Adults and Aging Qualified Service Providers (QSP)

Medium

Subscribe to the QSP Newsletter to receive news and updates sent directly to your email address

Enrolling as a Qualified Service Provider

Qualified Service Providers or QSPs are individuals or agencies that provide services to clients who receive services funded by North Dakota Health and Human Services.

People who qualify for home and community-based services can choose among available qualified service providers that offer competitively priced services.

QSPs are independent contractors that have met certain competency standards required to provide services to eligible clients.

The new QSP enrollment portal is here! Visit the portal now to start your enrollment application.

 

Access the QSP Enrollment Portal

Medium
Medium

Medium

Enrollment Assistance and Resources

Do you need help understanding or completing the enrollment forms or have questions about how to enroll?

The QSP Hub provides support, educational tools, and training opportunities to walk QSPs and QSP agencies through all stages of the QSP process.

Access the QSP Hub

Medium

Posted 10-17-2023

Claims guidance for when members lose and regain Medicaid eligibility 
On April 1, 2023, North Dakota began verifying coverage for regular Medicaid individuals whose coverage was temporarily extended due to the COVID-19 public health emergency.

Some Medicaid members may lose coverage if they do not return information that is needed to process their renewal.

If members lose and then regain eligibility, QSPs will have 180 days from the date the member’s eligibility was updated to resubmit claims that were previously denied because of no member eligibility.

QSPs can verify member eligibility by:

  1. Logging into ND Health Enterprise MMIS https://mmis.nd.gov/portals/wps/portal/EnterpriseHome. Click on the Member tab, then select “Check Eligibility."
  2. Using the Automated Voice Response System (AVRS); Call (877) 328-7098, Option 1.
  3. Calling the Provider Relations Call Center at (701) 328-7098 or (877) 328-7098.

Posted 6-21-2023

As a QSP you are required to revalidate (renew) your enrollment every five years instead of every two years!

Why revalidate?

Revalidations must be done to maintain QSP enrollment. If you do not revalidate your QSP enrollment, it may result in automatic closure of your QSP enrollment. Payments will be stopped if ND Medicaid does not get your completed revalidation packet by the due date.

How will I know if I need to revalidate?

A notice of revalidation will be sent to you before your QSP enrollment expires. Agency revalidation will be sent by email. All other revalidation information will be sent by mail. It is your responsibility to ensure all forms are correct and returned in a timely manner for processing. 

How do I revalidate?

Revalidations require much of the same paperwork you used for your initial enrollment. You must complete and submit a new forms packet and all required documentation. Some services require additional forms to complete revalidation. Make sure you are using the most current forms version!

Specific changes can be found in the Agency, Individual, Family Home Care and Family Personal Care QSPs handbooks.

Click here for QSP Q&A and other information on COVID-19.

IMPORTANT: QSP drop boxes for paper claims are located to the department's Prairie Hills Plaza building located at 1237 W. Divide Ave. - use Door #2, and the department's main office at the State Capital, 600 E. Boulevard Ave., Judicial Wing - third floor, Bismarck.

NEW: North Dakota QSP Hub - North Dakota’s centralized source of support and information for qualified service providers.

  • Get one-on-one individualized support by email, phone, or video conferencing with enrollment questions, service authorizations, electronic visit verification (Therap), documentation, billing processes, renewals and MORE!

Informational packet for NEW QSPs (330kb pdf) (August 2024)

Billing Instructions

Paper

Online

Claims Questions?

  • When will I get paid?
  • The "Informational packet for NEW QSPs" above has contact information and instructions for:
    • Automated Payment Line
    • MMIS Call Center
    • Therap
    • QSP Hub
    • How to voiding and replace claims
    • How to reset passwords
    • How to bill in Therap
    • How to bill in MMIS

QSPs / Explanation of QSP Billing Codes

Computer-Based Training

Various Links

Outreach/Educational Material

This application should not be completed unless you have already been in contact with a case manager or your client has already been approved for this service.

