Understanding Minnesota Health Care Programs: A Comprehensive Guide

Minnesota Health Care Programs (MHCP) are a suite of public health insurance options designed to ensure that Minnesotans have access to essential medical services. These programs, administered by the Minnesota Department of Human Services (DHS), provide coverage to eligible individuals and families, including those with low incomes, children, pregnant women, seniors, and people with disabilities. Understanding what Minnesota Health Care Programs are, who they serve, and how they operate is crucial for both residents seeking coverage and healthcare providers aiming to serve this population.

This guide delves into the intricacies of Minnesota Health Care Programs, providing a comprehensive overview that is optimized for clarity, accuracy, and search engine optimization. We will explore the different facets of MHCP, including enrollment processes, eligibility criteria, and the various services covered, ensuring you have a robust understanding of this vital healthcare safety net.

Navigating the Enrollment Process for Minnesota Health Care Programs

For healthcare providers, enrolling in Minnesota Health Care Programs is essential to serve MHCP members and receive reimbursement for provided services. The enrollment process is managed through the Minnesota Provider Screening and Enrollment (MPSE) portal, a streamlined online system designed to facilitate efficient application and management of provider information.

Step 1: Verifying Exclusion Status

Before initiating the enrollment process, it is imperative to check both federal and state excluded provider lists. This crucial first step ensures compliance and prevents potential complications.

The U.S. Department of Health and Human Services Office of Inspector General (OIG) maintains a List of Excluded Individuals and Entities (LEIE). Being on this list prohibits participation in Medicare, Medicaid, and all federal healthcare programs. Minnesota Health Care Programs adheres to these federal guidelines and also maintains its own state excluded provider list.

Providers must proactively ensure they, their employees, and contractors are not on either the federal or state exclusion lists. This verification should be conducted:

Prior to initial enrollment: As a foundational step in the application process.
Before hiring or contracting: To ensure all personnel are compliant.
Monthly ongoing checks: To monitor for any updates to the exclusion lists and maintain continuous compliance.

Any exclusions discovered must be immediately reported to MHCP Provider Eligibility and Compliance via fax at 651-431-7462. Further details can be found on the Excluded Provider Lists page within the MHCP Provider Manual.

Step 2: Meeting MHCP Requirements and Certifications

Eligibility for MHCP enrollment hinges on meeting specific requirements and certifications relevant to the type of healthcare service being offered. Providers must ensure full compliance with all stipulations before submitting their enrollment application.

To ascertain the precise requirements, providers should:

Consult the Eligible Providers section: This section, detailed later in this guide, outlines specific licensure and certification prerequisites for various provider types.
Review Provider Screening Requirements: The Provider Screening Requirements page of the MHCP Provider Manual offers a comprehensive overview of these essential criteria.

Step 3: Obtaining a Provider Identification Number (NPI or UMPI)

A crucial element of the enrollment process is securing the correct provider identification number. For most provider types, this is the National Provider Identifier (NPI). However, some may utilize a Unique Minnesota Provider Identifier (UMPI).

National Provider Identifier (NPI)

The NPI is a standardized, unique identification number for healthcare providers. It is used for administrative and financial transactions, including claims processing. Providers who are eligible for an NPI must obtain it from the National Plan and Provider Enumeration System (NPPES) before enrolling with MHCP. You can apply for and manage your NPI via the NPPES website.

Unique Minnesota Provider Identifier (UMPI)

Certain provider types, while not mandated to have an NPI, might have the option to use one if already registered. If these providers do not possess an NPI, they can still enroll. MHCP will then assign them a UMPI upon application processing. These provider types typically 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
Non-emergency medical transportation (NEMT) organizations
Doula providers (both individual and organizational)

It’s important to note that providers not meeting the HIPAA definition of a healthcare provider might not be NPI-eligible. In such cases, they can apply for enrollment, and MHCP will issue a UMPI upon successful application, confirmed via a Welcome Letter.

Specific provider types are not eligible to obtain an NPI prior to enrollment and will be assigned a UMPI by MHCP. 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

The NPI or UMPI is mandatory for all fee-for-service claims submitted to MHCP, ensuring accurate provider identification and payment processing for services rendered to MHCP members.

Step 4: Submitting Enrollment Documents to MHCP

Providers have two primary methods for submitting their enrollment documents to Minnesota Health Care Programs:

Online Enrollment via MPSE Portal: Registering and utilizing the Minnesota Provider Screening and Enrollment (MPSE) portal is the most efficient approach. The MPSE portal offers:
- Built-in guidance throughout the application process.
- Real-time error detection to minimize application issues.
- Application status tracking for transparency and progress monitoring.
Fax Submission: Alternatively, providers can complete the necessary documents and fax them to MHCP’s Provider Eligibility and Compliance division. The specific forms required are service-dependent and detailed in the Eligible Providers section.

