The capacity to care is the thing which gives life its deepest significance.
Pablo Casals - cellist, conductor
Thank you for caring for our ND Medicaid members every day!
Help kids successfully start the school year
School has started! Help our members get ready for the upcoming school year.
Did you know schools can request free Epi Pens?
Schools may qualify to receive free Epi pens through this program with valid prescriptions. Learn more at EpiPen4Schools. Help get the word out by sharing this information with families and local schools.
Convert sports physicals to well-child checks
Let’s ensure Medicaid-eligible teenagers are getting preventive well-care services, by encouraging families to schedule a ND Medicaid Health Tracks 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 Health Tracks webpage.
Services you should know about
Programs of All-Inclusive Care for the Elderly (PACE)
Do you have a patient that is 55 years of age or older? Are they needing additional help within their home to continue to live independently and safely? PACE may be able to help your patient.
PACE offers many different services such as adult day center, home care, recreational therapy, social services, and transportation to list just a few.
PACE programs are in Bismarck, Dickinson, Minot, and Fargo. For more information, visit the PACE website.
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Children's Hospice Waiver
ND Medicaid can help families who are struggling with the possible loss of their child in the next 12 months.
The Children’s Hospice waiver allows ND Medicaid to support a family and their child while they are still looking for curative possibilities. This waiver provides hospice services to support a child from birth up to their 22nd birthday and the child’s family, when the child remains in their home.
Available services include: case management, three levels of nursing cares (skilled nursing, hospice and palliative), respite, expressive therapy, equipment and supplies and grief counseling both before and after loss of child.
Services are provided by a local hospice agency. Once the child is accepted into the waiver, the child is also eligible for traditional Medicaid to assist with additional medical costs.
You can help families apply for this waiver. Requirements are:
- Complete a waiver application (SFN 743), and
- Have a letter from the child’s primary care provider stating their diagnosis may cause the loss of life within the next 12 months.
Send these to Dara Warkenthien at dawarkenthien@nd.gov. Questions can be directed to Katherine Barchenger, Children’s Waiver Administrator at (701) 328-4630.
Dual Special Needs Plans (D-SNPs) for members enrolled in Medicare and Medicaid
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North Dakota is implementing Dual Special Needs Plans (D-SNPs) on Jan. 1, 2025, per legislation passed in 2023.
Dual Special Needs Plan (D-SNP) are optional Medicare Advantage plans for qualifying individuals enrolled in both Medicare and Medicaid. These plans are designed to coordinate the care among Medicare and Medicaid to improve the member’s quality of care and lower health care costs. D-SNPs can also offer supplemental benefits through Medicaid, which are not typically available under Medicare.
Qualifying D-SNP recipients can continue receiving Medicaid benefits like personal care services and non-emergency transportation. D-SNPs serve as primary Medicare coverage for members followed by ND Medicaid. Medicaid services will continue to pay as Fee-for-Service (FFS) for D-SNP-enrolled members.
North Dakota has more than 13,000 dually eligible individuals, many of whom will meet eligibility criteria and benefit from D-SNPs. Program eligibility, benefits, and service areas may vary for each D-SNP and are specific to each plan.
North Dakota Health and Human Services will partner with private insurance companies overseen by Centers for Medicare and Medicaid Services. D-SNPs are responsible for maintaining the knowledge of ND Medicaid and care coordination outlined by contract.
For more information, visit the Dual Special Needs Plans website or email hhsdsnp@nd.gov.
Members with behavioral health conditions benefit from tobacco cessation counseling and we cover it
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Did you know that individuals with mental illnesses have high rates of cigarette use and high likelihoods of dying from tobacco-related causes.
It is estimated that 24% of individuals with a past-year major depressive episode and 36% of individuals with a substance use disorder smoked cigarettes compared with 16% of individuals without these conditions. Studies show similar or higher levels of motivation to stop smoking among individuals with mental illness compared to other individuals.
Good news - tobacco cessation counseling is covered for all ND Medicaid members!
Service Requirements
Counseling must be provided face-to-face by or under the supervision of a physician or other health care professional who is:
- legally authorized to furnish such services under state law within their scope of practice, and
- enrolled as a ND Medicaid provider.
CPT© Codes
- 99406 – Smoking and tobacco cessation counseling visit; intermediate, greater than three minutes up to 10 minutes.
- 99407 – Smoking and tobacco cessation counseling visit; intensive, greater than 10 minutes.
