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  • Applicants , Please Complete All Information Below ... - Ndhealth

Get Applicants , Please Complete All Information Below ... - Ndhealth

T Name Last Name Maiden/Middle Initial Current Mailing Address (Include C/O Address) City State Date of Birth F County E-Mail Address Home Phone M Zip Code Work Phone Social Security Number (Required) Cell Phone Name of Employer City State Employer s Contact Name Employer s Phone Number Registrant ID # Current Expiration Date ALL QUESTIONS MUST BE COMPLETED BY APPLICANT Have you ever been arrested, charged, or convicted of a felony (You must answer yes if the felony arr.

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Medicaid Expansion Patient Protection and Affordable Care Act (Health Care Reform): North Dakota has expanded access to Medicaid to cover more individuals.

All providers are required to apply for enrollment electronically on the ND Health Enterprise MMIS portal. The exception is Qualified Service Providers. All enrollment documentation submitted must include the application tracking number (ATN) from the online enrollment application.

A: No. Because each state has its own Medicaid eligibility requirements, you can't just transfer coverage from one state to another, nor can you use your Medicaid coverage when you're temporarily visiting another state, unless you need emergency health care.

ND Medicaid must receive a provider's original Medicaid primary claim submission within 180 days from the date of service. Final submission of claims that will be considered for adjudication (including resubmitted claims) must occur within 365 days from the date of service.

Report changes to your address, phone number or email address by using our Self-Service Portal at hhs.nd.gov/applyforhelp/ssp-help or contacting the Customer Support Center: Toll-free: 866-614-6005, 711 (TTY)

Who is eligible for North Dakota Medicaid Program? Household Size*Maximum Income Level (Per Year)1$19,3922$26,2283$33,0644$39,9004 more rows

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232