Minnesota Health Care Programs (MHCP), which includes Medicaid, provides essential health coverage to eligible individuals and families in Minnesota. For healthcare providers, enrolling in MHCP is crucial to serving this significant portion of the population and ensuring sustainable practice revenue. This guide provides a comprehensive overview of the MHCP enrollment process, eligibility requirements, and key considerations for providers looking to participate in Minnesota’s Medicaid program.
Navigating the MHCP Enrollment Process
Becoming an MHCP provider involves a structured process designed to ensure quality care and program integrity. MHCP offers resources to guide providers through each step, including quarterly webinars for first-time enrollees. These webinars, accessible through the MPSE training website, offer valuable insights into using the Minnesota Provider Screening and Enrollment (MPSE) portal, the primary tool for online enrollment.
To begin your journey as an MHCP provider, follow these essential steps:
1. Verifying Exclusion Status on Federal and State Lists
A critical first step in the enrollment process is to check both federal and state excluded provider lists. The Office of Inspector General (OIG) within the U.S. Department of Health and Human Services maintains a list of individuals and entities excluded from participating in federal healthcare programs like Medicare and Medicaid. Minnesota Health Care Programs adheres to these federal exclusions and also maintains its own state-level exclusion list.
MHCP is legally prohibited from enrolling or reimbursing providers who, or whose employees or contractors, appear on either the federal or state exclusion lists. Engaging with excluded parties can lead to significant penalties from the OIG.
To ensure compliance, providers must regularly check the OIG’s List of Excluded Individuals and Entities (LEIE). Proactive verification is necessary:
- Prior to Enrollment: Before submitting your MHCP enrollment application.
- Pre-Employment/Contracting: Before hiring new staff or engaging contractors.
- Monthly Monitoring: Regularly, at least monthly, to identify any new exclusions.
Any exclusion identified through these searches must be immediately reported to MHCP Provider Eligibility and Compliance via fax at 651-431-7462. Additional information can be found on the Excluded Provider Lists page within the MHCP Provider Manual.
2. Meeting MHCP Rules and Requirements for Enrollment
Eligibility for MHCP enrollment hinges on meeting specific requirements and certifications relevant to the healthcare services you intend to provide. Before initiating the enrollment process, providers must ensure they fulfill all necessary criteria.
To determine the precise requirements for your provider type:
- Consult the Eligible Providers Section: Review the “Eligible Providers” section on this page to locate your provider type and associated licensure or certification mandates.
- Review Provider Screening Requirements: Refer to the Provider Screening Requirements page of the MHCP Provider Manual for a comprehensive overview of screening procedures and prerequisites.
3. Obtaining a Provider Identification Number: NPI and UMPI
A crucial step in the enrollment process is securing the correct provider identification number. The National Provider Identifier (NPI) is a unique, standard identification number for healthcare providers, essential for submitting and processing claims and other healthcare transactions nationwide. Providers eligible for an NPI are mandated to obtain it from the National Plan and Provider Enumeration System (NPPES) before enrolling with MHCP.
However, some provider types may not be required or eligible for an NPI. For these providers, MHCP assigns a Unique Minnesota Provider Identifier (UMPI). The following provider types might not need an NPI initially and can be assigned a UMPI upon application processing:
- Home and community-based services providers
- Personal care provider organizations
- Day training and habilitation providers
- Early Intensive Developmental and Behavioral Intervention (EIDBI) Level II and III individuals
- Nonemergency medical transportation (NEMT) organizations
- Doula providers (Individual and organizational)
It’s important to note that providers not meeting the HIPAA definition of a healthcare provider may not be NPI-eligible. If NPI eligibility is not met, providers can still apply for MHCP enrollment and will receive a UMPI upon successful enrollment, confirmed via a Welcome letter.
