Navigating the process of enrolling in Minnesota Health Care Programs (MHCP) can seem complex, but with a clear understanding of the steps involved, providers can efficiently become part of this vital healthcare network. This guide provides a detailed, SEO-optimized walkthrough on How To Apply For Minnesota Health Care Programs, ensuring you have all the necessary information to successfully enroll. Whether you are a new provider or need to re-enroll, this comprehensive resource will streamline your application process.
Understanding Minnesota Health Care Programs (MHCP)
Minnesota Health Care Programs, encompassing Medicaid and MinnesotaCare, provide essential health coverage to eligible individuals and families in Minnesota. For healthcare providers, enrolling in MHCP means becoming a vital part of a network that serves a significant portion of the state’s population. This enrollment allows providers to offer their services to MHCP members and receive reimbursement for those services.
The Minnesota Department of Human Services (DHS) oversees MHCP enrollment. They utilize the Minnesota Provider Screening and Enrollment (MPSE) portal to manage applications efficiently. This online portal is designed to guide providers through each step of the enrollment process, making it more manageable and transparent. Providers also have the option to submit enrollment documents via fax, although the MPSE portal is generally recommended for its efficiency and tracking capabilities.
Step-by-Step Guide: How to Apply for MHCP Enrollment
To become an enrolled MHCP provider, follow these essential steps. This process applies to both fee-for-service and Managed Care Organization (MCO) network providers.
Step 1: Verify Exclusion Status
Before initiating your application, it’s crucial to ensure that neither you nor your entity is listed on any federal or state excluded provider lists. These lists are maintained to prevent individuals or entities who have engaged in fraud or abuse from participating in federal and state healthcare programs.
The Office of Inspector General (OIG) for Health and Human Services manages the List of Excluded Individuals and Entities (LEIE) at the federal level. MHCP also cross-references this list and maintains its state-level exclusion list. Being on either list can disqualify you from MHCP enrollment.
Why is this step important? MHCP is prohibited from enrolling or paying providers who are excluded. Furthermore, employing or contracting with excluded individuals can lead to civil monetary penalties.
How to check exclusion lists:
- Search the OIG LEIE: Visit the OIG LEIE website and search by individual or entity name.
- Regularly check the lists:
- Before starting the enrollment process.
- Before hiring new employees or contractors.
- Monthly, to stay updated on any changes.
If you discover any exclusions, immediately report them to MHCP Provider Eligibility and Compliance by fax at 651-431-7462. You can also refer to the Excluded Provider Lists page in the MHCP Provider Manual for more information.
Step 2: Meet Enrollment Requirements
Eligibility for MHCP enrollment hinges on meeting specific requirements and certifications pertinent to the type of healthcare services you intend to provide. These prerequisites ensure that all enrolled providers maintain a standard of quality and compliance.
How to determine your requirements:
- Identify your provider type: Refer to the “Eligible Providers” section later in this guide to find your specific provider category.
- Review service-specific requirements: Each provider type has unique licensure and certification needs. Consult the relevant service section under “Eligible Providers” for details.
- Consult Provider Screening Requirements: The Provider Screening Requirements page of the MHCP Provider Manual outlines comprehensive screening criteria you must meet.
Meeting these requirements is not just a preliminary step; it is an ongoing obligation to maintain your MHCP enrollment.
Step 3: Obtain Provider Identification Numbers (NPI/UMPI)
A crucial component of the enrollment process is securing the correct provider identification number. The type of number you need depends on your provider category.
National Provider Identifier (NPI): The National Provider Identifier (NPI) is a unique 10-digit identification number for healthcare providers. It is used for submitting and processing healthcare claims and other transactions nationwide.
Who needs an NPI? Most healthcare providers who are considered “covered entities” under HIPAA are required to obtain an NPI. This includes physicians, dentists, hospitals, and many other provider types.
How to obtain an NPI: Apply through the National Plan and Provider Enumeration System (NPPES) before you begin your MHCP enrollment.
Unique Minnesota Provider Identifier (UMPI): Some provider types that may not meet the federal definition of a healthcare provider under HIPAA may not be eligible for an NPI. For these providers, MHCP assigns a Unique Minnesota Provider Identifier (UMPI).