Important Note: MHCP does not accept enrollment documents via email. All submissions must be through the MPSE portal or by fax.

Application Fees: Understanding Costs

Certain MHCP provider types are required to pay a non-refundable application fee during initial enrollment, re-enrollment, or revalidation. It’s critical to ascertain if your provider type is fee-liable and to remit payment before submitting the enrollment application. Detailed information about application fee requirements is available in the Application Fees section of the Provider Screening Requirements page in the MHCP Provider Manual.

Electronic Funds Transfer (EFT): Streamlining Payments

Minnesota Health Care Programs strongly encourages all fee-for-service providers to enroll in Electronic Funds Transfer (EFT), also known as direct deposit. EFT offers numerous advantages over traditional paper checks:

Faster Payment Receipt: Access funds more quickly, eliminating mail delays and bank deposit trips.
Enhanced Security: Reduced risk of lost, stolen, or misdirected checks.
Simplified Cash Flow Management: Less paperwork and streamlined reconciliation.

Providers can initiate EFT enrollment during the application process itself, without waiting for enrollment approval.

To enroll in EFT, providers need an active 10-digit supplier ID and a 3-digit supplier location code from Minnesota Management and Budget (MMB). The process involves:

Supplier Portal Registration: Visit the Minnesota Supplier Portal and register as a “New Supplier” if you lack a supplier ID.
Banking Information Input: For existing supplier IDs, update banking details via the Supplier Portal (refer to the Update Supplier Profile guide) or submit the MMB EFT Bank Change Request form. For supplier ID inquiries, contact MMB at 651-201-8106.
Activation Timeline: Allow 10 business days for supplier ID activation post-banking information entry. Subsequently, input your EFT supplier ID and location code via the MPSE portal (instructions in the Enrollment Record Information section of the MPSE user manual) or fax the EFT Supplier ID Notification form (DHS-3725) to Provider Eligibility and Compliance at 651-431-7462.

Enrollment for Managed Care Organization (MCO) Providers

Federal mandates under the 21st Century Cures Act necessitate the enrollment of all Medicaid providers, including those participating in both fee-for-service and Managed Care Organization (MCO) networks. Enrollment for MCO in-network only providers commenced on July 17, 2023. These providers should follow the standard Enrollment Process outlined earlier.

For comprehensive information, refer to Enrollment process for MCO network providers and the Eligible Providers section for provider-specific requirements. Existing fee-for-service providers already contracted with an MCO are exempt from re-enrollment.

Providers seeking to join an MHCP managed care organization’s network must also directly contact the relevant health plan for contract and participation details. Additional information about MCOs is available on the MCOs page of the MHCP Provider Manual. MCO in-network provider enrollment instructions are found on the MCO In-Network Provider Enrollment page within the MPSE User Manual.

Enrollment Approvals: Effective Dates and Considerations

Minnesota-Based Providers

Providers located within Minnesota may receive retroactive enrollment approvals. If enrollment criteria are met, the effective date will be determined using the most beneficial of the following:

The provider’s requested effective date in MPSE or the application.
The first day of the month when the enrollment request is received.
Up to 90 days prior to the Medicare certification effective date.
The retroactive date of the member’s MHCP eligibility confirmation.
The date of confirmation that the provider meets all MHCP requirements.

For provider types requiring additional screening like site visits and background checks (categorized as moderate or high-risk on the Risk Levels page), approval will be contingent upon completion of these screenings.

Out-of-State Providers

Out-of-state providers can apply for MHCP enrollment specifically for dates of service provided to MHCP members. Eligibility for payment necessitates:

Compliance with licensing and certification standards of their state of location (Minnesota standards apply for home and community-based waiver services).
Submission of an enrollment request via the MPSE portal, including a copy of the Provider Agreement and necessary assurance statements and credentials, or faxing documents to Provider Eligibility and Compliance.

Further details are available in the Billing Policy Overview and Out-of-State Providers sections of the MHCP Provider Manual.

Consolidated Providers and Taxonomy Codes

A consolidated provider is defined as one utilizing a single National Provider Identifier (NPI) across multiple enrollment records. This scenario arises when a provider offers diverse services that cannot be billed under a single enrollment record, necessitating multiple records. Provider Eligibility and Compliance assesses providers with multiple active credentials to determine if record consolidation is needed.

MHCP Use of Taxonomy Codes (Non-MCO)

Taxonomy codes categorize providers by type, classification, and specialization. These codes are accessible on the X12 External Codes List.

When a provider bills across multiple records under one NPI (due to multiple locations or service types), MHCP consolidates these under a Provider Type (PT) 33 record, while the original records remain active and linked.