Certain provider types are not eligible to obtain an NPI before enrollment and will be assigned a UMPI by MHCP:
- Approved day treatment centers
- Children’s residential services providers
- Clearinghouses and billing intermediaries (Not MCO-only eligible)
- Health care case coordinators
- Individual personal care assistants (PCAs)
- Community health workers
- Women, Infants and Children (WIC) programs
- Head Start programs
- Electronic Data Interchange (EDI) trading partners (Not MCO-only eligible)
- Clearing houses (Not MCO-only eligible)
- Billing intermediaries (Not MCO-only eligible)
- Non-emergency medical transportation (NEMT) drivers
Whether an NPI or UMPI, this provider identification number is mandatory for all fee-for-service claims submitted to MHCP, enabling accurate payment for services rendered to MHCP members.
4. Submitting Your Enrollment Documents to MHCP
Providers have two primary methods for submitting enrollment documents to Minnesota Health Care Programs:
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Online Enrollment via MPSE Portal: Register for access to the Minnesota Provider Screening and Enrollment (MPSE) portal and complete your application online through the MPSE portal. This is the recommended, efficient method due to built-in application guidance, error review capabilities, and application status tracking.
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Fax Submission: Complete the required enrollment documents and fax them to MHCP’s Provider Eligibility and Compliance division.
To determine the specific forms required for your provider type, refer to the manual section relevant to your services, found in the Eligible Providers section below.
Important Note: MHCP does not accept enrollment documents via email. Submission must be through the MPSE portal or by fax.
Application Fees for MHCP Enrollment
Certain MHCP provider types are required to pay a non-refundable application fee during initial enrollment, re-enrollment, or revalidation. If applicable, this fee must be paid before submitting the enrollment application. Details regarding application fee requirements, including applicable provider types and fee amounts, are available in the Application Fees section of the Provider Screening Requirements page within the MHCP Provider Manual.
Electronic Funds Transfer (EFT) for Payments
MHCP strongly encourages all fee-for-service providers to enroll in Electronic Funds Transfer (EFT), also known as direct deposit, for claim payments. EFT enrollment can be initiated during the application process and does not require prior enrollment approval. EFT offers numerous benefits over traditional paper checks:
- Faster Payment Processing: Access funds more quickly, eliminating mail delays and bank deposit trips.
- Enhanced Security: Reduces risks associated with lost, stolen, or misdirected paper checks.
- Streamlined Cash Flow: Simplifies financial management with less paperwork.
To receive EFT payments from MHCP, providers must have an active 10-digit supplier ID and a 3-digit supplier location code issued by Minnesota Management and Budget (MMB).
Steps to establish a supplier ID for MHCP EFT payments:
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Supplier Portal Registration: Visit the Minnesota Supplier Portal and select “Register for an Account” to register as a “New Supplier” if you don’t already possess a supplier ID.
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Update Banking Information: For existing supplier IDs, update or add banking details through the Supplier Portal using the guide Update Supplier Profile or by submitting the MMB EFT Bank Change Request (PDF). For supplier ID activation status inquiries, contact MMB at 651-201-8106.
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EFT Activation and Notification: Allow 10 business days for banking information to activate within the supplier ID. After activation, enter your EFT supplier ID and location code via the MPSE portal (instructions in the MPSE user manual, Enrollment Record Information) or fax a completed EFT Supplier ID Notification (DHS-3725) (PDF) to Provider Eligibility and Compliance at 651-431-7462.
Note: EFT is not applicable to MCO in-network only providers.
Enrollment for Managed Care Organization (MCO) Providers
Federal mandates under the 21st Century Cures Act necessitate the enrollment of all Medicaid providers by state agencies, encompassing both fee-for-service and Managed Care Organization (MCO) network providers. MHCP initiated MCO in-network provider enrollment on July 17, 2023. The enrollment process for MCO providers mirrors the general Enrollment Process outlined earlier.
For detailed information, consult Enrollment process for MCO network providers. Refer to the Eligible Providers section for a list of enrolled provider types and specific enrollment requirements.
Providers already enrolled for fee-for-service and contracted with an MCO do not need to re-enroll for MCO participation.
