Home care billing · ND
Home care billing in North Dakota
Short answer
Home care billing in North Dakota splits by program. Traditional Medicaid pays personal care and HCBS waiver services fee-for-service to enrolled qualified service providers, and only after the department or its designee has assessed the client and granted prior authorization, with personal care capped at 120, 240 or 300 hours a month depending on need.
Adults in the ACA expansion group are in the Medicaid Expansion plan that Blue Cross Blue Shield of North Dakota runs, which has its own 180-day filing limit and Sandata EVV for home health. A dedicated Remitwright biller keeps each authorization, hour cap and payer route straight, serving North Dakota agencies remotely. Rules for other states are on the home care billing by state page.
Last reviewed by the Remitwright billing team. Editorial policy
Key facts for North Dakota home care billing
| Fact | In North Dakota | Source |
|---|---|---|
| Programs that pay | Medicaid Waiver for Home and Community Based Services (0273.R06.00); Traditional IID/DD Home and Community Based Services Waiver (0037.R09.00); Medicaid Waiver for Medically Fragile Children (0568.R04.00); Children's Hospice Waiver (0834.R03.00); Autism Spectrum Disorder (ASD) Birth through Twenty Waiver (0842.R03.00); State plan personal care (N.D. Admin. Code 75-02-02-09.5); Home health and private duty nursing (75-02-02-08) | 1 |
| How it is delivered | Mostly fee-for-service | 2 |
| Medicare home health and hospice | CGS Administrators, Jurisdiction 15 | 9 |
Programs that pay for home care in North Dakota1
Medicaid Waiver for Home and Community Based Services (0273.R06.00)
Adult day care, adult residential care, HCBS care coordination, homemaker, residential habilitation, respite, supported employment, waiver personal care, adult foster care, chore, community support, community transition, companionship, emergency response, environmental modification, extended personal care, family personal care, home delivered meals, non-medical transportation, specialized equipment and supplies, supervision and transitional living, for people 65 and older and people with physical or other disabilities ages 18 to 64 who meet a nursing facility level of care.
Traditional IID/DD Home and Community Based Services Waiver (0037.R09.00)
Day habilitation, homemaker, independent and residential habilitation, individual and small group employment support, prevocational services, extended home health care, adult foster care, behavioral consultation, community transition, environmental modifications, equipment and supplies, family care option, host home, in-home supports, infant development, parenting supports, remote monitoring and respite, for people of any age with intellectual or developmental disabilities who meet an ICF/IID level of care.
Medicaid Waiver for Medically Fragile Children (0568.R04.00)
Case management, institutional respite, dietary supplements, environmental modifications, equipment and supplies, in-home supports, individual and family counseling and transportation, for medically fragile children ages 3 to 21 who meet a nursing facility level of care.
Children's Hospice Waiver (0834.R03.00)
Case management, respite, hospice, skilled nursing, bereavement counseling, equipment and supplies, expressive therapy and palliative services, for medically fragile children and young people ages 0 to 21 who meet a nursing facility level of care.
Autism Spectrum Disorder (ASD) Birth through Twenty Waiver (0842.R03.00)
Respite, service management, assistive technology, community connector and remote monitoring, for children and young people with autism ages 0 to 20 who meet an ICF/IID level of care.
State plan personal care (N.D. Admin. Code 75-02-02-09.5)
Help with activities of daily living and instrumental activities of daily living so the recipient stays as independent as possible, for recipients the department or its designee assesses as impaired in at least one of bathing, dressing, eating, incontinence, mobility, toileting and transferring, or in at least three of medication assistance, laundry, housekeeping and meal preparation.
Defined in 75-02-02-08 and limited by 75-02-02-09.5, both listed in the sources: payment needs the department's prior authorization, goes only to an enrolled qualified service provider or a qualifying basic care provider, and stops at the hours in the approved service plan, up to 120, 240 or 300 hours a month.
