North Dakota Medical Billing and Payer Rules

Timely Filing in North Dakota Medical Billing and Payer Rules

North Dakota Medical Billing and Payer Rules Surprise Billing vs the Federal NSA

Major Payers

How Does North Dakota Medicaid Billing Work?

North Dakota Medicaid is run by North Dakota Health and Human Services through its Medical Services Division in Bismarck. The division's published contacts are (701) 328-7068, toll-free (800) 755-2604, and dhsmed@nd.gov.

Fee-for-service claims go through the ND Health Enterprise MMIS, the state's Medicaid claims system. The state's MMIS page says it serves enrolled providers in North Dakota Medicaid, the Children's Health Insurance Program and Home and Community-Based Medicaid Waiver services.

Claim status is available in the secure provider portal or by phone through the Automated Voice Response System at 1 (877) 328-7098, option 4. Provider enrollment is handled by Noridian Healthcare Solutions on the state's behalf: applications and documents go to its Fargo address, and the enrollment email is NDMedicaidEnrollment@noridian.com.

Medicaid Expansion covers adults 19 to 64 with household income up to 138 percent of the federal poverty level, and the state's Expansion page sends members to Blue Cross Blue Shield of North Dakota Member Services for coverage questions. Confirm with BCBSND how Expansion claims are submitted and what filing limit applies, because this page cites no source that states it.

What Is the North Dakota Medicaid Timely Filing Limit?

ND Medicaid must receive an original primary claim within 180 days of the date of service. The Timely Filing policy, updated October 2025, cites section 75-02-05-04.7 of the North Dakota Administrative Code and says the clock stops on the date ND Medicaid receives the claim, recorded as a Julian date.

The exceptions all depend on proof, so keep it with the account.

Reconsideration claims carry extra conditions. A replacement, resubmission or void must show the remittance advice date and the TCN of the original claim in the claim notes, so ND Medicaid can see the first claim was on time. The policy lists further extensions, including 180 days from a primary payer's adjustment notice dated after the Medicaid filing period.

Overpayment voids and state-generated mass adjustments are not bound by the limits.

What Counts as Proof of Timely Filing with ND Medicaid?

The policy accepts four documents: the ND Medicaid TCN with the remittance advice date, a Medicare or third party EOB, a retroactive eligibility letter from ND Medicaid, or a returned claim carrying a date stamp from ND Medicaid.

It does not accept reports generated by your office or billing software, claims that were previously denied for timely filing, or a note saying claims were held and not submitted.

The Timely Claim Filing Override Request form is the route when a claim was lost between you and the state. One listed reason is a claim that appeared on an ND Medicaid accepted claim report with no errors but was never processed or returned, and the form asks for the report page that shows your clearinghouse and the acceptance, not only the clearinghouse's own page. Another is a member who gave no ID card, which needs documentation of three attempts to get identification, proof the portal returned no eligibility, and the member's signed statement of no insurance.

The form must be received within 365 days of the date of service or it is not reviewed. The manuals cited here publish no formal appeal deadline for providers, so confirm that in the ND Medicaid provider manual index before you rely on a figure.

Do I Enroll Each Provider and Each Location Separately with ND Medicaid?

Each eligible provider enrolls and bills under its own NPI. The Provider Enrollment policy says providers may not bill under a supervising or peer provider's NPI, and the servicing and billing NPIs must be enrolled on the date of service.

The taxonomy code on the claim must match the code in the provider's enrollment record, or the claim denies. Individual and group taxonomy sets are separate, and the policy asks providers to update their NPPES record within 30 days of adding a taxonomy code.

Ordering, referring and prescribing providers must enroll too, and ND Medicaid cannot pay for a service that needs an order or referral unless that provider is enrolled.

• Effective date: a provider may pick a date up to 90 days before the complete application packet is received. For emergent care, ND Medicaid may approve a retroactive date up to 365 days from the date of service when the application explains why it could not be filed within 90 days and includes medical notes.
• Revalidation: at least every five years, or every three years for DME, non-emergency medical transportation and 1915(i) providers.
• Ownership: changes for owners with 5 percent or more interest must be reported within 35 days, and owners must match between Medicare and Medicaid enrollment.
• Out of state: a provider more than 50 miles from a North Dakota border is out of state and generally needs a service authorization, except for emergencies.

