You use Provider Application Maintenance to process provider enrollment applications received electronically or in paper format.
You can also add additional service locations for an active provider, which will copy a provider's information into a new set of records for the new enrollment application. This application must go through the approval process before the new provider service location becomes active.
An application workflow correspondence record (CR) is created in Contact Management upon receipt of the electronic or paper enrollment applications, which alerts you to process, review, update, and track the status of applications.
Providers are encouraged to submit their enrollment applications using the portal. At the time the provider submits their application, a CR is created by ND MMIS for tracking purposes, the unenrolled provider is assigned an entity ID, and the submitted application status is set to Pend Provider.
The electronic application process still requires the providers to mail in supporting documents (licenses, signature page, and others as determined by provider type). When the hardcopy documents are received:
Providers can still enroll using paper copies of the application. A new, unenrolled provider calls and requests a paper application. Medical Services creates a CR and obtains an entity ID that is assigned to the unenrolled provider. This entity ID is written on the first page of the application package that is assembled and mailed to the unenrolled provider. Once the application is mailed, the CR is then closed.
When the completed paper application is returned with all its supporting documentation from the provider, you can:
Providers can also download the application from the North Dakota MMIS Web Portal and print and complete it. In this case the paper application is received without an entity ID. This paper application is sent to Medical Services, and the provider's entity ID is obtained from ND MMIS. If an entity ID does not exist in ND MMIS, then a CR is opened to an established entity ID. A CR is also opened and the CR number is written on the top of the application. Then the application and all supporting documents are scanned, imaged, and stored in EDMS. ND MMIS links the imaged documents to the CR and alerts you to claim the CR.
Once you claim the CR, search for the application using Provider Application Maintenance in the Providers area of the Provider function.
Paper applications use essentially the same Provider Enrollment pages that the providers use if they choose to submit their application using the portal. You access the Individual or Group Provider Enrollment pages using the links that exist on the Provider Application Search page. Then you enter the entity ID of the unenrolled provider, so the system can link that entity to the provider entity that is created within the application process. The user must also enter the date the paper application was received.
An application tracking number (ATN) is generated when the application information is successfully saved. A note is added to the CR to identify the ATN that was generated at the time the paper application was submitted. The number is also added to the imaged application in EDMS. This number is important because it is used to access, update, and track an application throughout the rest of the provider application maintenance process.
Using the Provider Application Maintenance pages, you can find out the status of an application, verify information on the application, and edit information as needed.
For paper or electronic applications, duplicate provider information is resolved on the Enrollment Status page. To check for possible duplicates, you validate the application. ND MMIS checks the application against the Social Security number or employer identification number on applications in progress and for enrolled providers. If a match is found, the Duplicate Data table is displayed. If duplicate information is found, you must research the issues. Depending on the results of your research, you have two options. If you determine that the application being edited is for a provider whose application is already in progress or who is already enrolled, you can cancel the application. If you find that the application is not duplicating a provider, you can override the duplicate. The duplicate validation step is required before the application can be approved.
You use the Events page to track the progress of processing an application. The event codes posted on the Events page indicate what has been done with the application. Event codes may be automatically generated and posted by the system, and you can manually add them. You can identify system generated codes because they start with an S (S002 - Paper application received by DHS), while manually entered codes start with an M (M180 - Application is ready for State Approval). The overall status of the enrollment application is displayed in the Tracking Status pod. Certain event codes automatically update the overall application status. For example, when you post event code M010 - Application Missing Information, the application status is automatically changed to Pend Provider.
To complete the application, you must verify that all required information is received, current, and correct. As the necessary supporting documents are received, update the Required Attachment page. The information required for an application to be considered complete varies based on several factors including the type of provider that is requesting enrollment and whether the provider is requesting electronic funds transfer (EFT). Information that you commonly need to verify include licenses and certifications, W-9, and service location addresses.
Once an application is submitted it can be canceled at any time prior to approval or denial. You might cancel an application because you determined it to be a duplicate or because the provider did not send required information by the deadline. When an application is canceled, it can be recalled using the ATN at a later time. If necessary, the application process can then restart; for example, when required information is subsequently received.
