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Minnesota Department of Human Services Provider Manual
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Enrollment with Minnesota Health Care Programs (MHCP)

Revised: 07-23-2018

  • Eligible Providers
  • Enrollment Process
  • Enrollment Approvals
  • Processing Timelines and Actions
  • Changes to Enrollment
  • Billing Organizations
  • Eligible Providers

    Providers who choose to participate in MHCP must meet professional, certification and licensure requirements according to applicable state and federal laws and regulations. Refer to the manual section for each type of service you want to provide to be aware of all of the MHCP requirements for that provider type.

    Also contact the managed care organization with which you contract for their enrollment requirements.

    Provider types marked with an asterisk (*) in the following list may not receive direct payment for the services they provide; they must bill through an agency.

    The following health care provider types may be eligible for MHCP enrollment:

  • • Ambulatory Surgical Center (ASC)
  • • Audiologist
  • Billing Entity for Mental Health
  • Billing Entity for Physical Rehabilitation
  • • Billing Entity for Physician Group
  • • Case Management
  • Certified Mental Health Rehab Professional*
  • Certified Nurse Midwife (CNM)
  • Certified Registered Nurse Anesthetist (CRNA)
  • Chemical Health
  • • Child & Teen Checkups (C&TC) Clinic
  • Children’s Residential Treatment*
  • Chiropractor
  • Clinical Nurse Specialist (CNS)
  • Community Health Clinic
  • Community Health Worker*
  • • Community Mental Health Center
  • • Consolidated Chemical Dependency Treatment Fund (CCDTF)
  • • County Case Manager
  • • County Human Services Agency
  • County-Contracted Mental Health Rehabilitation
  • • Day Training & Habilitation (DT & H) or Day Activity Center
  • • Day Treatment
  • • Dental Hygienist
  • • Dentist or Dental Group
  • • Dental Therapist
  • Dietician
  • EDI Trading Partner
  • • Family Planning Agency
  • • Federally Qualified Health Center (FQHC)
  • • Health Care Case Coordinator
  • Home Care Nurse
  • Hospice
  • Hospital
  • Independent Diagnostic Testing Facility
  • • Indian Health Service (IHS) Facility
  • Institution for Mental Disease (IMD)*
  • Intensive Residential Treatment Services (IRTS)
  • Licensed Independent Clinical Social Worker (LICSW)
  • Licensed Marriage & Family Therapist (LMFT)
  • • Licensed Professional Clinical Counselors (LPCCs)
  • • Licensed Psychological Practitioner
  • • Licensed Psychologist
  • Long-term Care Facility (Nursing Facility)
  • • Medical Supply or Durable Medical Equipment
  • Moving Home Minnesota (MHM)
  • Nurse Practitioner (NP)
  • Nursing Facility
  • • Occupational Therapist (OT)
  • • Optometrist
  • Personal Care Assistant (PCA), Individual*
  • Personal Care Provider Organization (PCPO) or PCA Choice
  • Pharmacist* or Pharmacy
  • • Physical Therapist (PT)
  • Physician and Clinic
  • Podiatrist
  • Public Health Clinic
  • • Regional Treatment Center (RTC)
  • Rehabilitation Agency
  • Renal Dialysis
  • Rural Health Clinic (RHC)
  • • Speech-Language Pathologist
  • Home and Community Based Services (HCBS) Alternative Care and Waiver Service Provider
  • Enrollment Process

    After an individual or group provider meets professional, certification and licensure requirements, you can apply to be an enrolled MHCP provider. Follow these steps:

    1. Meet all rules and requirements

    Ensure that you meet all of the requirements and certifications for the type of service you want to provide before submitting enrollment information to MHCP. Refer to the appropriate service section in MHCP Provider Manual for licensure or certification requirements for your provider type.

    2. Check federal and state excluded providers lists

    The federal Health and Human Services–Office of Inspector General (OIG) has the authority to exclude individuals and entities from participation in Medicare, Medicaid and other federal health care programs. MHCP also excludes individuals and entities from participation in MHCP if they are on either the federal or state excluded provider list.

    MHCP cannot enroll and pay providers if they or their employees or contractors are excluded from participation in Medicare, Medicaid or other federal health care programs. The Office of Inspector General (OIG) may impose civil monetary penalties against providers who employ or enter into contracts with excluded individuals or entities to provide services or items to recipients.

    OIG makes a List of Excluded Individuals/Entities (LEIE) available to the public. As enrolling or enrolled MHCP providers, you must make sure you, your company, owners, managers, employees and contractors are not on the list. Search LEIE by the individual’s or entity’s name:

  • • Before you enroll
  • • Before you hire new employees/enter into a contract with a contractor
  • • Monthly, to see changes since your last search
  • Report any new exclusions you find in your search to MHCP Provider Enrollment at fax 651-431-7462. Use a cover sheet.

    Also see Excluded Provider Lists and MHCP Provider Screening Requirements.

    3. Get a provider identification number

    National Provider Identifiers (NPIs) are the standard unique identifiers to use in submitting and processing health care claims and other transactions. If you are a provider eligible for an NPI, you must obtain your NPI number(s) from the National Plan and Provider Enumeration System (NPPES) before you enroll with MHCP.