Family Home Care Provider (FHC) (September 2024) 

Family Personal Care Provider (October 2024)

When you enroll as a QSP, you choose the services you want to provide. All services have a number called a billing code that is used to submit a claim for payment to Health and Human Services. An explanation of billing codes includes important information about each service, how to document your time and certain requirements for each task. The information also gives you tips for how to bill.

Click here to view the billing codes.

Individual Service Provider (ISP) Training in Therap - Jan. 29, 2024
QSP Onboarding Training                                                                                                                          
T1020 Attendance Billing Training (Feb. 26, 2024)
ONLINE TRAINING - Fraud, Waste and Abuse

Claiming Your Account and Maintenance Requests (Aug. 12, 2024)

QSP Maintenance Training (Aug. 12, 2024)

Connect to Care - Individual QSPs (Sept. 26, 2024)

Connect to Care Overview (Sept. 26, 2024)

Nurse Educator Training-Extended Personal Care Services - (Oct. 16, 2024)

 

Aging Services is responsible for licensing Agency Foster Homes for Adults (AFHA). The purpose of an AFHA is to provide a residential setting where four or fewer Medicaid waiver recipients live together and are receiving Residential Habilitation or Community Support services. All referrals to receive Residential Habilitation or Community Support services in an AFHA must go through the Aging & Disability Resource Link (ADRL) intake process by calling phone #855-462-5465, and then be assigned to a  HCBS case manager to determine eligibility for services in this setting.

Providers interested in developing an AFHA should contact the ADRL.  This setting can only be licensed to assist Medicaid eligible individuals. An AFHA cannot accept individuals who private pay for services.

List of providers:

Prairie Home & Health, Mohall ND                                  prairiehomeandhealth@yahoo.com

Prudent Home Care, Bismarck & Mandan, ND              coker2991@gmail.com

Lake Region Corporation, Leeds, ND                               jjacobson@lakeregioncorp.com

Blessed Homes LLC, Jamestown, ND                               georgeblessing24@gmail.com

A Place to Call Home LLC, Fargo, ND                               info@aplacetocallhomecare.com

Ebenezer Agency Foster Home, Horace, ND                  wiltontravers@gmail.com

Shepherd Homes LLC, Horace, ND                                  shepherdhomesmn@gmail.com

Blossom Services Group, West Fargo, ND                      info@blossomservicesgroupllc.com

Home Instead, Bismarck, ND                                           erin.sorensen@homeinstead.com  

Frequently Asked Questions pdf

Question: What is a Home & Community-Based Services (HCBS) Provider Navigator?

Answer: A HCBS Provider Navigator assists HCBS case managers and Community Service Coordinators (CSCs) in finding a Qualified Service Provider (QSP) Individual and/or Agency(ies) to provide services to recipients that choose to remain in their own home and community.

Question: How do the HCBS Provider Navigators Assist the HCBS case manager and/or CSC? 

Answer: The HCBS case manager and/or CSC will send a referral(s) to the HCBS Provider Navigator if the recipient that needs in-home services wants help in finding a QSP Individual and/or Agency. If the recipient that needs in-home services already knows who they would like for an QSP Individual and/Agency the HCBS case manager and/or CSC will not send a referral to the HCBS Provider Navigator. So, this can limit the number of referrals that the HCBS Provider Navigator receives which will lead to limit number of emails going to out to QSP Individuals and/or Agencies. 

Question: What happens when the HCBS Provider Navigator Receives a Referral from the HCBS Case Manager or CSC?

Answer: The HCBS Provider Navigator: • Will review the referral received from the HCBS case manager and/or CSC for completeness, what services the recipient has been approved for, and if the recipient wants a QSP Individual and/or Agency. • Then will send an email to only the QSP Individuals and/or Agencies that have signed up to provide those services and are located in the community where the recipient resides. If there are no QSP Individuals and/or Agencies located in the community where the recipient resides the HCBS Provider Navigator will send an email to additional QSP Individuals and/or Agencies that have enrolled with the State to provide services in the county and are willing to drive.

