Welcome to Health Information Designs' North Dakota Department of Human Services Prior Authorization website.
Among other helpful information, this site provides all of the forms needed to request a Prior Authorization. You can find a form by name under PA Forms or by requested NDC in the NDC Drug Lookup application. Please download the proper form and fill it out COMPLETELY. You can fax the completed form to 1-866-254-0761 or e-mail it to firstname.lastname@example.org. If you need further assistance, please contact us at 1-866-773-0695.
For details about the information available on this website, view How to Use the North Dakota DHS Prior Authorization Website.
For other information regarding North Dakota Department of Human Services, visit the Medicaid Provider Information section of their website.
Most of the documents on this site are in .pdf format. In order to download, complete, and print these documents correctly, we recommend downloading and installing the latest version of Adobe Acrobat Reader.
All attempts are made to have the most current information on this website. However, the information on this website is NOT a guarantee of current policy or limits. Application of current policy and limits will occur when the claim is processed.