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- info@stream-rcm.com
- 14430 Ocean Point, El Paso, TX 79938
Medical billing in North Dakota can be complicated. You have two Medicaid payment paths, separate BCBSND rules and tight filing deadlines. At Stream RCM, our AAPC-certified medical billers and coders work for individual doctors, hospitals and small clinics. They check eligibility, code visits, send claims, post payments and chase denials while you serve the patients
. We bill Medicare, commercial plans, WSI workers’ comp and North Dakota Medicaid. Our real-time reports on claims, payments and A/R show your team what’s been paid and what still needs to work.
North Dakota Medicaid claims are often delayed by billing the wrong payer, missing the filing deadline or not catching a coverage change before the visit. The state runs two payment paths. Under traditional Medicaid, North Dakota Health and Human Services (HHS) pays you directly on a fee-for-service basis. Expansion adults ages 21 to 64 get their coverage through Blue Cross Blue Shield of North Dakota (BCBSND), which has its own network, prior authorization rules and fee schedule. If an original claim reaches ND Medicaid more than 180 days after the date of service, it can be denied for late filing. More change is coming, too. On January 1, 2027, expansion adults switch to six-month renewals, and some must meet new work rules.
Medicaid Enrollees
Expansion Members
Filing Deadline
We work with more than 50 specialties, each with its own coding requirements and payer rules. Pediatric and family practices choose preventive visit and screening codes based on the patient’s age. In behavioral health, coding depends on session time and provider credentials. Cardiology and orthopedic claims may require prior authorization or specific modifiers. Blue Cross Blue Shield of North Dakota (BCBSND) handles Medicaid Expansion claims, while UnitedHealthcare plans and NextBlue of North Dakota Medicare Advantage plans follow their own billing rules. Rural health clinics, FQHCs, Indian Health Service and tribal 638 facilities may use encounter-based billing. Critical access hospitals follow Medicare cost-based payment rules. Our coders check each claim against the medical record before submission.
Our medical billing specialists work with North Dakota practices on claims for Medicare, traditional Medicaid, BCBSND Medicaid Expansion and commercial plans. The team brings 15+ years of revenue cycle experience across 50+ specialties.
Every North Dakota claim we handle goes through the same 8 steps of our medical billing and coding process, from registration to payment. Patient details, coverage and codes get checked up front. After that, we keep tracking the claim until it’s paid or closed.
Patient Information
Insurance EligibilityClinical Coding
Complete Charge
Claim
Payment
Denial
A/R and PatientWe confirm each patient's legal name, date of birth, address, Medicaid ID and any other insurance. Medicare and employer plans are billed before Medicaid, so other coverage has to be on file. Starting January 1, 2027, ND Medicaid will backdate coverage only up to one month for expansion members and two months for traditional members. If a patient applies late, care from earlier months may go unpaid.
Before each visit, we check whether the patient has traditional Medicaid, Medicaid Expansion through BCBSND, Medicare or a commercial plan such as Sanford Health Plan. The answer decides where the claim goes and which authorization rules apply. Members ages 19 and 20 are billed through traditional fee-for-service Medicaid, even if they qualify for Medicaid expansion. Providers must also enroll with BCBSND to be paid for expansion members. Pharmacy claims work differently because ND Medicaid pays them directly for both expansion and traditional members. See our insurance eligibility verification services.
Our certified coders read every provider note and code only what the documentation backs up, using CPT, ICD-10-CM and HCPCS. Units and modifiers are checked against National Correct Coding Initiative (NCCI) edits. These federal edits flag code pairs that can't be billed together. Every billed service must have a diagnosis code that explains why it was needed. On the ND Medicaid side, each enrolled provider is listed under taxonomy codes that show their provider type and specialty. Adding a new service? You may need to add the matching taxonomy before you bill for it.
A charge that never gets entered is never billed, and it won't show up as a denial either. We line up visit notes, procedure logs and superbills against the charges in your system. The usual misses are injections, supplies, add-on codes and hospital rounds. Clinics that do in-office procedures, like orthopedic and gastroenterology (GI) groups, tend to get the most out of this check. Missing charges are added before the claim is built.
For Medicare Part A and B, North Dakota claims go to Noridian Healthcare Solutions, the state's Jurisdiction F Medicare Administrative Contractor (MAC). Noridian kept that role after CMS gave it a new contract in August 2025. Traditional Medicaid claims go through the ND Health Enterprise MMIS, the state's Medicaid claims system, while expansion claims follow BCBSND claim rules. We check each claim against the payer's billing rules before submission to avoid rejections and payment delays.
We post electronic remittance advice (ERA), paper explanations of benefits (EOBs) and ND Medicaid remittance advice line by line. Payments, adjustments and patient balances each land on the right claim line. When ND Medicaid or BCBSND pays less than the fee schedule or your contract says, we don't just write it off. We flag the claim for review. Clean posting keeps patient statements and A/R reports accurate.
