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ND Medicaid Provider Newsletter June 2022

Photo credit: Poppy Mills

Welcome to the North Dakota Medicaid Provider newsletter. We hope this newsletter provides you with important and beneficial information about the North Dakota Medicaid Program. If you have any suggestions for future articles, please send your ideas to dhsmed@nd.gov.

In this edition, you can learn about:

  • New timely filing policy,
  • Efforts to increase access to preventive health care services for children,
  • Benefits of primary care providers applying fluoride varnish during well-child visits,
  • New timely filing policy,
  • Upcoming training for Medicaid 1915(i) providers,
  • Opportunity to provide input on a new Department of Health and Department of Human Services website, and more!

Thank you for being a North Dakota Medicaid provider and serving our Medicaid members.

New timely filing policy

On Jan. 1, 2022, ND Medicaid implemented a new timely claims filing policy for claims with dates of services 01/01/2022 going forward.

This change was made to decrease the amount of time between a service being provided and the provider being reimbursed for that service.

Medicaid providers now have 180 days from the date of service to submit an original claim for payment. Originally, providers had 365 days from the date of service to submit a claim.

See the policy for exceptions to the 180 day timeframe.

NEW Health Tracks provider outreach team aims to increase access to preventive health care services for children

To support the department’s key priority - strong, stable families, ND Medicaid is creating a provider outreach team to improve the health and well-being of North Dakota children.

The impact of the pandemic has caused a delay or avoidance in children getting preventive care services that support their physical, mental, and emotional health and well-being.

This initiative aims to build stronger relationships with providers who can encourage families to have their children complete a yearly Health Tracks screening at local public health or a well-child visit with a doctor.

Health Tracks provides preventive health services to children birth through 20 years old who are enrolled in ND Medicaid. These include exams, hearing/vision checks dental visits and fluoride varnish applications, behavioral health screenings and other important health services.

How you can participate

We encourage your support in this effort by identifying a contact from your practice that provides health care and preventive screenings to children and youth populations.

Email the person’s name, title, email address and phone number to HTprovideroutreach@nd.gov.

In coming months, our provider outreach team will connect with that person and provide support and resources to help your practice increase well-child visits that benefit ND Medicaid children.

If you have any questions, please give our team a call.

Health Tracks Provider Outreach Team

Bailey Smith 701-795-3987

Cheri Langei 701-239-8976

Laurie Kramer 701-253-3021

Fluoride varnish: What primary care providers can do to help support children’s oral health

ND Medicaid and the ND Department of Health’s Oral Health Program are teaming up to encourage primary care providers who conduct Health Tracks or well-child visits to apply fluoride varnish to a child’s teeth during their appointment. This simple step can decrease cavities and improve a child's oral health.

Studies show fluoride varnish prevents almost 40% of cavities in primary teeth.

On Jan. 1, 2022, ND Medicaid increased the fluoride varnish limit to three applications per calendar year. This allows dentists to provide two applications and a primary care provider to apply an additional application.

Fluoride varnish is safe, inexpensive and effective. It also strengthens tooth enamel and stabilizes and prevents existing cavities from getting worse.

Provider Resources

ND Medicaid has developed resources for primary care providers on fluoride varnish applications.

These include:

  • Informational sheet,
  • Dental fluoride varnish payor comparison and
  • Medicaid fluoride varnish coding guideline.

Training is also available on how to apply fluoride varnish. Free continuing education units are available through the Smiles for Life Curriculum.

If your practice has questions or is interested in learning more about applying fluoride varnish, contact Jodi Hulm at 701-328-2323 or email jmhulm@nd.gov.

Insufficient documentation errors: What are they and how you can avoid them?

Insufficient documentation is a leading cause of claims errors. Effective and complete documentation is necessary across the entire health care spectrum.

Insufficient documentation errors occur when the medical documentation submitted is inadequate to support payment for the services billed. For example, a reviewer could not conclude that some of the allowed services were actually provided, were provided at the level billed, or were medically necessary.

Specific documentation components are required as a condition of payment, such as a physician signature on an order or a form that is required to be completed in its entirety. When components such as these are missing, they are identified as insufficient documentation errors.

Other insufficient documentation errors include:

  • Incomplete progress notes (i.e. unsigned, undated, insufficient detail)
  • Unauthenticated medical records (i.e no provider signature, no supervising signature, illegible signature or attestation to identify the signer, an electronic signature without the electronic record protocol or policy that documents the process for electronic signatures)
  • No documentation of intent to order services and procedures (i.e. incomplete or missing signed order or progress note describing intent for services to be provided)

IMPORTANT: If there is insufficient documentation on claims that have already been adjudicated, reimbursement may be considered an overpayment and the funds can be partially or fully recovered.

Provider Resources

Here are some resources to help ND Medicaid providers avoid insufficient documentation errors.

Announcing new Medicaid 1915(i) training and technical assistance opportunity for providers

Starting in August, the North Dakota Department of Human Services, in partnership with the Corporation for Supportive Housing (CSH), will be offering a six-week Medicaid Academy that focuses on providing services through the state’s Medicaid 1915(i) State Plan Amendment.

This training opportunity will help new Medicaid 1915(i) providers:

  • Complete their group and individual provider enrollments,
  • Develop policy and procedures,
  • Update their business model to incorporate Medicaid billing, claims submissions and more.

The Medicaid Academy is also available for providers who have started the enrollment process and for those who are currently enrolled but need technical assistance.

In addition to the six weekly training sessions, providers will have the opportunity to join a weekly technical assistance call and connect by email with a member of the CSH team for any additional technical assistance needs.

To register or to learn more about the Medicaid Academy, contact Monica Haugen, Behavioral Health Division Medicaid 1915(i) program administrator at mohaugen@nd.gov.

Medicaid Medical Advisory Committee seeks new members

We need you! There are openings on our Medicaid Medical Advisory Committee. The committee provides feedback and guidance to the ND Medicaid program and hears important news and updates from program administrators.

To fill the vacancies, we will be taking nominations for two new members. The nomination process is simple! Send an email to Krista at krfremming@nd.gov that describes the nominee and why they should be a member. The nomination should describe which partner group or individual perspective the nominee represents and their experience with Medicaid. The nominee themselves or a colleague can submit.

Nominations will be accepted through Aug. 5, 2022. We will announce the new members at the Aug. 16 meeting.

Survey opportunity: Your input is welcome on a new ND Health and Human Services website

The Department of Health and Department of Human Services are becoming one agency in September and will have a new website.

We want to make sure the website meets the needs of ND Medicaid providers and other key partners who visit the site.

This survey should take 5-10 minutes to complete. This will help the state of North Dakota better understand its customers. Thank you for your input!

As of May 1, 2022, ND Medicaid is no longer accepting Medicaid primary dental paper claims. Primary dental claims received on paper will be returned to the provider unless an exemption has been approved. Dental providers will be allowed to bill secondary dental claims on paper without an exemption.

Reminder for prolonged E&M coding

HCPCS code G2212 must be used when billing for prolonged evaluation and management (E/M) services which exceed the maximum time for a level five (99205, 99215) office/outpatient E/M visit by at least 15 minutes on the date of service.

Effective Jan. 1, 2021, CPT codes 99417, 99358 and 99359 will not be accepted with 99202 - 99215.

See MLN Matters MM12071 for further information. Claim lines billed as 99417 will be denied for invalid procedure code.

Manual update

The Medication Therapy Management Provider Manual has been updated and renamed Provider Manual for Pharmacy Medical Billing. It now includes additional medical services that may be billed by pharmacies/pharmacists.

Reach for Resilience: Free webinars for health care professionals and leaders

Upcoming Meetings

Medicaid Medical Advisory Committee

  • Aug. 16 – 4 to 6 p.m. CT
  • Nov. 15 – 4 to 6 p.m. CT

Autism Spectrum Disorder Task Force

  • Aug. 29 – 1 to 4:30 p.m. CT
  • Nov. 28 – 1 o 4:30 p.m. CT

Money Follows the Person Program

  • Aug. 9 – 1 to 4 p.m. CT
  • Nov. 8 – 1 to 4 p.m. CT

U.S. Department of Justice N.D. Settlement Agreement Stakeholders

  • Sept. 15 – 1 to 3 p.m. CT
  • Dec. 8 – 1 to 3 p.m. CT