Who may get a UMPI? Certain provider types are not mandated to have an NPI and can be assigned a UMPI by MHCP if they do not already have an NPI. These include:
- 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)
Providers not eligible for NPI before enrollment: Certain provider categories should not obtain an NPI before applying for MHCP enrollment. MHCP will assign them a UMPI upon approval. These include:
- Approved day treatment centers
- Children’s residential services providers
- Clearinghouses and billing intermediaries (for non-MCO enrollment)
- 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 (for non-MCO enrollment)
- Non-emergency medical transportation (NEMT) drivers
Your NPI or UMPI is essential for all fee-for-service claims submitted to MHCP. It ensures accurate billing and payment for services provided to MHCP members.
Step 4: Submit Your Enrollment Application
Once you have verified your exclusion status, met the necessary requirements, and obtained your provider identification number (if required), you are ready to submit your enrollment application to MHCP. You have two primary methods for submission:
1. Minnesota Provider Screening and Enrollment (MPSE) Portal (Online Application)
The most efficient and recommended method is to use the Minnesota Provider Screening and Enrollment (MPSE) portal.
Benefits of using the MPSE portal:
- Efficiency: Streamlines the application process.
- Built-in Guidance: Provides step-by-step instructions and tips.
- Error Review: Helps identify and correct common errors before submission.
- Application Tracking: Allows you to monitor the status and progress of your application.
- Direct Access: Register for MPSE access to begin your online enrollment.
2. Fax Submission (Paper Application)
Alternatively, you can complete the required documents and fax them to MHCP’s Provider Eligibility and Compliance division.
How to find required documents:
- Navigate to Eligible Providers: In the “Eligible Providers” section of this page, locate your provider type.
- Service-Specific Manual Section: Click on the provided link for your service type. This section will detail MHCP requirements and list the necessary forms for enrollment.
Important Note: MHCP does not accept enrollment documents via email. You must use either the MPSE portal or fax to submit your application.
Application Fees for MHCP Enrollment
Certain MHCP provider types are required to pay a nonrefundable application fee. This fee applies to new enrollments, re-enrollments, and revalidations.
When is an application fee required?
If your provider type is subject to an application fee, you must pay it before submitting your enrollment application.
How to determine if a fee is required and how to pay:
Refer to the Application Fees section within the Provider Screening Requirements page of the MHCP Provider Manual. This section provides details on fee requirements and payment procedures.
Setting up Electronic Funds Transfer (EFT)
Minnesota Health Care Programs encourages all fee-for-service providers to enroll in Electronic Funds Transfer (EFT), also known as direct deposit. EFT offers a more efficient, secure, and convenient method for receiving payments compared to paper checks.
Benefits of EFT payments:
- Faster Access to Funds: Payments are deposited directly into your bank account, eliminating mail time and bank deposit trips.
- Enhanced Security: Reduces the risk of lost, stolen, or misdirected checks.
- Simplified Cash Flow Management: Less paperwork and easier reconciliation of payments.
How to enroll in EFT:
You can initiate EFT enrollment during the MHCP application process itself – there’s no need to wait for approval.
Steps to establish EFT for MHCP payments:
- Minnesota Supplier Portal Registration:
- Visit the Minnesota Supplier Portal.
- If you do not have a Supplier ID, select “Register for an Account” and register as a “New Supplier.”
- Add or Update Banking Information:
- If you have an existing Supplier ID and need to add or update bank details, consult the Update Supplier Profile guide.
- Alternatively, you can submit the MMB EFT Bank Change Request (PDF).
- For questions about your Supplier ID status for direct deposit, contact MMB at 651-201-8106.
- Activate Supplier ID for EFT: Allow 10 business days for your Supplier ID to become active after adding banking information.
- Notify MHCP of EFT Enrollment:
- Enter your EFT Supplier ID and 3-digit Supplier Location Code in the MPSE portal (refer to the MPSE user manual for Enrollment Record Information).
- Or, fax a completed EFT Supplier ID Notification (DHS-3725) (PDF) to Provider Eligibility and Compliance at 651-431-7462.
Enrollment for Managed Care Organization (MCO) Providers
Federal regulations now mandate that all Medicaid providers, including those participating exclusively in Managed Care Organization (MCO) networks, must be enrolled with the state Medicaid agency (DHS). This requirement ensures comprehensive oversight and screening of all providers within the Medicaid system.
Enrollment process for MCO in-network only providers:
Follow the same Enrollment Process steps outlined earlier in this guide.
Key resources for MCO providers:
- Enrollment process for MCO network providers: Link to MCO Enrollment Information for additional details.