Providers seeking to join an MHCP managed care organization network must also directly contact the relevant health plan for network participation and contract details. Additional information on MCOs is available on the MCOs page in the MHCP Provider Manual.
Specific instructions for MCO in-network provider enrollment are provided on the MCO In-Network Provider Enrollment page of the MPSE User Manual.
MHCP Enrollment Approvals and Effective Dates
Minnesota-Based Providers
MHCP may grant retroactive enrollment approvals for Minnesota-based providers. If enrollment requirements are met, the effective date will be determined by one of the following, whichever is earliest:
- The provider’s requested effective date in MPSE or the application.
- The first day of the month the enrollment request is received.
- Up to 90 days prior to the provider’s Medicare certification effective date.
- The date of confirmed MHCP member eligibility.
- The date the provider meets all MHCP requirements.
For providers requiring additional screening, such as site visits or background checks (typically moderate- and high-risk providers as detailed in the Risk Levels section), approval will be granted upon completion of these screenings.
Out-of-State Providers
Out-of-state providers can apply for MHCP enrollment for specific dates of service to MHCP members. To qualify for MHCP reimbursement, out-of-state providers must:
- Adhere to the licensing and certification standards of their state of operation (except for home and community-based waiver service providers, who must meet Minnesota’s waiver plan requirements).
- Submit an enrollment request through the MPSE portal with a copy of the Provider Agreement, assurance statements, and credentials, or fax documents to Provider Eligibility and Compliance.
Further requirements are detailed in the Billing Policy Overview and Out-of-State Providers sections of the MHCP Provider Manual.
Consolidated Provider Enrollment
A consolidated provider is defined as a provider entity with multiple enrollment records linked to a single National Provider Identifier (NPI).
While providers may offer diverse services, billing all services under a single enrollment record might not be permissible. Depending on service types, multiple enrollment records may be necessary. Provider Eligibility and Compliance reviews providers with multiple active credentials across different enrollment records to determine if consolidation is required.
MHCP Taxonomy Codes (Not applicable to MCO in-network only providers): A taxonomy code classifies the provider type, specialization, and classification. Codes and descriptions are available on the X12 External Codes List website.
When a provider utilizes one NPI for multiple records due to varied service locations or service types, MHCP may consolidate these under a Provider Type (PT) 33 record. Individual records remain active and linked to this PT33 record.
- For NPIs representing multiple records at the same physical address or zip code, providers must submit taxonomy codes for each record post-enrollment and MN–ITS registration. If records share the same taxonomy code, a custom code can be used. MHCP uses these codes for billing purposes only.
- Taxonomy or custom taxonomy codes are submitted through MN–ITS. A tutorial is available: Adding Taxonomy Codes.
- If an NPI covers records with unique physical addresses, the service facility location must be submitted on claims.
MN–ITS Registration for Fee-for-Service Providers
MN–ITS is a free, HIPAA-compliant, web-based system essential for MHCP providers. Upon enrollment approval, Provider Eligibility and Compliance sends a Welcome letter with initial MN–ITS User ID and Password. Providers enrolling via fax must register for MN–ITS using registration instructions. MPSE users can log in using the credentials in the Welcome letter.
Minnesota law mandates electronic claim submission for all MHCP-eligible providers and suppliers. Paper claims are not processed; therefore, MN–ITS registration is mandatory for all providers and affiliated billing services.
MN–ITS functionalities for registered providers include:
- Verifying member program eligibility.
- Retrieving enrollment-related notices and letters.
- Submitting authorization requests for services or supplies.
- Submitting service agreement (SA) requests for home care.
- Accessing authorization and service agreement letters and other communications in the MN–ITS mailbox.
- Submitting claims (including those with third-party insurance or Medicare).
- Copying or replacing incorrectly submitted paid claims.
- Checking claim status (paid/denied).
- Utilizing the MN–ITS Mailbox for Remittance Advices (RAs) and information.
- Accessing MPSE to manage enrollment records.
MN-ITS Registration for MCO In-Network Only Providers
MN–ITS is also mandatory for MCO in-network only providers. Upon MHCP approval, a Welcome letter containing MN–ITS credentials and registration instructions is provided. MCO in-network providers use MN–ITS to access the MPSE portal for enrollment management and to retrieve enrollment-related communications.
Managing Changes to Your MHCP Enrollment
Providers are responsible for maintaining up-to-date enrollment information. The most efficient method for reporting changes is through MPSE. MHCP provides quarterly webinars on managing enrollment changes via the MPSE portal, accessible through the MPSE Training site.
Alternatively, providers can fax specific forms to report changes:
- Individual Practitioner MHCP Provider Profile Change Form (DHS-3535) (PDF): For individual enrollment changes or affiliation updates.
- Organization MHCP Provider Profile Change Form (DHS-3535A) (PDF): For organizational contact or enrollment information changes.
- Disclosure of Ownership and Control Interest of an Entity (DHS-5259) (PDF): For changes in management, board, or ownership.
- Electronic Remittance Advice (RA) Request Form (DHS-4087) (PDF) (Not for MCO in-network only): To manage electronic RA settings. More info: remittance advice.
- EFT bank change form (PDF): For direct deposit information changes (submitted to MMB).
- EFT Supplier ID Notification (DHS-3725) (PDF) (Not for MCO in-network only): To update MMB-issued EFT Vendor Number or Location Code.
- Provider Entity Sale or Transfer Addendum (DHS-5550) (PDF): For ownership changes due to sale or transfer. Requires new enrollment documents and must be submitted 30 days prior to the sale date. May result in payment reversals for terminated providers.
Provider Eligibility and Compliance processes change requests and will notify providers of any needed documentation. Enrollment status letters are sent for changes in provider participation.
Processing Timelines and Actions for Enrollment Requests
Provider Eligibility and Compliance aims to process complete enrollment requests within 30 days of receipt, regardless of submission method (MPSE or fax). This 30-day timeline applies equally to new, corrected, and resubmitted requests.
Complete Enrollment Requests
A complete request includes fully filled fields and all required documents. For MPSE submissions, refer to the Request Submitted and Next Steps section of the MPSE user manual for status updates and outcomes.
For incomplete new enrollment requests, a request for more information (RFMI) letter is sent via MN–ITS mailbox or U.S. mail. Providers have 60 days to respond with missing information using the original application method (MPSE or fax – methods should not be mixed). Partial submissions will result in a second RFMI with an additional 30-day response window. Failure to provide complete information within these timeframes will lead to request denial.
If corrections or additional information are required, allow up to 30 days from the latest submission date for processing.
Inactive Enrollment Records
Inactive enrollment records necessitate provider re-enrollment via the MPSE portal or faxing a new application to Provider Eligibility and Compliance.
Billing Organizations for MHCP Claims
MHCP-enrolled providers can utilize clearinghouses or billing intermediaries as billing agents for electronic claim and transaction submissions to MHCP.
Clearinghouses and billing intermediaries submitting claims on behalf of enrolled providers must enroll as a billing organization with MHCP.
Note: Billing organizations are not applicable to MCO in-network only providers.
Eligible Provider Types for MHCP Enrollment
Providers participating in Minnesota Health Care Programs must meet all professional certification and licensure requirements according to state and federal regulations relevant to their service offerings. After meeting these prerequisites, providers can apply for MHCP enrollment via the Minnesota Provider Screening and Enrollment (MPSE) portal or by submitting required application materials by fax.
Providers should also consult their contracted Managed Care Organizations (MCOs) for their specific enrollment requirements.
Fee-for-service providers marked with ¹ do not receive direct payment and must bill through an organization. Providers marked with ² are not eligible for MCO-only enrollment.