Question: What happens when the QSP Individual and/or Agency accepts a referral from the HCBS Provider Navigator? 

Answer: When a QSP Individual and/or Agency accepts a referral the HCBS Provider Navigator will send out an acknowledgment form that must be filled out the QSP Individual and/or Agency before officially acquiring the referral. The acknowledgment form is letting the HCBS Provider Navigator, HCBS Case Manager, and/or CSC know that you have staff located in that community where the recipient resides and/or have staff willing to drive to provide the needed services. Question: How come some QSP Individuals and/or Agencies are receiving more emails with referrals from the HCBS Provider Navigator? Answer: The HCBS Provider Navigator has a spreadsheet with all the QSP Individuals and Agencies. That spreadsheet contains what counties the QSP Individual and/or Agency selected when they registered with the state, what services they provide, and contact information. Based on the location of where the recipient is located will determine the number of QSP Individuals and/or Agencies that will receive an email from the HCBS Provider Navigator. 

• I.e. If the recipient is located in Bowman, ND there are a limited number of QSP Individuals and/or Agencies that provide services there so the HCBS Provider Navigator will send an email out to all the QSP Individuals and Agencies that have stated they provided services there. If none of the QSP Individuals and Agencies respond within 24 hours, then the HCBS Provider Navigators will send an email out to other QSP Individuals and Agencies that are willing to travel from another town (located in Dickinson and willing to drive to Bowman). 

• I.e. If the recipient is located in Fargo, ND where there is an abundance of QSP Individuals and Agencies the HCBS Provider Navigator will send an email out to a limited number of QSP Individuals and Agencies that meet the criteria of the referral such as: 

  • How many units have been approved by the HCBS Case Manager.
  • What QSP Individual and/or Agency provide all or the majority of services the recipient needs. 
  • What QSP Individuals and/or Agency has already received a referral. 

QSP Individuals and/or Agencies will have 24 hours to respond back to the HCBS Provider Navigator. If there are no responses in 24 hours the HCBS Provider Navigator will send an email out to additional QSP Individuals and/or Agencies. If multiple QSP Individuals and/or Agencies respond with a "yes" in the 24 hours that they will accept the referral and have not received one from the HCBS Provider Navigator. The HCBS Provider Navigator will send all the “yes” responses to the HCBS Case manager/CSC. The HCBS Case Manager/CSC will then contact the recipient that will be receiving in-home services to discuss all the QSP Individuals and/or Agencies to provide all the options. This will allow the recipient to choose who they would like to accept as their provider.

Question: How is the HCBS Provider Navigators ensure no QSP Individuals and/or Agencies are receiving more referrals where there is an abundance or providers? 

Answer: The HCBS Provider Navigators track all counties. The counties that that have an abundance of QSP Individuals and Agencies have additional tracking measures to ensure no QSP Individual and/or Agency is being favored over another one. The counties that have an abundance of QSP Agencies have the additional tracking measures like: • Which QSP Agency was sent an email from the HCBS Provider Navigator. 

  •  Which QSP Agency responded back stating "no" they were unable to accept the referral. 
  • Which QSP Agency has already received a referral. 
  • Which QSP Agency responded back stating “yes” they could accept the referral but did not get the referral as it went to another agency. 

The HCBS Provider Navigator will put the QSP Agencies on a rotation of when an email will be sent to them, and it will vary on the number of Agencies that are enrolled in that specific community. I.e. Fargo as of August 1, 2024, have 80 QSP Agencies so they there will be a rotation of 10 QSP Agencies at a time. 

Question: What hours do the HCBS Provider Navigators work? 

Answer: The HCBS Provider Navigators are full-time State employees. Hours of operation are Monday through Friday 8:00am to 5:00pm. The navigators are not available when State offices are closed during the recognized State approved 10 holidays. 

Question: How do I reach a HCBS Provider Navigator? 

