State · ND
Medical billing services in North Dakota
Short answer
Medical billing services in North Dakota split along one line: whether the patient is in traditional Medicaid, paid fee-for-service by North Dakota Health and Human Services through the ND MMIS web portal, or in Medicaid Expansion, the state's only full-benefit MCO, run by Blue Cross Blue Shield of North Dakota with 23.2 percent of enrollees in CMS's 2024 count.
Expansion claims must reach BCBSND electronically within 180 calendar days of the date of service, Expansion rides come from state-enrolled NEMT providers, and home health agencies send Expansion visit data through the Sandata Aggregator. A Remitwright dedicated biller works those rules, serving North Dakota practices remotely. Rules for other states are on the medical billing services by state page.
Last reviewed by the Remitwright billing team. Editorial policy
Billing in North Dakota: what's different
The rules below change how a claim is filed and paid in North Dakota. Each line links to the official page it was read from, and the date at the top of this page is when it was last checked.
| Fact | In North Dakota | Source |
|---|---|---|
| Medicaid program | North Dakota MedicaidNorth Dakota Health and Human Services (HHS), Medical Services Division | 1 |
| Fee-for-service portal | ND MMIS Web Portal | 1 |
| How Medicaid is delivered | Mostly fee-for-service | 4 |
| Managed care plans | 2 plansNorth Dakota Medicaid Expansion (Blue Cross Blue Shield of North Dakota), Northland PACE | 5 |
| Medicaid Expansion (BCBSND) claim filing limit | 180 calendar days from the date of service | 2 |
| Medicaid MCO prompt pay | 42 CFR 447.46, timely claims payment by MCOs | 11 |
| NEMT | Provider model for Medicaid Expansion | 2 |
North Dakota Medicaid
North Dakota Medicaid is run by the North Dakota Health and Human Services (HHS), Medical Services Division. Fee-for-service claims and provider enrollment go through the ND MMIS Web Portal1, at mmis.nd.gov. Mostly fee-for-service: CMS counted 24,546 of North Dakota's 105,070 Medicaid enrollees, 23.4 percent, in managed care in 2024, and the remaining 76.6 percent were outside managed care4. CMS's 24,546 covers the Medicaid Expansion plan, with 24,356 members, and Northland PACE, with 190, so the Expansion plan alone is 23.2 percent of enrollees; the plan list below gives the split from CMS's plan file.
Medicaid Expansion (BCBSND) claim filing limit: 180 calendar days from the date of service for Medicaid Expansion-only claims, filed electronically as 837P or 837I transactions to BCBSND payer ID 558912. A claim for a member whose coverage was granted retroactively gets 180 days from the retroactive coverage notification, and a claim involving third-party liability gets 365 calendar days from the date of service; anything outside those windows is denied unless BCBSND or its subcontractor caused the error. Corrected claims (frequency type 7) are due within 90 days of the original claim's remittance date, while corrections involving coordination of benefits, workers' compensation, no-fault, subrogation or another third-party payer get 365 days from the date of service. BCBSND also requires a provider to participate with ND Medicaid before it sees an Expansion member, so the practice keeps the state's deadline for traditional claims and the plan's deadline for Expansion claims side by side.
Managed care plans5
- North Dakota Medicaid Expansion (Blue Cross Blue Shield of North Dakota)The state's only full-benefit MCO, statewide, 24,356 members in CMS's 2024 count
- Northland PACEProgram of All-Inclusive Care for the Elderly in specific ZIP codes, 190 members in 2024, 174 of them dually eligible
Each plan is credentialed separately, has its own portal and its own appeal route. A practice that joins North Dakota Medicaid through one plan is not in network with the others until each contract is in place.
Commercial payers and plan payment standards
Commercial payers active in North Dakota9: Blue Cross Blue Shield of North Dakota, Sanford Health Plan, Medica, UnitedHealthcare. Each has its own filing window, corrected-claim process and appeal levels in its provider manual, and the timely filing limits table lists verified payer deadlines with their sources.
For Medicaid managed care, the clean-claim payment standard under 42 CFR 447.46, timely claims payment by MCOs: 90 percent of clean practitioner claims paid within 30 days of receipt and 99 percent within 90 days, the standard 447.46 requires every Medicaid MCO contract, BCBSND's Expansion contract included, to carry unless an alternative schedule is written into the contract11. Receipt is counted from the payer's date stamp on the claim and payment from the date of the check or other payment, so an aged Expansion claim is measured from BCBSND's own receipt date. In A/R follow-up, a managed care claim that is past that standard is raised with the plan, with the contract term cited.
NEMT and home care in North Dakota
Non-emergency medical transportation. Provider model for Medicaid Expansion: NEMT providers enrolled with the State of North Dakota coordinate rides to and from medical appointments for BCBSND Medicaid Expansion members when no other transportation source is available, with BCBSND review and approval in advance, and the manual's meal and lodging provider section points Expansion billing to the NDDHHS coding in the ND Medicaid Non-emergency Transportation Fee Schedule2. Each trip record has to show the member name and Expansion ID, pickup address, date and time of pickup and of the return home, drop-off facility, vehicle type, starting and ending mileage and the member's signature, kept for at least seven years, or the claim can be denied or returned for more information. The NEMT billing in North Dakota page covers trip documentation, broker claims and reconciliation.