A denial can come from an eligibility gap, a missing authorization, a coding error, late filing or an enrollment problem. We find the cause first, then correct, resubmit or appeal the claim. ND Medicaid accepts timely filing override requests only when they arrive within 365 days of the date of service. When a member gets retroactive eligibility, the claim is due within 180 days of the eligibility decision. Learn more about our denial management services.
We sort open claims by filing a deadline first, then by age and balance. ND Medicaid, BCBSND, Medicare and commercial plans each set their own limits for claims and appeals. Workers' comp claims go to Workforce Safety & Insurance (WSI), the state's only workers' comp insurer. Our team checks claim status in payer portals, calls when a status is unclear, sends corrected claims and files appeals when the records support payment. Older balances are reviewed on a set schedule until they are paid or closed.
The better choice depends on your full billing cost, not one salary. An in-house team needs benefits, training, software and backup for time off, plus time to learn BCBSND rules and the 2027 Medicaid changes. When you outsource medical billing in North Dakota, much of that cost becomes a fee based on your collections. The table compares both models.
| Billing Consideration | In-House Billing | Outsourced Stream RCM |
|---|---|---|
| Staffing Structure | Hiring, payroll and backup for time off | A certified billing team assigned to your account |
| Claim Performance | Depends on each biller's experience and workload | 98% clean claim rate |
| Denial Management | Handled between front-desk and phone tasks | Root-cause review, correction and appeal |
| Operating Cost | Salaries, benefits and software every month | 40–50% cost savings |
| Performance Visibility | Limited to what your billing software shows | Real-time reports on claims, denials and A/R |
Pick the services you need or hand us your full revenue cycle.
We check, send and track claims until the payer replies. Rejected claims are fixed and sent again.
Coders match CPT, ICD-10-CM and HCPCS codes, modifiers and taxonomy codes to the chart before release.
Denials are sorted by cause, the issue is fixed and appeals are filed when the record supports payment.
Open balances are managed by age and amount through portal checks, payer calls, corrected claims and timely appeals.
We handle provider credentialing for ND Medicaid, Medicare and commercial payers, plus BCBSND network enrollment.
Our billing team supports healthcare practices across all 53 North Dakota counties. These figures show Medicaid eligibility in September 2026, based on the North Dakota HHS dashboard.
Fargo and West Fargo sit in Cass County, where 24,374 residents were eligible for Medicaid in September 2026.
Bismarck is in Burleigh County, where 12,227 people were eligible for Medicaid in September 2026, the second-highest count.
Ward County, home to Minot, counted 9,022 Medicaid eligibles in September 2026, according to North Dakota HHS records.
Grand Forks County, home to Grand Forks, recorded 9,275 Medicaid eligibles in September 2026, according to state records.
Rolette County, home to the Turtle Mountain Reservation, recorded 5,002 Medicaid eligibles in the September 2026 dashboard.
Mandan and nearby communities in Morton County recorded 4,803 Medicaid eligibles in September 2026, according to state data.
Dickinson is in Stark County, where 4,416 people were eligible for Medicaid during September 2026, according to HHS.
Williams County, home to Williston and Tioga, had 4,827 Medicaid eligibles in September 2026, according to HHS.
Jamestown is in Stutsman County, where 2,809 people were eligible for Medicaid in September 2026, state data shows.
Benson County, including Fort Totten and Minnewaukan, recorded 2,385 Medicaid eligibles in September 2026, based on state figures.
Ramsey County, home to Devils Lake, had 2,193 Medicaid eligibles in September 2026, according to the state dashboard.
Richland County, which includes Wahpeton, recorded 1,933 Medicaid eligibles in September 2026, according to state enrollment data.
Sioux County, home to Fort Yates, recorded 1,633 Medicaid eligibles in September 2026, according to the HHS dashboard.
New Town and Stanley are in Mountrail County, where 1,962 residents were eligible for Medicaid in September 2026.
Walsh County, home to Grafton, had 1,635 Medicaid eligibles in September 2026, according to the state HHS dashboard.
These figures come from Stream RCM client results across many specialties. Your own numbers can differ, depending on your payer mix, claim volume and where your billing stands now.
Our North Dakota billing services cover the full cycle: eligibility checks, coding, claim submission, payment posting, denial management and A/R follow-up. Provider credentialing is also available.
Yes. Expansion claims go to BCBSND, and traditional fee-for-service claims go to ND Medicaid. We follow each payer’s own rules.
You have 180 days from the date of service for ND Medicaid to receive the original claim. If the patient’s eligibility is granted retroactively, the 180 days start from that decision instead.
From January 1, 2027, some expansion adults will need 80 hours a month of work or other approved activities to keep coverage. Expansion renewals also move to every six months, though tribal members keep annual renewals.
Yes. Our credentialing team helps with ND Medicaid enrollment through the ND Health Enterprise MMIS portal and Noridian. We also track revalidation, which is due at least every five years.
Check that the company has certified coders and real experience with ND Medicaid and BCBSND. Clear pricing and reports you can review matter too. Ask for claim results in your specialty.
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