Credentialing in North Dakota

ND HHS has a "Provider Enrollment Moratoria" notice posted (2026-06-11). Check the current moratoria list before starting any ND Medicaid enrollment, some provider types may be frozen.

ND HHS, Medicaid Provider Enrollment · checked Jul 2026

North Dakota Medicaid is run by ND Health & Human Services, which contracts with Noridian Healthcare Solutions to complete provider enrollment for all providers except Qualified Service Providers (QSP). Providers apply for enrollment electronically on the ND Health Enterprise MMIS portal (mmis.nd.gov) in a 4-step process: search existing enrollment, online application, supporting documents, approval.

ND HHS, Medicaid Provider Enrollment · checked Jul 2026

Traditional ND Medicaid pays claims fee-for-service through the state's MMIS, there is no MCO layer for the classic populations. The single managed-care carve: Medicaid Expansion (adults 19-64, at or below 138% FPL) is administered by Blue Cross Blue Shield of North Dakota (BCBSND). Sanford Health Plan is the former Expansion carrier (pre-2022), stale directories still say Sanford, but the current holder is BCBSND.

ND HHS, Medicaid Expansion · checked Jul 2026

Revalidations are required for all provider records, regardless of provider type, at least every five years. DME suppliers are required to revalidate every three years.

ND HHS, Medicaid Provider Enrollment · checked Jul 2026

None. No North Dakota prompt-credentialing statute was found: the NDCC Title 26.1 (Insurance) chapter index contains no credentialing chapter. Unlike some states, no ND law forces an insurer to complete credentialing within a set number of days.

North Dakota Century Code Title 26.1 chapter index (verified negative) · checked Jul 2026

ND Medicaid's Other Licensed Providers (OLP) policy direct-enrolls Licensed Psychologists, Licensed Clinical Social Workers (LCSWs), Licensed Master Social Workers (LMSWs), Licensed Professional Clinical Counselors (LPCCs), Licensed Professional Counselors (LPCs), Licensed Marriage and Family Therapists (LMFTs), and Licensed Addiction Counselors (LACs), the eligible servicing and billing provider's National Provider Identifiers (NPIs) must be enrolled on the date of service, so mid-tier LMSWs and LPCs render under their own NPI. LMSWs were added to the eligible-provider list in January 2026.

ND Medicaid Billing and Policy Manual, Other Licensed Providers (OLPs), updated January 2026 · checked Jul 2026

North Dakota is a Counseling Compact member (on the counselingcompact.gov compact-jurisdictions list) but was not an issuing state as of July 2026.

Counseling Compact, Compact Jurisdictions · checked Jul 2026

ND Medicaid relies on Medicare screening to expedite enrollment and revalidation: the name/NPI/SSN (individual) or legal business name/TIN/location/ownership (group) must match the Medicare record exactly, after which only form SFN 615 (plus SFN 1168 for groups) is required. Any exact-match discrepancy forces full re-documentation, so pre-check PECOS data against the ND record.

ND HHS, Medicaid Provider Enrollment · checked Jul 2026

"ND Medicaid does not enroll out of state providers if the service is available in state". "out of state" means more than 50 miles from the ND border, and enrollment requires a service authorization (emergencies get retroactive authorization). Telehealth delivered to members located in ND is NOT out-of-state care; submit the OOS Telehealth Attestation with the application.

ND HHS, Medicaid Provider Enrollment · checked Jul 2026

The pre-licensed counselor tier (LAPC) is not an Other Licensed Provider. It enrolls only as an eligible provider type under the Behavioral Health Rehabilitative Services policy (skills training, screening/triage), not standard outpatient psychotherapy. There is no supervisor-billed lane: these practitioners "may not bill for services under a supervising practitioner's NPI." Border-state practitioners may enroll for BH rehab services upon attesting to ND Medicaid of their comparable license/certification.

ND Medicaid Billing and Policy Manual, Behavioral Health Rehabilitative Services, updated March 2026 · checked Jul 2026