Shared Physical Address: If records under one NPI share a physical address or zip code, taxonomy codes for each record are required post-enrollment and MN–ITS registration. If taxonomy codes are identical across records, a custom taxonomy code can be used. MHCP utilizes these codes solely for billing purposes.
Unique Physical Addresses: For records under one NPI with distinct physical addresses, the service facility location must be specified on claims.

Taxonomy and custom taxonomy codes are submitted via MN–ITS. A tutorial is available via the Adding Taxonomy Codes video for consolidated providers.

MN–ITS Registration: Essential for Fee-for-Service Providers

MN–ITS (Minnesota Information Transfer System) is a free, HIPAA-compliant, web-based platform. Upon enrollment approval, providers receive a Welcome Letter containing an initial MN–ITS User ID and Password. Providers enrolling via fax must register for MN–ITS using provided registration instructions. MPSE portal enrollees can use the login details in their Welcome Letter.

Minnesota law mandates electronic claim submission for all MHCP-eligible healthcare providers and suppliers. MN–ITS registration is therefore compulsory for all providers and their affiliated clinics or billing services, as MHCP does not process paper claims.

MN–ITS functionalities include:

Verifying MHCP member eligibility.
Accessing enrollment-related letters and notices.
Submitting authorization requests for services and supplies.
Submitting service agreement (SA) requests for home care.
Retrieving authorization and service agreement letters and other documents via the MN–ITS Mailbox.
Submitting claims (including those with third-party insurance or Medicare).
Copying or replacing previously submitted claims.
Checking claim status (paid/denied).
Utilizing the MN–ITS Mailbox for Remittance Advices (RAs) and communications.
Accessing MPSE for enrollment record management.

MN-ITS for MCO In-Network Only Providers

MN–ITS is also mandatory for MCO in-network only providers. Upon MHCP approval, a Welcome Letter with MN–ITS login credentials and registration instructions is provided. MCO in-network providers primarily use MN–ITS to access the MPSE portal for MHCP enrollment management and to retrieve enrollment-related communications.

Managing Enrollment Changes

Providers are responsible for maintaining up-to-date enrollment information. The most efficient method for reporting changes is via the MPSE portal. MHCP offers quarterly webinars on managing enrollment changes through MPSE, with registration available on the MPSE Training site.

Alternatively, providers can fax forms relevant to their practice:

Individual Practitioner MHCP Provider Profile Change Form (DHS-3535) for individual enrollment changes and affiliation updates.
Organization MHCP Provider Profile Change Form (DHS-3535A) for organizational contact or enrollment information updates.
Disclosure of Ownership and Control Interest of an Entity (DHS-5259) for changes in management, board composition, or ownership.
Electronic Remittance Advice (RA) Request Form (DHS-4087) (non-MCO) to manage electronic RA settings. See the remittance advice page for details.
EFT bank change form for direct deposit updates (submitted to Minnesota Management and Budget – MMB).
EFT Supplier ID Notification (DHS-3725) (non-MCO) to report changes to MMB-issued EFT Vendor Number or Location Code.
Provider Entity Sale or Transfer Addendum (DHS-5550) for ownership changes due to sale or transfer. Requires new enrollment documents and must be submitted 30 days pre-sale to avoid billing disruptions. Credentialing is required, and processing time is similar to new enrollments. Ownership changes may lead to payment reversals for terminated providers.

Provider Eligibility and Compliance processes change requests and will request additional documentation if needed. Enrollment status letters are sent to providers, including updates on service expansions or reductions.

Processing Timelines and Actions

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 to new, corrected, and resubmitted requests.

Complete Requests

A complete request includes all required fields and documents. MPSE users can consult the Request Submitted and Next Steps section of the MPSE user manual for status details and outcomes.

For incomplete new enrollment requests, a request for more information (RFMI) letter is sent via MN–ITS mailbox or U.S. mail, detailing missing information. Providers have 60 days to respond using the original application method (MPSE or fax – methods should not be interchanged). Partial responses trigger a subsequent RFMI with an additional 30-day deadline. Failure to provide complete information within these timelines results in request denial. Correcting incomplete or incorrect submissions also allows up to 30 days for processing from the latest submission date.

Inactive Enrollment Records

Inactive enrollment records necessitate re-enrollment via the MPSE portal or faxing a new application to Provider Eligibility and Compliance.

Billing Organizations: Streamlining Claims (Non-MCO)

MHCP-enrolled providers can utilize clearinghouses or billing intermediaries as billing agents for electronic claim and transaction submissions. These entities must enroll as a billing organization with MHCP.

Eligible Providers: A Diverse Network

Participation in Minnesota Health Care Programs requires providers to meet professional certification and licensure standards as per state and federal regulations relevant to their services. Post-qualification, providers can apply for MHCP enrollment via the MPSE portal or by faxing required application materials. