Medicaid Expansion Non-Emergency Medical Transportation (NEMT) Providers

Overview

The BCBSND Medicaid Expansion program provides the opportunity to NEMT providers to coordinate non-emergency medical transportation to and from medical appointments for our ND Medicaid Expansion members when no other transportation source is available.

BCBSND began administering services for North Dakota’s Medicaid Expansion program effective January 1, 2022. NEMT Providers who have credentialed with the North Dakota Department of Human Services (NDDHS) ND Medicaid program can now participate with BCBSND Medicaid Expansion network program.

Jump to section:

How to get started

Requirements to submit claims

Billing requirements

Claim corrections and void requests

Frequently Asked Questions (FAQ)

Member Transportation Requirements

Additional Resources

Questions?

How to get started

1.    Enroll in our network by contacting our Provider Contracting department at providercontracting@bcbsnd.com.
2.    Start transporting members.
3.    Begin submitting claims.

Requirements to submit claims

Claims will be submitted through the Availity Essentials provider portal. Availity Essentials is a secure online portal to submit, review and manage claims.

1.    Review the Availity Essentials provider portal getting started course.

2.    Begin registration on the Availity Essentials provider portal.

• Choose a person to be the administrator for your organization.
• There are two options to register as a NEMT provider through Availity Essentials.
  • A provider who has a National Provider Identification (NPI) number.
    or
  • An atypical provider (a service provider who does not have an NPI number).
    • For questions on Availity Essentials registration, contact Availity Client Services at 1-800-282-4548, Monday through Friday, 7 a.m. - 7:00 p.m.

3.    Once registered through Availity Essentials.

• Availity Essential offers free training, to access training, log into your Availity Essentials account.
• Click on Help & Training or Payer Spaces located on one of the two menu bars.

• Through Help & Training or Payer Spaces, the administrator and provider can find training resources to learn how to submit a claim, review the remittance viewer and administrative responsibilities and tasks.
• Through Claims and & Payments, the provider Administrator will also need to sign up for payment remittance advice notification and electronic funds transfers (EFT) through transaction enrollment.

4.    Providers who are currently unable to complete your Availity Essentials registration, BCBSND Medicaid Expansion will allow NEMT providers to file a paper claim and invoice one of two ways.

• Complete and submit the BCBSND Medicaid Expansion Non-Emergency Transportation, Meals, Lodging Billing Form and include invoice(s) by mail.
  or
• Complete and submit the CMS-1500 paper claim form and include a blank copy of the Medicaid Expansion Non-Emergency Transportation, Meals, Lodging Billing Form and your invoice(s) by mail. Including a copy of the Medicaid Expansion billing form will assist BCBSND in accepting the paper form and processing in a timely manner. BCBSND is not able to provide or complete the CMS-1500 claim form.

• Paper submission also means paper check payment, unless you register in Availity Essential for EFT and sign up for the EFT option. See step 3 for assistance. 

Print and mail the completed Medicaid Expansion Non-Emergency Transportation, Meals, Lodging Billing Form and your internal invoices to:

Blue Cross Blue Shield of North Dakota
Attn: Medicaid Expansion Claims
4510 13th Avenue South
Fargo, ND 58121

Billing Requirements

NEMT providers refer to following procedure codes for billing guidelines.

*ND Medicaid rate is based on the ND Medicaid Non-Emergency Medical Transportation Fee Schedule in effect on the date of transport

*A typical transport involved one base rate per way. There are minimal exceptions to the base rates allowed; for clarification on additional base rates for A0100, A0120 and A0130.

Claim Corrections and Void Requests

NEMT providers may need to correct a claim due to billing errors, by submitting a replacement or void (cancellation) of the original claim.  Providers will follow the appropriate guidelines and timeframes to correct claims.

• Claim corrections must be:
  • Submitted after the original claim has finalized.
  • Submitted within 90 days from the initial/original claim processing date.

Frequently Asked Questions (FAQ)

Member Transportation Requirements

A ND Medicaid Expansion member or authorized representative will contact our BCBSND Medicaid Expansion Customer Contact Center at 1-833-777-5779 two days or more in advance to schedule a ride for a NEMT request for an upcoming appointment. Once the request is authorized, our Customer Contact Center will reach out to the NEMT provider to arrange a ride.

Additional Resources

• The Medicaid Expansion provider manual
• The BCBSND Availity Essentials webpage

Questions?

For general questions, call our ND Medicaid Expansion Customer Contact Center at 1-833-777-5779.

For contracting questions, email providercontracting@bcbsnd.com.

For Availity Essentials registration and electronic claim submission questions, contact Availity Client Services at 1-800-282-4548.