ND Medicaid Provider Newsletter - June 2023

The General Information for Providers manual, Behavioral Health Services Provider manual and the Pharmacy Billing manual have all been updated in the last few months. Visit the Provider Manuals and Guidelines webpage to view the updated manuals.

We expect to have additional updates in July 2023 to these manuals: the General Information for Providers, Behavioral Health Services Provider and Dental.

Check the Provider Manuals and Guidelines webpage so you don’t miss any important updates. We will be highlighting policy changes so providers can more easily identify new and changed language.

Medicaid member engagement is about connecting and communicating with our members to learn from them and create a feedback loop that improves the member experience. 

ND Medicaid wants to:

• Know what it means to be a Medicaid member,
• Explore ways to improve the member experience, and
• Find and elevate the missing voices of our members. 

Member engagement is about communication and connection with our members.

Communication means:

• Using language our members understand in Medicaid information and resources, and 
• Creating materials to help our members understand and use their Medicaid benefits. 

Connection means:

• Collecting feedback from providers and community-based partners, and 
• Hearing from a diverse group of members that will share their member experience. 

If you know a Medicaid member interested in sharing their experiences, please let us know! 

Learn more about Medicaid member engagement and how you can partner in these efforts as a provider by contacting Jen Waldner at jawaldner@nd.gov or (701) 328-8666.

ND Medicaid’s continuous enrollment of members whose coverage was temporarily extended through the COVID-19 public health emergency ended on March 31, 2023. Now, human service zone offices will need to check to see if members still qualify for coverage. This will take place over the next 12 months.  

What providers need to know

• Members may get a pre-filled renewal form that they must complete and return to ND Medicaid during the month before their renewal is due. Renewal forms are sent to a member’s address on file. The envelope looks like this:

• Renewal forms should be completed and returned to the Customer Support Center within 30 days.  

Email: applyforhelp@nd.gov
Mail: P.O. Box 5562 Bismarck, ND 58506

• Members may also complete the renewal process online through the Self-Service Portal (SSP). 

Members who no longer qualify for ND Medicaid may qualify for low-cost coverage through the federal Health Insurance Marketplace. ND Navigators can help find other coverage. Contact them at (800) 233-1737 or www.ndcpd.org/NDnavigator.

How you can help your patients, clients, friends, and family

• Encourage members to update their contact information by contacting the Customer Support Center toll-free (866) 614-6005, 711 (TTY) or applyforhelp@nd.gov.

• Help explain this process and share resources.

• Print and post Stay Covered ND materials found at hhs.nd.gov/StayCoveredND. There are:

  • Videos,

  • Posters, flyers, and other printed materials, and

  • Social media copy and graphics available for you to use.

The updated policy includes adoption of all currently covered Medicare telehealth services, in addition to many ND Medicaid-specific telehealth services such as remote delivery options through the Medicaid 1915(i) state plan amendment. Many services are available audio-only as well. Our provider resources page has a spreadsheet that lists all covered codes and indicates if the service is available audio-only.

New Telehealth Services

We are pleased to announce added coverage of digital health services. These are evaluation and management (E/M) services initiated by a patient that can take place over an appropriate digital platform in a seven-day period.

Practitioners eligible to independently bill Medicaid for E/M services may also bill for audio-only patient-initiated telephone services. These audio-only services will be covered through Dec. 31, 2024. 

Want to learn more?

See the telehealth chapter in the General Information for Providers manual. For behavioral health telehealth services, see the General Information for Behavioral Health Services manual. A webinar on the updated policy was held on May 1, 2023. We’ve made available the recording, presentation slides, and a FAQ.

ND Medicaid expanded coverage for sports physicals as of Jan. 1, 2023.  

How can providers help?  

It’s that time of the year when parents will be calling to have a sports physical scheduled for the upcoming year. Since many kids go several years between checkups - especially if your patient is a teenager, we are encouraging that providers schedule a sports physical within a Health Tracks/Well-Child check. 