When all necessary information has been received and verified, the provider enrollment or relations staff completes the application on the Approval page. Then the system performs a final validation of the application. If issues are encountered, the system displays a message and you can correct the issues, return to the Approval page, and click Complete again.This procedure can be done until all issues are corrected.
After validation edits are run, the provider information is checked against the Office of the Inspector General (OIG) sanctions database. This database is routinely updated with files downloaded from the OIG containing providers who are currently sanctioned and those who have been reinstated. If the Social Security number or the employer identification number of the enrolling provider or a managing employee is found, Medical Services sends the CR to the Surveillance and Utilization Review System (SURS) to investigate.
Next, if the provider has a previous ND Medicaid provider number, which you can find on the page containing identifying information, the enrollment application is checked against the inactive converted provider record to reconcile the information on the application with the converted information. This is done to make sure that the previously converted information and all of the most current information captured on the application are reconciled. If the information in the converted record and on the application match exactly, no action is required. If a discrepancy is found between information on the enrollment application and the converted provider records, you must research the issue and decide how to proceed before you can complete the application. An example of a discrepancy might be a service location listed in the enrollment application that is not found in the converted provider record. In this case, you might determine that this is a new location for the provider and it needs to be added to the provider's record. In the Override field, you can select New, and the service location becomes a new active provider, with no historical records. You might also determine after your research, that the information on the enrollment application is more current or accurate than what is in the converted provider record, in this case you can select Apply to Previous and the information is updated on the converted provider's record. You can continue to research, update the Override field, and click Complete until all previous provider match discrepancies are addressed. If the application being approved includes multiple service locations, each location's information is compared to its associated converted records and the results are displayed in the Previous Provider Match panel. The provider record is active once the application is Approved and includes the information collected and assigned during the enrollment process.
Finally, once you've resolved any validation and previous provider match issues, you route the CR to management as appropriate.
Medical Services management determines whether the application is approved or denied. When you approve or deny an application, it applies to all locations existing on that application. You access the Provider Application Maintenance Approval page to complete the following steps as needed:
Approve - First add information to the application as needed. For example, on the Financial page you can enter In-Kind information. Repeat the steps on the Enrollment Status page to check for duplicates, and then click Complete again on the Approval page. Next you click Approve, enter the Enrollment Effective date, and then you can add the provider to the appropriate networks. Finally, click Confirm Approval. ND MMIS assigns the provider a ND Medicaid provider number. A welcome letter is sent to notify the provider of approval and it includes their ND Medicaid provider number. The letter also lists any affiliations the provider may have. For example, if Group Provider A is affiliated with Individual Provider B and Individual Provider C, the welcome letter for Group Provider A lists both affiliations. The welcome letters for Individual Provider B and C only show Group Provider A as an affiliation. The approval date displays automatically when the application is approved.
Note: If the application includes multiple service locations, each service location is assigned a new ND Medicaid provider number, but only one welcome letter is sent to the mailing address of the primary location.
The provider application is kept in provider application maintenance for historical record. However, once approved, all future updates to the provider's record are done in Provider Maintenance.
Business entities that submit or receive electronic transactions to or from ND MMIS must be enrolled as trading partners. This may include providers themselves, in which case providers need only complete the regular provider enrollment application process indicating that they will act as their own billing agent by including vendor software information. See What Is a Trading Partner? for more information
How to Search for a Provider Application
How to Add an Individual or Group Provider Enrollment Application
How to Add an Additional Service Location Provider Enrollment Application
How to Edit a Provider Enrollment Application
How to Approve or Deny a Provider Application
Provider Application Search Pages
Edit, Approve or Deny Provider Application Maintenance Pages
Add Group Provider Enrollment Applications Pages
Add Individual Provider Enrollment Applications Pages
About Provider Inquiry/Maintenance
Version as of 5/16/14.
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Before an application is finalized, its status can indicate where it is in the process.