    Unique Minnesota Provider Identifier (UMPI): Providers who do not meet the federal definition of a health care provider under HIPAA may not be eligible to receive an NPI. If you are not eligible for an NPI and apply for enrollment, MHCP will assign you a 10-digit UMPI and send you a Welcome Letter to confirm your enrollment.

    If you are one of the following providers, do not obtain an NPI before submitting your enrollment forms:

  • • Approved day treatment centers
  • Children’s residential services
  • Clearinghouses & billing intermediaries
  • • Health care case coordinators
  • • Individual PCAs
  • Transportation (non-medical)
  • • Community Health Workers
  • • WIC Programs
  • • Head Start Programs
  • • EDI Trading Partners
  • • Clearing Houses
  • • Billing Intermediaries
  • The following providers are not required to obtain an NPI, but may have the option of using an NPI registered to the provider:

  • • Home and community based services
  • • Prsonal care provider organizations
  • • Day training and habilitation
  • Your NPI or UMPI is required on all claims submitted to MHCP. This number allows you to be paid for MHCP-covered services provided to eligible MHCP members.

    4. Register for MN–ITS

    After you are enrolled you will need to register for MN–ITS. MN–ITS is a free, web-based, HIPAA-compliant system. We will send you a Welcome Letter to confirm your enrollment. Your enrollment Welcome Letter includes a MN–ITS initial User ID, Password and registration instructions.

    Minnesota law requires all persons or entities that provide health care services or supplies within Minnesota for a fee and are eligible for MHCP reimbursement to submit all claims electronically. All providers and their affiliated clinics or billing services must register for MN–ITS. MHCP does not process paper claims.

    As a registered MN–ITS user, you can:

  • • Verify active provider enrollment status
  • Verify program eligibility for one or more MHCP recipients at one time
  • Submit authorization requests for medical or dental services or medical supplies
  • • Submit service agreement (SA) requests for home care services
  • • Retrieve your authorization and service agreement letters
  • Submit claims (including claims with third party insurance or Medicare)
  • • Copy previously submitted MN–ITS claims or replace incorrectly submitted paid claims
  • • Check a claim's paid or denied status
  • • Use the MN–ITS Mailbox to access information, including Remittance Advices (RAs)
  • Enrollment Approvals

    Providers Located in Minnesota

    Minnesota providers are approved retroactively:

  • • As indicated for a Requested Enrollment Date on the application
  • • To the first day of the month of application
  • • For up to 90 days to the effective date of Medicare certification of the provider
  • • To the date of the recipient's established retroactive MHCP eligibility
  • Providers Located Outside of Minnesota

    Out-of-state providers may apply for MHCP enrollment for the date(s) of service to an MHCP recipient. To be eligible for payment under MHCP, an out-of-state provider must:

  • • Comply with the licensing and certification requirements of the state where the provider is located, except for home and community-based waiver services providers who must meet the licensing and certification requirements of Minnesota’s federally approved waiver plan
  • • Complete, sign and return the MHCP Provider Enrollment Application and Provider Agreement to MHCP
  • Refer to additional requirements under Billing Policy and billing information for Out-of-State Providers.

    Enrollment with Managed Care Organizations

    Providers who choose to participate in an MHCP managed care organization’s (MCO's) network must contact the appropriate health plan for participation requirements. Refer to Prepaid Minnesota Health Care Programs for additional information about MCOs.

    Changes to Enrollment

    Notify MHCP Provider enrollment in writing of any changes to your enrollment application. Use one of the following forms:

  • Individual Practitioner MHCP Provider Profile Change Form (DHS-3535) (PDF)
  • Organization MHCP Provider Profile Change Form (DHS-3535A) (PDF)
  • MHCP sends enrollment status letters to providers, including when changes in provider participation occur (such as when providers expand or reduce the services they provide).

    Processing Timelines and Actions

    MHCP processes only complete requests within 30 days of receiving the request. Each request, including corrected and resubmitted requests is considered a new request and is subject to the same processing timelines (30 days) as an initial request.

    Incomplete Requests

    Complete requests mean that all required fields are completed and all required documents have been received.

    If a new enrollment request is incomplete, MHCP will send you a request for more information (RFMI) letter to tell you the information we still need to process your request. You have 60 days to respond and return the missing information. If we receive part of your information, but there is still missing information, we will send an additional RFMI to tell you the information that is still missing and give you an additional 30 days to return the missing information. If information is still missing or incomplete after that, we will deny the request.

    If enrollment documents submitted are not complete and correct and we requested additional information or corrections, you must allow up to 30 days from the date you sent the most recent paperwork for processing.

    Inactive enrollment records

    If your enrollment record becomes inactive due to lack of claims activity and your enrollment record has been screened within the last 3 1/2 years (2 years for PCA agencies and individual Direct Support Workers), contact the MHCP Provider Call Center to request your record be reactivated.

    Billing Organizations

    MHCP-enrolled providers can assign clearinghouses or billing intermediaries as their billing agents to submit claims and other transactions electronically to MHCP

    Clearinghouses and billing intermediaries sending MHCP claims and other transactions on behalf of enrolled providers must enroll as a billing organization.

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    © 2018 Minnesota Department of Human Services Updated: 7/23/18 11:11 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 7/23/18 11:11 AM