See the Preventive Services and Chronic Disease Management policy for more information.
Claims Tips
The following tips will ensure your claims are processed and reimbursed in a timely manner.
Paper Claims, Adjustments, and Attachment Criteria
Documents not meeting the following criteria will be returned to the provider.
- Use only black (preferable) or blue ink. No red ink.
- Ensure pages are clean.
- No highlighter or liquid white out.
- No dark smudges, blackouts, or dark print that runs together.
- No stickers, labels, or tape.
- No highlighter or liquid white out.
- One-sided documents only.
- Leave pages loose, do not staple.
- Folded claims should be folded with one third larger than the other two thirds. Don’t fold them evenly! This leaves a small amount of space in the envelope, which allows our envelope opening equipment to cut open the envelope without damaging the claims.
Medicare Primary claims
For members with Medicare, Medicare Supplement or Medicare Replacement/Advantage policy, submit the following claims using the appropriate claim type:
- Inpatient: Claim type needs to be Medicare Part A
- Outpatient: Claim type needs to be Medicare Part C
- Physician: Claim type needs to be Medicare Part B
- Nursing Home/Swingbed/Basic Care: Claim type needs to be N – Nursing Home
What you need to know about Medicaid Expansion provider enrollment
Medicaid Expansion in North Dakota is for adults ages 21 to 64. It is administered by Blue Cross Blue Shield of North Dakota (BCBSND).
BCBSND is currently North Dakota’s only Managed Care Organization (MCO). Enrolling with BCBSND expands the potential pool of patients your practice can serve. There are 25,216 enrolled Medicaid Expansion members as of April 2024.
You must separately enroll with Medicaid Expansion (BCBSND) to serve Expansion members.
Federal law separates these enrollments so enrollment with ND Medicaid does not get automatically transferred to Medicaid Expansion. ND Medicaid providers choose whether they want to also enroll with BCBSND.
Provider enrollment is the formal process used to verify a provider’s education, training, and licensure; banking information needed for direct deposit; employer identification information needed for tax purposes; and outline of expectations for the provider. Below are some common Expansion enrollment questions.
Q: How do I begin the enrollment process?
A: Visit Medicaid enrollment for ND Medicaid enrollment information. Visit Medicaid Expansion for Medicaid Expansion enrollment information.
Q: How long does the enrollment process take?
A: On average, the process takes 30-60 days. Delays can occur if documentation is missing or incorrect.
Q: I already have a contract with Blue Cross Blue Shield of North Dakota. How do I add Medicaid Expansion?
A: You would contact Blue Cross Blue Shield of North Dakota via email at providercontracting@bcbsnd.com requesting an addendum to add Medicaid Expansion.
Still have questions about enrolling as a ND Medicaid Expansion provider? Contact Jared Ferguson, HHS Medicaid Expansion Administrator, jadferguson@nd.gov.
Take advantage of behavioral health trainings
North Dakota Health and Human Services Behavioral Health Division offers a variety of webinars, lunch and learns, mental health provider trainings, and on-demand behavioral health webinars for your convenience.
Upcoming opportunities include The Art of Setting Boundaries webinar on Sept. 17, where attendees will explore what healthy boundaries can look like with our families, friends, co-workers, and ourselves; virtual Peer Support Specialist training from Nov. 4-8, and the Behavioral Health & Children and Family Services Conference (virtual and in-person attendance) from Sept. 16-19 in Bismarck.
See all trainings on the division's training webpage.
HHS is accepting public comment on amendment to Medicaid 1915(c) home and community-based services waiver
Providers: We’d like to hear your feedback on an amendment to the state’s Medicaid 1915(c) Home and Community-Based Services (HCBS) waiver.
The waiver serves older adults and adults with physical disabilities. It pays for a variety of in-home and community-based services that allow people who qualify for nursing home care to remain living in their homes and communities.
The proposed changes would help improve access to these services for qualifying individuals and improve the enrollment process for providers.
Public comment will be accepted until Thursday, Sept. 26, 2024, at 5 p.m. CT.
View the draft amendment and learn how to provide public comment on the Medicaid waivers webpage.
Stay in the know! ND Medicaid provider newsletter subscription
Signing up to receive ND Medicaid’s quarterly provider newsletters is easy.
Step 1: Go to the Provider webpage.
Step 2: Enter your email address and click submit.
Step 3: Follow directions to set up and choose your subscription options. Select Medicaid Provider Newsletter.