North Dakota Department
of Health and Human Services
Welcome to Acentra Health's North
Dakota Medicaid Prior Authorization website.
- This website hosts North Dakota Medicaid’s prior authorization (PA) forms and coverage criteria for outpatient pharmacy products.
- The Preferred Drug List (PDL) link contains preferred drug status and PA criteria for coverage and is linked at the top of this page.
- The PA Forms Lookup Tool and PA Forms links can be used to find the correct forms to be submitted. A request may be dismissed for missing information if the incorrect form is used.
- To submit a PA request, please download the proper form, 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 other information regarding North Dakota Department of Health and Human Services,
visit the Medicaid Provider Information section of their website.
Most of the documents on this site are in .pdf format. To download, complete, and print these documents
correctly, we recommend downloading and installing the latest version of Adobe Acrobat Reader.
Disclaimer
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.