Home health and private duty nursing (75-02-02-08)
Intermittent or part-time skilled nursing from a home health agency, intermittent or part-time RN or LPN nursing, physician-ordered medical supplies, equipment and appliances, and home health aide services under the plan of treatment, given in the recipient's residence other than a hospital or skilled nursing facility, plus private duty nursing for recipients who need more individual and continuous care than a visiting nurse or a facility's nursing staff routinely gives.
Section 75-02-02-08, listed in the sources, requires a physician order, medical necessity and a written plan of care for home health, and counts home health and private duty nursing together toward one monthly visit limit.
How the program is delivered
Mostly fee-for-service. CMS's 2024 state tables list two North Dakota programs: Medicaid Expansion, a statewide managed care organization program under 1915(b) and 1937 authority since January 1, 2014 with mandatory enrollment for the ACA expansion adults, whose benefits include hospice but not state plan personal care, HCBS waiver services or private duty nursing; and PACE, a region-specific program since August 1, 2008 with voluntary enrollment for aged, blind or disabled adults and full duals.2 The BCBSND Medicaid Expansion Provider Manual, cited below, says a member loses expansion coverage on enrolling in Medicare or North Dakota's traditional Medicaid program, so dual-eligible and waiver clients are billed to the state, and expansion claims go to Blue Cross Blue Shield of North Dakota.
Electronic visit verification
North Dakota attested that its EVV system meets section 1903(l) of the Social Security Act for personal care under the section 1905(a)(24) state plan benefit and the section 1915(c) waivers, and CMS's determination letter of January 15, 2021 accepted that attestation, so no FMAP reduction applies to personal care under those authorities.3 Home health is less settled: CMS's table of home health EVV compliance as of January 1, 2024, listed in the sources, shows North Dakota as non-compliant with no approval letter, so check the department's current home health EVV instructions before billing visits. For Medicaid Expansion members, the BCBSND manual tells home health providers who deliver in-home services to use EVV through the Sandata Aggregator, which takes visit data from third-party EVV systems, and to register before seeing members.
Services under EVV3
- Personal care under the section 1905(a)(24) state plan benefit
- Personal care services delivered under the section 1915(c) home and community-based services waivers
Authorizations
By the department. Under N.D. Admin. Code 75-02-02-09.5, no payment is made for personal care unless the department or its designee has assessed the recipient and found impairment in at least one of bathing, dressing, eating, incontinence, mobility, toileting and transferring, or in at least three of medication assistance, laundry, housekeeping and meal preparation, and no payment is made unless the department has granted prior authorization. Approved time runs up to 120 hours a month, up to 240 hours for a recipient who meets nursing facility or intermediate care facility level of care criteria, and up to 300 hours for one impaired in five or more activities of daily living who meets those criteria.5 Payment goes only to an enrolled qualified service provider that meets chapter 75-03-23, or to a basic care provider with a rate under 75-02-07.1. Section 75-03-23-07, cited below, has the individual select a provider from the list and the department's designee issue the authorization to that qualified service provider, and section 75-03-23-06 includes case management among the covered waiver services.
Where the claims go
For traditional Medicaid, to the department after the service is delivered: section 75-03-23-07 lets the department issue a service payment to a qualified service provider that bills it after delivering authorized services. For a service that needed prior treatment authorization that was never secured, section 75-02-02-08 lets the department refuse payment, but it may pay if the provider shows good cause in a request received within twelve months of the date of service, with the related claim still filed within the timely claims submission requirements.6 Medicaid Expansion claims go to BCBSND instead: its manual requires professional (837P) and institutional (837I) claims to be filed electronically to payer ID 55891 within 180 calendar days of the date of service for expansion-only claims, 180 days from a retroactive coverage notice, and 365 days from the date of service when third-party liability is involved; claims outside those limits are denied unless BCBSND or its subcontractor caused the error.