Electronic visit verification. Home health providers who deliver in-home services to Medicaid Expansion members must use EVV; BCBSND has partnered with Sandata, whose Sandata Aggregator lets a provider's own third-party EVV system share visit data with the plan, and home health providers register before seeing members2. Registration runs through Sandata's support site, linked from the Expansion manual, and has to be finished before the first visit to an Expansion member. See home care billing in North Dakota for waiver programs, EVV exceptions and authorizations.
Rules that change how North Dakota claims are billed
Expansion claims are electronic only, due in 180 days, to payer ID 558912
BCBSND's Medicaid Expansion manual takes professional (837P) and institutional (837I) claims only electronically, under payer ID 55891, within 180 calendar days of the date of service for Expansion-only claims, 180 days from the retroactive coverage notification when coverage was backdated, and 365 calendar days from the date of service when another payer is involved; late claims are denied unless BCBSND or a subcontractor created the error. The claim carries the NDDHHS-assigned taxonomy codes for the billing and rendering providers, the North Dakota Medicaid provider ID, an NDC on every medical drug line, and exactly one billing and one rendering provider, because the plan's system ignores extra rendering NPIs on claim lines even where Availity Essentials lets you add them. Methadone and opioid treatment clinics billing H0020 use taxonomy 261QM2800X.
Health and Human Services decides eligibility, and a retroactive loss means recoupment2
North Dakota HHS determines eligibility for the Medicaid Expansion Program and passes it to BCBSND, which mails the member an ID card and enrollment packet. Coverage ends when the member leaves North Dakota, stops meeting the program's requirements, dies, or becomes covered by Medicare, by traditional North Dakota Medicaid or by another state's Medicaid; the plan covers no newborns or dependents, and a member who becomes pregnant may move to the traditional program. When HHS tells BCBSND that eligibility ended retroactively, federal rules require the plan to recoup what it paid, so the eligibility check on the date of service protects the claim twice: once at the visit and again against a later recoupment letter.
One plan, one authority: Expansion has run as a 1915(b) and 1937 program since 20146
CMS's 2024 state tables record North Dakota Medicaid Expansion as a statewide full-benefit MCO operating under section 1915(b) and the section 1937 alternative benefit plan authority since January 1, 2014, with its waiver running through December 31, 2025; enrollees are pre-assigned to the plan. The plan is accredited through the National Committee for Quality Assurance and URAC. The only other managed care program is the Program of All-Inclusive Care for the Elderly, running since August 1, 2008, and the tables list no transportation broker program for the state.
CMS accepted North Dakota's personal care EVV attestation in January 20217
CMS's January 15, 2021 letter to the North Dakota Department of Human Services accepted the state's attestation that its EVV system met section 1903(l) of the Social Security Act for personal care services under the section 1905(a)(24) state plan benefit and the 1915(c) home and community-based services waivers, so no FMAP reduction applied to those services. The letter tells the state to update its compliance survey if it adds authorities, which is why an agency keeps its EVV records ready for the state as well as for BCBSND.
Four insurers filed 2026 individual or small group rates in North Dakota9
CMS's 2026 rate review public use file, built from the single risk pool filings insurers submit for the individual and small group markets, lists Blue Cross Blue Shield of North Dakota, Sanford Health Plan and Medica in both markets, with UnitedHealthcare of the Midlands in the individual market and UnitedHealthcare Insurance Company in small group. The file shows which carriers filed rates for 2026, not their size or their large group business, so a practice's own payer mix sets the order in which contracts and portals are worked.
BCBSND commits to 30 days for clean electronic commercial claims12
BCBSND's February 12, 2026 provider notice commits the plan to pay applicable clean electronic claims within 30 days and clean paper claims within 45 days, unless the provider's contract says otherwise, and says it is updating its systems to track claim status and apply interest when necessary. The notice covers its commercial lines of business only, so Expansion claims stay on the Medicaid managed care standard and an A/R report keeps the two books apart.
Services for North Dakota practices
Remitwright serves North Dakota practices remotely, inside the practice management or EHR system the practice already uses. A dedicated biller works the account; nothing is pooled. Each service below explains what that biller does.
- Medical billingClaims worked by one named biller
- CredentialingEnrollment, CAQH and PECOS kept current
- Eligibility verificationCoverage and benefits checked before visits
- Prior authorizationAuths requested, tracked, attached to claims
- Denial managementEvery denial read, worked and appealed
- A/R follow-upUnpaid claims chased before filing limits
FAQ
Questions from North Dakota practices
What is the North Dakota Medicaid timely filing limit?
Which Medicaid plans do we contract with in North Dakota?
How quickly must BCBSND pay a clean claim in North Dakota?
Does North Dakota require EVV for home care visits?
Who arranges Medicaid transportation in North Dakota?
Where do North Dakota Medicaid fee-for-service claims go?
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