Providers are medical or non-medical persons or institutions that provide healthcare services that are paid for by Medicaid. Examples of medical providers include physicians, dentists, and laboratories. Examples of non-medical providers include ambulance services and medical equipment suppliers.
A healthcare practitioner must enroll to become a Medicaid "participating provider." A participating provider is a physician or other medical provider who has agreed to accept a set fee for services provided to members of a specific health plan. Enrolled providers are deemed to be "in-network". Providers can enroll online, or they can enroll by mail.
Once a healthcare practitioner has applied to become a Medicaid provider, the submitted paperwork and provider medical licenses are reviewed by the state department that is officially designated to handle provider enrollments, in order to ensure compliance with federal and state regulations. When the application is approved and accepted, the provider receives a notice that they are an active Medicaid provider. The notice includes a provider number, provider address, payee information, and the effective date of enrollment.
There are various types of medical persons or institutions that provide healthcare services to Medicaid members. Examples of these include:
Many states also have programs where non-medical people provide services to Medicaid members so that Medicaid members can remain in their homes instead of being housed in a nursing facility. Examples of some of these services are:
Information on individual and group providers is collected and stored in North Dakota MMIS Web Portal pages in the following categories:
You can use Provider Application Maintenance in the Providers function of Provider to process provider enrollment applications received electronically or in paper format. The application must go through the approval process before the new provider becomes active.
Using Provider Inquiry in the Providers function of Provider, you can search for and view a provider record in view-only mode, so the record is protected from changes.
Using Provider Maintenance in the Providers function of Provider, you can search for and view a provider record in edit mode.
Letters for enrollment, recertification, termination and maintenance are sent to providers on a predetermined schedule to ensure information is kept up-to-date.
About Provider Inquiry/Maintenance
About Provider Application Maintenance
Version as of 5/16/14.
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