Answer: The HCBS Provider Navigators can be reach via email at qspnavigator@nd.gov. 

Question: Why can’t I open my email that came from the HCBS Provider Navigator? 

Answer: All emails sent by the HCBS Provider Navigator are secure as they contain protected health information (PHI). As a QSP Individual and/or Agency it is your responsibility to ensure you have the technology capable to open the email.

Question: How come another QSP Individual and/or Agency received an email with a referral from the HCBS Provider Navigator and I did not? 

Answer: If you did not receive an email from the HCBS Provider Navigator with a possible referral might be due to: 

  • The recipient is looking for a certain provider. 
  • The recipient does not care for their current provider. 
  • You as a QSP Individual and/or Agency do not offer the services that the recipient needs. 

Emails that are only sent specific QSP Individual(s) and/or Agency(ies) by the HCBS Provider Navigator cannot be shared with other QSP Individual(s) and/or Agency(ies). All emails are confidential and by sharing them you as the QSP Individual and/or Agency would be in violation of HIPPA.

Question: How come I as a QSP Agency am not getting referrals where the recipient requires a lot of services keep my employees busy and at one location? 

Answer: It is the responsibility of the QSP Agency to manage their employees’ schedules to keep them busy. There is no guarantee of what the recipient needs for in-homes services which means there are not a lot of referrals that have large number of units attached.

Question: Do you as a QSP Individual and/or Agency provide services in all the counties in North Dakota?

 Answer: If a QSP Individual and/or Agency only provide services in a certain county it is important that you are only selecting that county in when you enroll to be a provider. If you select counties where you do not intend to provide services could put you at risk for:

  • Receiving a lot of emails from the HCBS Provider Navigator when it is not relevant. 
  • Missing emails because of being overlooked due to receiving so many. If the QSP Individual and/or Agency only select the counties where they intent to provide services might see an increase in emails with possible referrals as the HCBS Provider Navigator would have a better understanding of exactly where you have staff and are willing to provide services.

Question: How do I change what counties I provide services in? 

Answer: If the QSP Individual and/or Agency would like to add or delete counties please reach out to the QSP Hub at North Dakota Qualified Service Provider Hub (ndqsphub.org) and they can assist you.

Question: Is a QSP Individual and/or Agency guaranteed a referral from the HCBS Provider Navigator? 

Answer: No. The HCBS Provider Navigator cannot guarantee that a QSP Individual and/or Agency will receive referrals from the State as the recipient gets to choose who they would like as a provider. It is important that you as a provider are also promoting your services to private pay recipients. 

Question: What is Recipient Liability (RL)/Client Share? 

Answer: The Client Share is the amount you need to pay toward your medical costs for the month. Your Client Share is based on how much you make every month. It is like an insurance policy deductible. If you would like additional information please refer to ND Medicaid’s FAQ page at Medicaid Frequently Asked Questions | Health and Human Services North Dakota.

Question: What are Service Payments for the Elderly and Disable (SPED) fee? 

Answer: The SPED fee is the amount a recipient is required to pay toward the cost of their services. 

Question: Who is responsible for collecting the RL, SPED fee, or any other fees? 

Answer: It is the responsibility of the QSP Individual and/or Agency to collect the RL, SPED fee, or any other fees from the recipient. The State will not collect the RL, SPED fee, or any other fees from the recipient on your behalf in order to receive the in-home services. 

Question: How does the QSP Individual and/or Agency know if the recipient has an RL or other fees? 

Answer: The QSP Individual and/or Agency is notified right away in the email that is sent by the HCBS Provider Navigator if the recipient has an RL or other fees. The RL and other fees will be written in the service auth that is provided to the QSP Individual and/or Agency from the HCBS case manager.

 

QSP - CNA Renewal (October 16, 2024)

Medium

Sign Up for our ND QSP Newsletter

Enter your email address and click submit. This will take you to a new page. Scroll down to the Adult and Aging heading and select ND QSP Newsletter. You can also select other topics you'd like to receive updates on.