Transcription of Qualified Service Provider Handbook - North Dakota
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Qualified Service Provider Handbook - North Dakota
April 2022 Qualified Service Provider Individual Provider Handbook enrollment Procedures & Required Standards Issued By: All QSP Handbooks can be found at the following website: Individual QSP s are required to have a copy of the most current Handbook on file. You must also have a Forms Packet to complete your application. This Handbook contains the requirements for you to enroll as a Provider delivering services for which you want to receive public pay. 2 Provider enrollment questions? Call 701-277-6933 Forms must be completed with a pen or typed. Send completed packets by email, fax or mail to: Email: Fax: 701-277-6635 Mail: Noridian Healthcare Solutions Attn: ND Medicaid Provider enrollment QSP PO Box 6055 Fargo, ND 58108-6055 3 TABLE OF CONTENTS INDIVIDUAL Qualified Service Provider Handbook HCBS INFORMATION.
Applicants requesting enrollment for the following services, must send all required additional information listed below. You will not be approved for the following services without all required information. Additional forms, if required, can be obtained by calling the QSP Enrollment at 701-328-4602 or at the following website:
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