HHS launches Voices of Impact series
As health care providers, you wake up every day wanting to make a difference in someone’s life.
It’s this same passion that helps drive North Dakota Health and Human Services’ (HHS) vision to make North Dakota the healthiest state in the nation.
In a new series called Voices of Impact, explore how our work with partners and providers is positively impacting the health and well-being of North Dakotans and advancing our progress toward our vision.
In this Medicaid provider newsletter, learn how HHS’ Nursing Facility Incentive Program is improving health outcomes and quality of life for North Dakotans living in nursing facilities.
New Salem nursing facility invests in residents’ health and well-being
Grand Forks nursing facility residents benefit from care team collaboration and communication
Parkside Lutheran Home improves lives and reduces resident falls
Stay in the know - Medicaid coverage policy updates and public comments
Check out the Provider Guidelines, Manuals, and Policies webpage for the most up-to-date provider policies.
Quarter four policies are updated and currently available on the webpage. The updated policies will have the updated date next to the title.
North Dakota Medicaid is launching a new policy public comment process for new or changing provider policies.
This process is:
- Limited to policies that implement a change from current practice.
- Open to the public for comment.
- Will be used to inform the final policy.
For more information and to add your email to the notification listserv, visit the Public Comment Notification webpage.
Updated provider enrollment application requirements
This does not pertain to Qualified Service Providers or Developmental Disability Providers.
Effective March 1, 2025, providers must use the newest version of the Application Requirements located on the Provider Enrollment webpage. If old versions are submitted after March 1, 2025, Noridian will send the provider a Request for Information directing them to use the new forms.
For questions, email NDMedicaidEnrollment@Noridian.com or call (877) 328-7098 (toll-free) or (701) 328-7098. Live support is available 8 a.m. - 5 p.m. CT, Monday – Friday.
Important tax information
The State of North Dakota is receiving a large volume of returned 1099 tax forms due to incorrect addresses.
Your agency’s 1099 is sent to the billing address on file in the Medicaid Management Information System (MMIS).
To update address information in MMIS, the following forms must be completed:
- Provider Enrollment Coversheet
- SFN 1299 - Group Address Update
You can submit the completed forms to Noridian at NDMedicaidEnrollment@Noridian.com.
Your prompt attention to this matter is appreciated.
Medicaid Expansion eligibility lookup
Medicaid Expansion eligibility can now be viewed in the MMIS portal. Under the Eligibility Confirmation header in the Eligibility Inquiry screen, a red banner will display stating “Eligibility is under ND Medicaid Expansion” if the member has eligibility through Medicaid Expansion. Previously, no eligibility results would display for members eligible under Medicaid Expansion.
Visit member eligibility instructions for detailed information on how to check member eligibility in the MMIS portal.
Convert sports physicals to well-child checks. Don’t forget the fluoride varnish
School is slowly winding down, but families will soon be getting sports physicals for fall sports.
Help ensure Medicaid-eligible teenagers are getting preventive well-care services by encouraging families to schedule a well-child check when they call your office for a sports physical if the youth hasn’t had a well-child check in the last year. Sports physicals can easily be done as part of a well-child check. To find information, including the sports physical form, visit the North Dakota High School Activities Association website. Learn more on sports physical coverage by visiting the Preventive Services and Chronic Disease Management policy.
ND Medicaid encourages medical providers to integrate fluoride varnish applications into well-child check. The fluoride varnish CPT© code for medical providers is 99188. Fluoride varnish may be applied two times per year for children. If a child is in need of additional fluoride varnish, a service authorization is required. Visit the Health Tracks/Well-Child Checks Provider Toolkit for information on oral health, fluoride varnish and orthodontia.
Revalidation Process
When a provider or organization is due for revalidation, an email will be sent with directions on the revalidation process. Individual providers enrolled in Medicare must submit the SFN 615 Provider Agreement. Facilities or organizations enrolled in Medicare must submit the SFN 615 Provider Agreement and the SFN 1168 Ownership/Controlling Interest and Conviction Information form.
To ensure proper handling of applications, submit all requests to:
Email: NDMedicaidenrollment@noridian.com
For questions concerning Provider Enrollment, contact (877) 328-7098 (toll-free) or (701) 328-7098 option 1 or 711 (TTY).
Health, behavioral health and dental professionals can apply for student loan repayment
North Dakota Health and Human Services is raising awareness about three health care loan repayment programs that are open to qualifying health, behavioral health and dental professionals in North Dakota. These federal and state-funded programs help recruit and retain qualifying professionals to serve underserved populations and rural areas – which is vital to reaching our goal of being the healthiest state in the nation.
Assistance ranges from $22,000 to $50,000 over two to five years depending on the service commitment and health profession. An employer match may also be required. Thirty-two hours a week of direct patient care is required. Applicants must also serve Medicaid members.
Qualifying health professions include:
- Physicians
- Registered nurses
- Pharmacists
- Clinical psychologists
- Dentists and dental hygienists
- Advanced practice providers such as physician assistants, nurse practitioners and others
- Marriage and family therapists
- Certified nurse midwives
- Psychiatric nurse specialists
In addition, these professions can apply:
- Licensed addiction counselors
- Licensed professional counselors
- Licensed clinical social workers
- Behavioral analysts
Full-time direct patient care is required for these programs. Individuals are encouraged to apply now through March 31, 2025.
