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U.S. Department of Health and Human Services

Provider Registration

Eligible Providers:

A provider must currently participate in either the Medicare or the Medicaid program in order to be eligible for reimbursement.  Eligible providers cannot be excluded, debarred or suspended from participation in Medicare or any other federal health care program.

If you currently participate in the Medicare program, reimbursement rates will be determined using Medicare Part A and Part B payment policies.

If you do not participate in the Medicare program but do actively participate in your State’s Medicaid program, reimbursement rates will be determined using your State’s Medicaid payment policies.

Payment Information:

Payments will only be made via electronic funds transfer by Federal Fiduciary  on behalf of the NDMS.  1099 forms will be issued by Federal Fiduciary as well.


Provider Registration:

To be reimbursed under this program, each provider organization will be required to submit a Provider Registration form, a W-9 form and an ACH Vendor Enrollment form to Federal Fiduciary.  These forms only need to be completed one-time even if your organization is submitting multiple claims on different dates.  Although these forms do not have to be completed before a public health emergency occurs or before claims are submitted to the program, please note that payments cannot be released until all forms have been received.

 

  • W-9 Form [PDF]
  • ACH Vendor Enrollment Form  [PDF]
  • NDMS Definitive Care Reimbursement Program Provider Enrollment Form [PDF]
NDMS Seal 

  • This page last reviewed: November 16, 2017