How Should a North Dakota Hospital Bill UB-04 Claims to ND Medicaid?

Inpatient and outpatient hospital claims follow the Hospital Services policy, updated April 2026. In-state prospective payment hospitals are paid inpatient claims under APR-DRG version 39, and the claim cannot be submitted until the patient is discharged or transferred.

Outpatient lines at those hospitals are grouped under EAPG, and all outpatient services for one member on the same day go on one claim. Lines with modifier JW are not reimbursed on EAPG claims. Related outpatient services in the three days before admission fold into the inpatient claim under the 3-day payment window.

A critical access hospital is paid differently from a PPS hospital, so confirm which applies. Check the revenue code and bill type on every claim.

Dual-eligible claims follow Medicare first. With Part A, the inpatient stay is billed entirely on an institutional claim. With only Part B, charges go to Medicare first, then to ND Medicaid on an institutional claim that includes the Medicare payment. The Claims Guidance policy requires Medicare submission before ND Medicaid.

Who Is the Medicare MAC for North Dakota?

Noridian Healthcare Solutions is the Medicare Part A and B MAC for North Dakota, in Jurisdiction F. CMS's list of MACs by state puts North Dakota in that jurisdiction alongside Alaska, Arizona, Idaho, Montana, Oregon, South Dakota, Utah, Washington and Wyoming.

The same CMS list assigns durable medical equipment claims to Noridian's DME MAC D and home health and hospice claims to CGS Administrators in jurisdiction 15.

Noridian's JF Part B site carries the Noridian Medicare Portal login. Under 42 CFR 424.44, a Medicare claim must be filed no later than the close of the period ending one calendar year after the date of service. CMS or its contractor can extend that for an error or misrepresentation by an employee, a Medicare contractor or an agent of the Department of Health and Human Services.

What Is the North Dakota Prompt Pay Law for Insurers?

North Dakota Century Code section 26.1-36-37.1 gives an insurer fifteen business days after it receives a health insurance proof of loss form to pay the claim, pay the uncontested part, deny it, or make an initial request for more information.

If a claim or part of it is contested, the insured or the insured's assignee must be told in writing that it is contested and why. Once the insurer receives the information it asked for, it has another fifteen business days to pay or deny.

The section also directs the Insurance Commissioner to prescribe a standard proof of loss and claim form for all health care services. The section text states no interest rate for late payment, so we state none.

This statute applies to insurers regulated by North Dakota. A self-funded employer plan under ERISA is generally outside state insurance law, so check the plan type before you chase a late payment under it.

Does North Dakota Have Its Own Surprise Billing Law?

CMS recorded that North Dakota has no All-Payer Model Agreement and named no state law governing the out-of-network rate, so the federal independent dispute resolution process sets the rate for insured plans. That finding is in CMS's December 15, 2021 letter to the governor, the Insurance Commissioner and the Medicaid director.

The letter says federal IDR under 45 CFR 149.510 and 149.520 applies to items and services furnished by nonparticipating providers, emergency facilities and air ambulance providers in insured plans, and that North Dakota will enforce the outcome of the federal process. Our state surprise billing laws guide compares states.

The letter is from 2021 and CMS may have updated its information since, so we date the statement. See out-of-network billing and IDR for how we run disputes.

Which Payers Matter Most in North Dakota?

The payers we can show operate in North Dakota are Medicare through Noridian, ND Medicaid fee-for-service through the ND Health Enterprise MMIS, and Blue Cross Blue Shield of North Dakota, which the state's Medicaid Expansion page names for member services.

This page cites no Insurance Department market share report, so it names no other commercial insurers or Medicare Advantage plans and gives no share figures. See our Medicare and Medicaid payer guides.

Compare neighbouring Minnesota and Montana, where the Medicaid filing limits and prompt pay rules differ.

How Do We Handle Billing in North Dakota?

We put the 180-day Medicaid limit on every North Dakota account at charge entry, track the 365-day reconsideration and override windows separately, and keep the TCN and remittance advice date with each claim. Claims are sent within 24 hours of charge entry, and denials are worked within 48 hours.

Out-of-network disputes run through open negotiation and federal IDR with deadline tracking on both. For hospital claims we check bill type, revenue codes and the APR-DRG and EAPG paths before a claim leaves. To review your North Dakota accounts, book a call. See also hospital and facility billing.