- Eligible Providers Section: Review the Eligible Providers section for a list of provider types enrolled by DHS and specific enrollment requirements.
- MCO In-Network Provider Enrollment Guide: Refer to the MCO In-Network Provider Enrollment page in the MPSE User Manual for specific instructions.
- Contacting MCOs: For participation and contract details within a specific MCO network, contact the appropriate health plan directly.
- MHCP Provider Manual – MCOs: For general information about MCOs within MHCP, see the MCOs page in the MHCP Provider Manual.
Note for existing fee-for-service and MCO providers: If you are already enrolled as a fee-for-service provider and also contract with an MCO, you do not need to re-enroll.
Understanding Enrollment Approvals and Timelines
The approval process and effective dates for your MHCP enrollment depend on whether your provider location is within or outside Minnesota.
Providers Located in Minnesota
Minnesota-based providers may be eligible for retroactive enrollment. If all enrollment requirements are met, the effective date will be determined using the most beneficial of the following:
- Provider-Requested Date: The date you specify in your MPSE application or enrollment application.
- Application Receipt Date: The first day of the month in which MHCP receives your enrollment request or application.
- Medicare Certification Retroactive Date: Up to 90 days before the effective date of your Medicare certification.
- MHCP Member Eligibility Date: The retroactive date the member is confirmed eligible for MHCP.
- Provider Requirement Met Date: The date you are confirmed to have met all MHCP provider requirements.
Providers requiring additional screening, such as site visits or background checks (typically moderate- to high-risk provider types as listed on the Risk Levels section), will be approved upon completion of these screenings.
Providers Located Outside of Minnesota
Out-of-state providers can apply for MHCP enrollment specifically for dates of service provided to an MHCP member within Minnesota.
Requirements for out-of-state providers:
- State Licensing and Certification: Comply with the licensing and certification standards of your state, except for home and community-based waiver services providers, who must meet Minnesota’s waiver plan requirements.
- Application Submission: Submit your application via the MPSE portal with a copy of the Provider Agreement and required assurance statements and credentials. Alternatively, fax documents to Provider Eligibility and Compliance.
Additional resources for out-of-state providers:
- Billing Policy Overview: Billing Policy Overview in the MHCP Provider Manual.
- Out-of-State Providers Section: Out-of-State Providers in the MHCP Provider Manual for further requirements.
Managing Your MHCP Enrollment
Once enrolled, it is crucial to maintain your enrollment information and stay compliant with MHCP regulations.
Changes to Enrollment Information
Providers are responsible for keeping their enrollment information current. Timely updates ensure accurate payments and prevent potential issues.
Recommended method for reporting changes:
- MPSE Portal Updates: The most efficient way to report changes is through the MPSE portal.
MPSE Training Webinars: MHCP offers quarterly webinars to guide providers on making enrollment changes via MPSE. Register for these sessions on the MPSE Training site.
Alternative Fax Forms for Changes:
You can also use fax forms for specific changes:
- Individual Practitioner Change Form (DHS-3535): Individual Practitioner MHCP Provider Profile Change Form (DHS-3535) (PDF) for individual enrollment changes and affiliation updates.
- Organization Change Form (DHS-3535A): Organization MHCP Provider Profile Change Form (DHS-3535A) (PDF) for organization contact or enrollment information updates.
- Disclosure of Ownership Form (DHS-5259): Disclosure of Ownership and Control Interest of an Entity (DHS-5259) (PDF) for changes in management, board composition, or ownership.
- Electronic Remittance Advice (RA) Request Form (DHS-4087): Electronic Remittance Advice (RA) Request Form (DHS-4087) (PDF) for adding electronic RA or managing RA affiliations (not for MCO in-network only providers).
- EFT Bank Change Form: EFT bank change form (PDF) for direct deposit changes (submitted to Minnesota Management and Budget – MMB).
- EFT Supplier ID Notification (DHS-3725): EFT Supplier ID Notification (DHS-3725) (PDF) for changes to MMB-issued EFT Vendor Number or Location Code (not for MCO in-network only providers).
- Provider Entity Sale or Transfer Addendum (DHS-5550): Provider Entity Sale or Transfer Addendum (DHS-5550) (PDF) for reporting ownership changes due to sale or transfer. Requires new enrollment documents and should be submitted at least 30 days prior to the sale date.
