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Medicaid Expansion 1915(i) Providers

Overview

The BCBSND Medicaid Expansion program provides the opportunity to Providers who deliver home- and community-based services to individuals with behavioral health conditions for our ND Medicaid Expansion members. These services support individuals to live safely and successfully in the community of their choice and avoid a higher level of care than they need.

BCBSND began administering services for North Dakota’s Medicaid Expansion program effective January 1, 2022. 1915(i) 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.

How to get started

1.     Enroll as a North Dakota Medicaid 1915(i) provider with the State of North Dakota.

a. Make sure to enroll all affiliated clinics and providers who may be rendering services.

b. Enrolled 1915(i) providers choose to offer one or more of the following services: Care Coordination, Respite, Training and Support for Unpaid Caregivers, Non-Medical Transportation, Family Peer Support, Peer Support, Supported Education, Benefits Planning, Pre-Vocational Training, Supported Employment, and Housing Support.

2.     Enroll in our BCBSND Medicaid Expansion network by contacting our Provider Contracting department at providercontracting@bcbsnd.com.

3.     Once you are enrolled, verify the member’s benefit requirements for eligibility to receive 1915(i) services by calling BCBSND at 701-282-1003 during normal business hours.

a. It is the provider’s responsibility to verify a member’s 1915(i) eligibility, reasons for this include, but are not limited to, a member being eligible for Medicaid Expansion but not eligible for 1915(i) services. A member may lose eligibility for 1915(i) services during their treatment. It is the provider’s responsibility to verify a member’s 1915(i) eligibility.

4.      Submit a precertification on behalf of the member through the Availity Essentials provider portal.

Things to note for precertification/authorization requests:

a. The request should be submitted prior to seeing the member.   

b. Authorizations can only start the date the request is received.

c. The provider’s name on the request should be the practice name, not the individual rendering the service.

d. If the authorization is incomplete and missing information necessary to complete the request, a fax will be sent back to obtain the information to the number listed on the initial authorization request.

e. If you have a question on your request or need the status of your request, call the Utilization Management department by calling 1-800-952-8462.

5.    Start seeing members.

6.    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.
  • Sign up as provider who has a National Provider Identification (NPI) number.
    • For questions on Availity Essentials registration, contact Availity Client Services at 1-800-282-4548, Monday through Friday, 7 a.m. – 7 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.
  • The BCBSND Availity Essentials webpage, listed in the Additional Resources section below, also has additional information regarding functionality, and how to search for training materials.

Billing Requirements

1915(i) providers should refer to the policies and/or procedures outlined on the www.bcbsnd.com website as applicable.

*The allowance on a claim is based on the ND Medicaid 1915(i) Fee Schedule in effect on the date of service.

Claim Corrections and Void Requests

1915(i) 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 remittance date.

Frequently Asked Questions (FAQ)

Additional Resources

You can utilize the table of contents within the Medicaid Expansion provider manual to find additional helpful information.

Questions?

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

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