When a family calls into your office for a sports physical, encourage them to schedule a well-child visit. This would provide the benefit of having preventive care services and meet all requirements of a sports physical.   

How to bill

ND Medicaid sports physical only - use CPT© code 99429 along with ICD-10 code Z02.5 for billing.   
 
ND Medicaid well-child visit and sports physical at the same visit - bill as well-child only.  

Additional details are available at the General Information for Providers manual on page 130. Note: This is a preventive code and does not require a primary care provider referral.  

Learn more on the Health Tracks provider webpage. 

ND Medicaid is currently undergoing an information technology infrastructure upgrade to our Health Enterprise MMIS (MMIS.ND.GOV) application. This upgrade will require a complete system outage.

All connectivity and access to the system will be shut down during the outage, and we will not be able to accept any inbound traffic, including Batch and Realtime Electronic Data Interchange (EDI) X12 transactions (claims, eligibility inquiries, etc.).

If you are a provider that submits transactions to Health Enterprise MMIS, we ask that you hold, queue or disable all transactions to the MMIS system during this outage.

If any transactions are sent during this outage, they will need to be resent after the system maintenance and outage is complete. 

Below are the dates and estimated times of the outage.  

* This includes all inbound and outbound traffic and individual user interface access to mmis.nd.gov.

If there are any changes to these dates and times, updates will be posted on the ND Medicaid provider updates webpage. 

Thank you for your patience and understanding during this system maintenance outage!  If you have any questions, please reach out to mmisinfo@nd.gov.

Here are answers to some frequently asked questions about the monthly letters (ND-RP-01-0075) Health Tracks PCPs are receiving.  

Why am I getting these letters?

All PCPs who have a panel of patients will receive this letter monthly. The letter identifies patients assigned to them who are due for a Health Tracks/Well-Child Visit.   

What if I don’t provide primary care services or don’t have a primary care panel of patients? 

To be removed from an auto assignment or if you have questions related to the Primary Care Case Management (PCCM) Program or about being a PCP, you can request removal from the list. 

Email or fax your name, credentials and NPI number along with the reason you want to be removed from the list. (EX: Do not want to see primary care patients).   

• Email: dhsmci@nd.gov or 
• Fax:  ATTN: Managed Care at (701) 328-1544  

For all other questions about Health Tracks (EPSDT), please contact the Health Tracks provider outreach team by emailing HTprovideroutreach@nd.gov.  

As early as the first day of kindergarten, we begin signing our name on things. That trend continues through school and the workplace. The signature continues to be a key component in the link between patient, provider and a third-party payor like ND Medicaid.

Your signature, in all acceptable forms, is how you as a provider confirm that the documented services being billed to ND Medicaid have been provided by you or under your supervision. It’s that simple. 

ND Medicaid requires that medical records truly and accurately reflect services provided. A documentation correction cannot overturn an audit finding of an incomplete medical record. Providers in these situations will need to amendment the medical record to ensure accuracy moving forward.

Providers are encouraged to look at signature requirements to ensure that their documentation is fully compliant with the standards set by both Medicare and ND Health and Human Services. The omission of a signature can lead to an audit finding and take backs for services provided. 

ND Medicaid signature guidelines found in its provider manuals are based on Medicare requirements. 

If you are a QSP– listen up! You are now 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.

Attention providers of psychiatric services to youth under age 21 - migration to AssessmentsPro is scheduled for completion on June 20.

Here’s what you need to know.

Who will be affected?

State service providers who have processes using Under 21 Psychiatric Service Assessments as well as hospital and Psychiatric Residential Treatment Facility (PRTF) workers.

How will I know if I am going to be affected by the migration?

There will be email communications for stakeholder outreach, which will include the pre- and post-migration timeline. 

What kind of information will I receive?

You will get regular updates, “how to” instructions, training webinar details and registration information, as well as support resources, web content and user guides. Migration is scheduled for completion on June 20.

Who can I contact if I have questions?

If you have questions, call the ND Under 21 Help Desk at (629) 230-5034 or visit this website.