Provider Eligibility and Compliance will process change requests and notify you if additional documentation is needed. Enrollment status letters are issued to providers, including notifications of changes in participation or service offerings.
MN-ITS Registration
MN–ITS (Minnesota Information Transfer System) is a free, web-based, HIPAA-compliant system essential for interacting with MHCP electronically.
Registration process:
- Fee-for-Service Providers: Upon application approval, you will receive a Welcome letter with your MN–ITS initial User ID and Password. If you applied by fax, registration instructions will be included. Registration instructions. If you used MPSE, login details will be in the Welcome letter.
- MCO In-Network Only Providers: Similar to fee-for-service providers, you will receive a Welcome letter with MN–ITS login details and registration instructions after approval.
Key functions of MN-ITS:
- Eligibility Verification: Verify program eligibility for MHCP members.
- Secure Messaging: Retrieve enrollment letters and notices.
- Authorization Requests: Submit authorization requests for services and supplies.
- Service Agreements: Submit service agreement (SA) requests for home care services.
- Document Retrieval: Access authorization and service agreement letters and other documents.
- Claims Submission: Submit claims electronically (required by Minnesota law https://www.revisor.mn.gov/statutes/cite/62J.536).
- Claim Management: Copy or replace claims.
- Claim Status Checks: Check paid or denied status.
- MN–ITS Mailbox: Access MN–ITS Mailbox for Remittance Advices (RAs) and other communications.
- MPSE Access: Access MPSE to manage enrollment records.
Processing Timelines and Actions
Provider Eligibility and Compliance aims to process complete enrollment requests within 30 days of receipt, regardless of whether submitted via MPSE or fax. This 30-day timeline applies to new, corrected, and resubmitted requests.
Complete Requests: A request is considered complete when all required fields are filled, and all necessary documents are submitted. MPSE users can refer to the Request Submitted and Next Steps section of the MPSE user manual for status updates and outcomes.
Incomplete Requests and RFMI: If your initial enrollment request is incomplete, Provider Eligibility and Compliance will issue a Request for More Information (RFMI) letter via your MN–ITS mailbox or U.S. mail. You have 60 days to respond with the missing information using the same submission method as your original application (MPSE or fax – do not switch methods). Failure to provide complete information within the deadlines may lead to denial of your enrollment request.
Processing Time After Resubmission: If you need to resubmit documents or corrections, allow up to 30 days from the most recent submission date for processing.
Inactive Enrollment Records: If your enrollment record becomes inactive, you will need to re-enroll with MHCP via the MPSE portal or by faxing a new application.
Billing Organizations and MHCP
MHCP-enrolled providers can utilize clearinghouses or billing intermediaries to submit claims and transactions electronically. However, these billing agents must also enroll with MHCP as billing organizations to conduct business on behalf of providers.
Who Can Enroll? Eligible Provider Types
A wide range of healthcare providers are eligible to enroll in Minnesota Health Care Programs, contingent upon meeting specific professional certification and licensure requirements. After fulfilling these prerequisites, providers can apply for MHCP enrollment using the Minnesota Provider Screening and Enrollment (MPSE) portal or by submitting required application materials via fax.
It’s also advisable for providers to contact any Managed Care Organizations (MCOs) they contract with to understand their specific enrollment requirements.
Note: Providers marked with ‘1’ in the lists below typically do not receive direct payments and must bill through an organization. Providers marked with ‘2’ are generally not eligible to enroll as MCO-only providers.
Eligible Health Care Provider Types:
| ### Organization Providers | ### Individual Providers |
|---|---|
| Adult Day Treatment – 46 | Acupuncturist – AP |
| Allied Oral HealthProfessional Group – 31 | Alcohol and Drug Counselor – DC |
| Ambulatory Surgical Center – 22 | Allied Oral HealthProfessional– 31 |
| Birthing Center – B1 (Enrollment webpage forthcoming. Contact the MHCP Provider Resource Center for enrollment 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 enrollment information.) |
Conclusion
Enrolling in Minnesota Health Care Programs is a significant step for healthcare providers aiming to serve a broader community and ensure access to care for eligible Minnesotans. By following this comprehensive guide, understanding each step, and utilizing the resources provided by the Minnesota Department of Human Services, you can navigate the application process effectively. Whether you choose the efficient MPSE portal or opt for fax submission, being prepared and informed is key to a successful MHCP enrollment. Start your application today and become a part of the Minnesota healthcare safety net.
