North Dakota Administrative Code
Title 45 - Insurance, Commissioner of
Article 45-06 - Accident and Health Insurance
Chapter 45-06-03.1 - Standardized Health Claim Form Model Regulation
Section 45-06-03.1-03 - General provisions

Universal Citation: ND Admin Code ยง 45-06-03.1-03

Current through Supplement No. 394, October, 2024

1. Health care practitioners and institutional care practitioners shall file claims in a manner consistent with the requirements of this chapter. Claims filed in paper form must be printed on eight and one-half by eleven-inch [21.59 by 27.94-centimeter] paper.

2. Issuers shall accept forms submitted in compliance with this chapter for the processing of claims.

3. Health care practitioners, institutional care practitioners, and issuers shall:

a. Use and accept the most current editions of the HCFA form 1450, HCFA form 1500, prescription universal claim form, or J512 form and most current instructions for these forms in the billing of patients or their representatives filing claims with issuers.

b. Modify their billing and claim reimbursement practices to encompass the coding changes for all billing and claim filing by the effective date of the changes set forth by the developers of the forms, codes, and procedures required under this chapter.

4. Issuers may not require health care practitioners to use any coding system for the initial filing of claims for health care services other than the following:

a. HCPCS codes.

b. ICD-9-CM codes.

c. Revenue codes.

5. Issuers may not require health care practitioners to use any other descriptor with a code or to furnish additional information with the initial submission of a HCFA form 1500 except under the following circumstances:

a. When the procedure code used describes a treatment or service that is not otherwise classified; or

b. When the procedure code is followed by the CPT-4 modifier 22, 52, or 99.

General Authority: NDCC 26.1-36-37.1, 26.1-36-38

Law Implemented: NDCC 26.1-36-37.1

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