Medicaid Provider Enrollment

Provider Enrollment Information:

• In-State and Border UB-04 or CMS/HCFA 1500 Billing For Services
  • Any billable service by a licensed individual requires a separate enrollment from that of the facility enrolled. This includes hospital ER Physician fees and those practicing as a sole-proprietor, LLC, Partners, etc.
  • Providers within the 50-mile radius of the ND border
  • Physicians billing Independently
  • Physicians affiliated with the enrolled border facility

  All NEW CMS/HCFA 1500 facilities billing for services must include a list of their medical professional personnel and their Medicaid numbers to link to the billing facility if already enrolled. If medical professional personnel are not enrolled this requires a separate enrollment application.

• Out-of-State UB-04 or CMS/HCFA 1500 Billing for Services
  • ND Medicaid enrolls the facility as a group and requires the attending medical professional personnel(s) license
  • ND Medicaid enrolls Physicians billing Independently

  "Out-of-State Provider" means a provider who provides a service to a North Dakota Medicaid Eligible Recipient at a site located within a state other than North Dakota, 51 or more miles from the border.

  All out-of-state services require prior authorization, unless the services provided in response to an emergency service.

  An out-of-state provider may apply for retroactive enrollment as a provider effective on the date of service to a North Dakota Medicaid Eligible Recipient. However, North Dakota Medicaid has a one-year timely filing limit. This means you have one year from the date of service to become an enrolled provider and bill for your services.

• Dental Providers
  • Any licensed and practicing dentist must be enrolled with North Dakota Medicaid to see Medicaid recipients
  • Services billable by a licensed individual would require a separate enrollment from that of the facility enrolled. This includes those practicing as a sole-proprietor, LLC, Partners, etc.
  • Separate application(s) are required for billing dental services versus medical services.

• Additional Information for Transportation, Meals and Lodging Providers
• All Out-of-state travel, meals and lodging must be prior approved by the state Medicaid office.
  
• North Dakota Medical Assistance requires all transportation providers enrolling as a provider to include a copy of a valid North Dakota driver’s license and proof of Liability Insurance with their application.
  
• North Dakota Medicaid does not allow payment to a recipient, recipient's parent, spouse, family member or household member as an enrolled provider for transportation for the recipient. Private vehicle mileage will not be allowed if there is free or low-cost transportation services available, including friends, family members or household members. This excludes providers of foster care for children.
• Taxi Provider Memo regarding the required vouchers for reimbursement by ND Medicaid (Sept 10, 2013)

Medicaid Provider Enrollment Electronic Application Information (MMIS)

Required Documents for Online Enrollment

All completed applications should be mailed to:

North Dakota Dept. of Human Services
Medicaid Provider Enrollment
600 E. Boulevard Ave., Dept. 325
Bismarck, ND 58505-0250

If you have any questions on enrollment call:

North Dakota Medicaid Provider Enrollment
1-800-755-2604 or 701-328-4033
Monday through Friday
8 a.m. to 4:30 p.m. (CT)

 

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