37
E0466 (NU)
$13,690.73
E0466 (NU)
$13,690.73

Posted 1-25-2016

There has been an issue with claims inaccurately denying with remark code 38, Services not provided or authorized by designated (network/primary care) providers.

A provider billing for Emergency Room, Obstetric Care, Dental, or Vision Services and have had claims deny in Health Enterprise with remark code 38 should resubmit their claims.

Posted 12-29-2015

The Department will cover A0433 (advanced life support, level 2) at the rate of $768.47, with dates of service starting January 1, 2016.

Posted 12-28-2015

The Automated Voice Response System (877-328-7098 or 701-328-7098) is now available to all providers, including dental and vision benefit information.

Posted 12-16-2015

ND Medicaid has determined that service authorizations will be authorized for a five-year timeframe for recipients that meet the requirements for the dental frequency list or DD List.

For previously approved recipients – an authorization must be sent with all billable codes and the frequency must be indicated in Box 35 of the dental PTAR form or web based service authorization. Any applicable documentation may be sent as well.

For new recipients to be authorized – all billable codes must be sent and the frequency must be indicated in Box 35 of the dental PTAR form or web based service authorization. For new recipients to be approved for “extra time” code D9920 – please see the ND Medicaid Dental Manual, pg. 7 at: http://www.nd.gov/dhs/services/medicalserv/medicaid/docs/dental-manual.pdf. The service authorization number must be on the claim when billed in Box 2.

Please contact the Department with any questions.

Posted 12-1-2015

There has been an issue with claims inaccurately denying with remark code MA120, Missing/incomplete/invalid CLIA certification number. A provider billing lab codes must have a valid CLIA number on file with ND Medicaid. Providers who have a valid CLIA number on file with ND Medicaid and have had claims deny in Health Enterprise with remark code MA120 should resubmit their claims.

Posted 10-26-2015

ND Health Enterprise MMIS requires a service authorization number on claims after service authorization approval has been given. Please submit claims with the service authorization number that has been assigned to the service that has been approved. Thank you.

Posted 10-19-2015

Important Message: As of 11:50 a.m. (CT) Oct. 19, 2015

The Automated Voice Response System (877-328-7098 or 701-328-7098) is now available to all providers, with the exception of Dental and Vision benefit information. The Department is continuing to trouble-shoot and resolve this known issue. In the interim, please contact the ND Medicaid Provider Call Center at (877) 328-7098 or (701) 328-7098 for assistance with benefit information regarding these services. Thank you for your patience while we complete these important updates.

Posted 10-7-2015

Important Message: Suspended Claims

With the launch of ND Health Enterprise MMIS, the Department of Human Services is committed to ensuring the highest quality and accuracy in claims processing. This process includes a step that places claims in a suspended status.

A suspended claim means the claim has been received and requires additional action to move to a completed status. This may be an additional review for medical necessity, checking for a service authorization, waiting for an attachment or supporting documentation, or verifying member or provider enrollment information.

PLEASE allow sufficient time for suspended claims to complete processing and do not resubmit a duplicate claim.The recent Transition Period during which claim processing was on hold has resulted in higher than normal claim volumes.

Thank you for your patience during this start-up period while the Department is working diligently to process all claims as soon as possible.

  • Providers can check claim status through the Automated Voice Response System by dialing 1-877-328-7098 and selecting option 4. Claim status can also be obtained through the secure provider portal.

We appreciate your participation in the ND Medicaid program and continuing to care for our North Dakota citizens.

Posted 10-5-2015

The new ND Health Enterprise MMIS is now live! - Effective 8 a.m. (CT) October 5, 2015

ND Health Enterprise MMIS is available to all active enrolled Medicaid providers. Users can now access the portal.

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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