Medicare home health and hospice in North Dakota
CGS Administrators, the A/B MAC for Jurisdiction 15, processes Medicare home health and hospice claims for North Dakota, together with Colorado, Delaware, the District of Columbia, Iowa, Kansas, Maryland, Missouri, Montana, Nebraska, Pennsylvania, South Dakota, Utah, Virginia, West Virginia and Wyoming.9 For North Dakota Medicaid, section 75-02-02-08, listed in the sources, defines home health care services as items and services furnished on a physician order, medical necessity and a written plan of care in the recipient's residence, excluding a hospital or skilled nursing facility, and limits coverage for home health and private duty nursing, on an average monthly basis, to the equivalent of one hundred seventy-five visits, a limit that may be exceeded when medical necessity is documented and the department approves a prior treatment authorization request. The same CMS tables cited above list hospice among Medicaid Expansion benefits, so hospice for an expansion member is billed to that plan.
Common rejections in North Dakota, and the fix
Personal care billed without the department's prior authorization
The fixSection 75-02-02-09.5 bars payment for personal care unless the department has granted prior authorization. Your biller confirms the authorization on file for each client and service before any visit is entered for billing.
Hours billed above the monthly limit for the client
The fixPersonal care is approved at up to 120, 240 or 300 hours a month depending on level of care and the number of impaired activities of daily living. The biller loads each client's approved monthly hours and stops a claim that would exceed them before it is sent.
Service billed by an agency that is not an enrolled qualified service provider
The fixPersonal care is paid only to an enrolled qualified service provider meeting chapter 75-03-23 or a qualifying basic care provider. The biller checks the agency's QSP enrollment and renewal dates and keeps services for a lapsed enrollment out of the queue.
Visit delivered before the authorization was issued to your agency
The fixThe client selects a provider and the department's designee then issues the authorization to that qualified service provider. The biller matches the authorization start date to the first visit and holds anything dated earlier.
Prior treatment authorization never secured for the service
The fixThe department may refuse payment, but it can pay when the provider shows good cause in a request received within twelve months of the date of service. The biller logs the date of service, files the good cause request well inside that year and keeps the claim within the timely claims submission requirements.
Medicaid Expansion claim filed late or sent to the state
The fixExpansion claims go electronically to BCBSND payer ID 55891 within 180 calendar days of the date of service, or 365 days when other insurance is involved. The eligibility check records whether a client is in the expansion group, and the biller routes and dates the claim from that.
Expansion home health visit missing from the Sandata Aggregator
The fixBCBSND requires EVV through the Sandata Aggregator for in-home home health services to expansion members, and providers register before seeing members. The biller confirms the agency's registration and that each visit transmitted before the claim is built.
Remitwright serves North Dakota home care and home health agencies remotely, inside the agency software you already use, with a dedicated biller.
FAQ
Questions from North Dakota agencies
Who authorizes the personal care hours we bill in North Dakota?
Does our agency have to be a qualified service provider to get paid?
Do our Medicaid Expansion clients go to the state or to Blue Cross Blue Shield of North Dakota?
What if a service went out before the prior treatment authorization was in place?
Does EVV apply to our North Dakota home health visits?
Which Medicare contractor pays our home health and hospice claims in North Dakota?
Which programs pay for home care in North Dakota?
Is home care in North Dakota paid through managed care or fee-for-service?
Where do North Dakota home care claims go?
What do you need from us to start billing for our North Dakota agency?
Next step
Get a billing review for your North Dakota agency
Three quick questions, no client data. Tell us your payers and visit volume and we reply in writing with what we would check first.
- Three questions, about two minutes
- No patient data, no software to buy
- A written reply from a biller, not a sales deck
You answer three questions
A billing specialist reads them
A written reply by email
Prefer email? sales@remitwright.com
Request received
Thanks. Your review request is in.
Reference . Quote it if you write to us about this request.
- A billing specialist reads your answers and replies by email.
- If a look at real claims makes sense, we agree read-only access under a BAA first.
- You get a written summary of what is worth working and what it would take. No commitment.
While you wait: see the sample weekly report or read the home care billing guide. You can also download the sample weekly report (PDF).