North Dakota Application Service Provider Agreement

State:
Multi-State
Control #:
US-CP1027-AM
Format:
Word; 
Rich Text
Instant download

Description

This sample form, a detailed Application Service Provider Agreement document, is for use in the computer, internet and/or software industries. Adapt to fit your circumstances. Available in Word format.
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FAQ

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.

Medicaid expansion in North Dakota is managed by Blue Cross Blue Shield of North Dakota (this is as of 2022; prior to that, the managed care contract was with Sanford Health Plan).

Q. Can I use my Medicaid coverage in any state? 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.

Medicaid is a program that helps pay for medical services for qualifying low-income adults, children, pregnant women, older adults and people with disabilities. Medicaid Members: Learn more about Medicaid renewals and what you need to do to prepare on our Stay Covered ND webpage.

Who is eligible for North Dakota Medicaid Program? Household Size*Maximum Income Level (Per Year)5$46,7376$53,5737$60,4098$67,2454 more rows

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North Dakota Application Service Provider Agreement