The following tables list eligible organization and individual provider types for MHCP enrollment:
| ### Organization Providers | ### Individual Providers |
|---|---|
| Adult Day Treatment – 46 | Acupuncturist – AP |
| Allied Oral Health Professional Group – 31 | Alcohol and Drug Counselor – DC |
| Ambulatory Surgical Center – 22 | Allied Oral Health Professional– 31 |
| Birthing Center – B1 (Enrollment webpage forthcoming. Contact the MHCP Provider Resource Center for information.) | Audiologist – 43 |
| Certified Registered Nurse Anesthetist Organization – 67 | Certified Mental Health Rehabilitation Professional¹- 26 |
| Child and Teen Checkup Clinic – 16 | Certified Nurse Midwife – 66 |
| Children’s Residential Treatment Facility¹- 06 | Certified Professional Midwife – C1 |
| Community First Services and Supports (CFSS) – CFSS | Certified Registered Nurse Anesthetist – 67 |
| Community Health Clinic – 58 | Chiropractor – 37 |
| Community Mental Health Center – 10 | Clinical Nurse Specialist – 68 |
| County Case Manager²- 23 | Community Health Worker¹ – 55 |
| County Human Services Agency² – 45 | Dentist – 30 |
| Day Training and Habilitation for ICF/DD– 19 | Direct Support Worker, Individual¹, ² – 38 |
| Dental Group – 30 | Doula – DA |
| Doula Entity – DA | Early Intensive Developmental and Behavioral Intervention² – EI |
| Durable Medical Equipment – 76 | Health Care Case Coordinator – 27 |
| Early Intensive Developmental and Behavioral Intervention² – EI | Hearing Aid Dispenser – 77 |
| Electronic Data Interchange (EDI) Trading Partner² – 28, 95, 98 | Home Care Nurse – 64 |
| Family Planning Agency – 54 | Licensed Independent Clinical Social Worker – 14 |
| Federally Qualified Health Center – 52 | Licensed Marriage and Family Therapist – 25 |
| Home and Community-Based Services (HCBS) – 18 | Licensed Professional Clinical Counselor- 63 |
| Moving Home Minnesota – 18 | Licensed Psychologist – 42 |
| Housing Stabilization Services – 18-HSS | Nurse Practitioner – 65 |
| Housing Support Supplemental Services – 18 | Occupational Therapist – 29 |
| Home Care Nursing Agency Group – 64 | Optometrist – 35 |
| Home Health – 60 | Pharmacist¹ – 70 |
| Hospice – 02 | Physical Therapist – 39 |
| Hospital – 01 | Physician – 20 |
| Independent Diagnostic Testing Facility – 32 | Physician Assistant – 69 |
| Independent Laboratory – 80 | Podiatrist – 36 |
| Independent X-ray – 81 | Registered Dietician or Licensed Nutritionist – 15 |
| Indian Health Services – 51 | Speech-Language Pathologist – 40 |
| Individualized Education Program – 09 | Transportation Driver¹ – DR |
| Institution for Mental Disease¹ – 03 | |
| Intensive Residential Treatment Services – 50 | |
| Intermediate Care Facilities – 05 | |
| Medical Services Group – 49 | |
| Medical Transportation – 82 | |
| Mental Health Group – 34 | |
| Non-Profit Dental Organization | |
| Nursing Facility – 00 | |
| Optical Company – 75 | |
| Personal Care Provider Organization² – 38 | |
| Pharmacy¹ – 70 | |
| Psychiatric Residential Treatment Facility – PR | |
| Physician Clinic – 20 | |
| Public Health Clinic – 57 | |
| Public Health Nursing Organization – 61 | |
| Recovery Community Organization – RC | |
| Recuperative Care Services – RE | |
| Regional Treatment Center – 17 | |
| Rehabilitation Agency – 11 | |
| Rehabilitation Group – 48 | |
| Renal Dialysis Center – 04 | |
| Rural Health Clinic – 53 | |
| Substance Use Disorder – 62 | |
| Targeted Case Management – 44 or 18 | |
| Transportation Coordinator² – 72 (Enrollment webpage forthcoming. Contact the MHCP Provider Resource Center for information.) |
