North Dakota Department of Human Services

Welcome to Health Information Designs' North Dakota Medicaid Prior Authorization website.

Among other things, this website hosts North Dakota Medicaid’s prior authorization (PA) and other criteria for coverage of outpatient pharmacy products, as well as outlining other (non-PA) coverage rules for outpatient pharmacy products. PA criteria for coverage are all located within the Preferred Drug List (PDL), all versions of which are within the page linked on the right-hand side of this page. The PDL also directs providers to which PA request form should be used when submitting a PA request at the top of each criteria heading. All PA request forms are located on the “PA Forms” page of this website and can also be found by searching for a drug using the “PA Form Lookup” tool linked to this website.

To submit a PA request, please download the proper form and fill it out COMPLETELY, and fax the completed form to 855-207-0250. 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.



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