Participants can include students graduating this year, new health care graduates and established health professionals with student loan debt. Individuals must be licensed to practice in North Dakota and should refer to each loan repayment program for details.
In 2024, 116 eligible North Dakota health professionals participated in these programs and helped meet health-related needs in 28 counties across the state.
Learn more and apply at hhs.nd.gov/health/primary-care-office/nd-health-service-corps.
For questions, contact the Primary Care Office at (701) 328-8674, 711 (TTY), or doh-pco@nd.gov.
Service managers needed for Autism Spectrum Disorder waiver
The Autism Spectrum Disorder (ASD) waiver is looking to increase the number of available service managers across the state to work with children and families who are dealing with an autism diagnosis.
The role of a service manager is to assist members in gaining access to waiver and state plan services as well as medical, social, educational, and other needed services, regardless of the funding source. They also help direct the development of a participant service plan, which is done by having an in-person meeting at the member’s home and identify community resources and which waiver or other additional service(s) would support the needs of the child and family.
The service manager must be employed by a Medicaid-enrolled agency and hold a degree in one of the following:
- Social work,
- Psychology,
- Occupational therapy,
- Physical therapy,
- Child development and family science,
- Communication disorders (includes audiology or speech pathology),
- Special education,
- Sociology,
- Elementary education,
- And must have two years of experience working with children with autism or related conditions.
The service may be approved for up to 16 hours a month at a current rate of $22.13 per 15-minute unit.
Visit the Autism Services webpage for more information or contact Katherine Barchenger, Children’s Waiver Administrator at 701-328-4630, 711 (TTY) or kbarchenger@nd.gov.
Public comment now open on Medicaid 1915(i) State Plan Amendment five-year renewal
North Dakota Health and Human Services (HHS) would like to hear from providers about proposed updates to the five-year renewal of the state’s Medicaid 1915(i) State Plan Amendment. Public comment is being accepted until Friday, March 28 at noon, CT.
The Medicaid 1915(i) State Plan Amendment allows Medicaid to pay for home and community-based services for qualifying children and adults with mental health conditions, substance use disorders and/or brain injuries.
HHS is proposing language updates to align with behavioral health best practices and implementing improved quality measurements that support quality care and services for members.
The draft renewal is online at hhs.nd.gov/1915i. Copies are available upon request.
You can provide public comment in many ways.
Email: stanleycody@nd.gov
Phone: 701-239-8987, 711 (TTY)
Mail: North Dakota Health and Human Services
Medical Services Division
Attn: Cody Stanley
600 East Boulevard Ave., Dept. 325
Bismarck, ND 58505-0250
Fax: 701-328-1544
Timely Filing Policy for Claims Submission
Reminder: ND Medicaid’s Timely Claims Filing policy outlines when original Medicaid primary claims must be received and under what circumstances the 180-day deadline may be extended. The policy covers forms of documentation accepted as proof of timely claim filing.
The policy also explains timely filing circumstances when there is a retroactive member or provider eligibility, claims with third-party liability, Medicare crossover claims and claims submitted for reconsideration.
Friendly Reminder:
As providers, you are responsible for providing proof of timely filing at the time of claim submission. Documents accepted as proof of timely filing include:
- ND Medicaid Transaction Control Number (TCN) AND Remittance Advice Date;
- Medicare/Third Party Explanation of Benefits;
- Letter of retroactive eligibility from ND Medicaid; or
- A returned date stamped claim from ND Medicaid.
If you have further questions, reach out to the Medical Services Call Center at (701) 328-7098, (877) 328-7098, 711 (TTY) or email mmisinfo@nd.gov.
Bendamustine Coverage Updates
Use HCPCS code J9034 - Bendeka 100 mg/4mL vials or J9033 – bendamustine for generic 25 mg or 100 mg vials (do not require service authorization). Belrapzo J9036 and Vivimusta J9056 now require a service authorization.
Bendamustine coverage changes, effective February 1, 2025, are reflected in the 2025 Preferred Drug List.
G2211 Paid at $0.00 Effective January 1, 2025
Under the current billing and reimbursement policies, the HCPCS code G2211—visit complexity E/M add-on will be reimbursed at $0.00, effective January 1, 2025.
Telehealth Changes for 2025
Effective for service dates on or after January 1, 2025, ND Medicaid will accept the new CPT© codes 98001-98015 for Synchronous Audio-Video Evaluation and Management Services. Providers should no longer submit CPT© 99202-99215 with POS 02 or 10 or modifiers GT or 95 on claims for members with ND Medicaid as the primary payer.
See the Telehealth Policy and Telehealth Approved Services on the Provider Guidance, Policies, and Training webpage for full details.
Service Authorization Change for members with Medicare primary
Codes listed on the Drug tab and Acentra tab of the Codes Requiring Service Authorization spreadsheet will no longer require Service Authorization for Medicaid members who have Medicare primary and is a service covered by Medicare.