North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-03.1 - Standardized Health Claim Form Model Regulation › Section 45-06-03.1-01 - Definitions

Current through Supplement No. 393, July, 2024
As used in this chapter:
1. "CDT-1 codes" means the current dental terminology
				  prescribed by the American dental association.
2. "CPT-4 codes" means the current procedural terminology
				  published by the American medical association.
3. "HCFA" means the health care financing administration of
				  the United States department of health and human services.
4. "HCFA form 1450" means the health insurance claim form
				  published by HCFA for use by institutional care practitioners.
5. "HCFA form 1500" means the health insurance claim form
				  published by HCFA for use by health care practitioners.
6. "HCPCS" means HCFA's common procedure coding system, a
				  coding system which describes products, supplies, procedures, and health
				  professional services and includes the American medical association's physician
				  current procedural terminology, fourth edition (CPT-4) codes, alphanumeric
				  codes, and related modifiers. This includes:
a. "HCPCS level 1 codes" which are the American medical
				  association's CPT-4 codes and modifiers for professional services and
				  procedures.
b. "HCPCS level 2 codes" which are national alphanumeric
				  codes and modifiers for health care products and supplies, as well as some
				  codes for professional services not included in the American medical
				  association's CPT-4.
c. "HCPCS level 3 codes" which are local alphanumeric codes
				  and modifiers for items and services not included in HCPCS level 1 or HCPCS
				  level 2.
7. "Health care practitioner" means:
a. An addiction counselor licensed under North Dakota Century
				  Code chapter 43-45.
b. An audiologist licensed under North Dakota Century Code
				  chapter 43-37.
c. A chiropractor licensed under North Dakota Century Code
				  chapter 43-06.
d. A corporation or partnership of health care practitioners
				  defined in this section.
e. A dentist licensed under North Dakota Century Code chapter
				  43-28.
f. A nurse licensed under North Dakota Century Code chapter
				  43-12.1.
g. A nutritionist licensed under North Dakota Century Code
				  chapter 43-44.
h. An optometrist licensed under North Dakota Century Code
				  chapter 43-13.
i. A pharmacist licensed under North Dakota Century Code
				  chapter 43-15.
j. A physician licensed under North Dakota Century Code
				  chapter 43-17.
k. A podiatrist licensed under North Dakota Century Code
				  chapter 43-05.
l. A psychologist licensed under North Dakota Century Code
				  chapter 43-32.
m. A social worker licensed under North Dakota Century Code
				  chapter 43-41.
n. A physical, speech, occupational, or respiratory therapist
				  licensed under North Dakota Century Code chapters 43-26, 43-37, 43-40, or
				  43-42.
o. A home health care provider licensed under North Dakota
				  Century Code chapter 23-17.3.
8. "ICD-9-CM codes" means the diagnosis and procedure codes
				  in the international classification of disease, ninth revision, clinical
				  modifications published by the United States department of health and human
				  services.
9. "Institutional care practitioner" means:
a. A hospice licensed under North Dakota Century Code chapter
				  23-17.4.
b. A hospital licensed under North Dakota Century Code
				  chapter 23-16, 23-17, or 23-17.1.
c. Certified rural health clinic, nursing facility, basic
				  care facility, intermediate care facility for the mentally retarded, and
				  residential treatment center.
10. "Issuer" means an insurance company, fraternal benefit
				  society, health care service plan, health maintenance organization, or
				  third-party administrator, or any other entity reimbursing the costs of health
				  care expenses.
11. "J512 form" means the uniform dental claim form approved
				  by the American dental association for use by dentists.
12. "Medicare" means the Health Insurance for the Aged Act,
				  title XVIII of the Social Security Amendments of 1965, as then constituted or
				  later amended.
13. "Medical assistance or medicaid" means title XIX of the
				  federal Social Security Act [
				  42 U.S.C.
				  1396, et seq.] as then constituted or later
				  amended.
14. "Prescription universal claim form" means the uniform
				  claim form used by pharmacists.
15. "Revenue codes" means the codes established for use by
				  institutional care practitioners by the national uniform billing committee.
General Authority: NDCC 26.1-36-37.1, 26.1-36-38
Law Implemented: NDCC
					 26.1-36-37.1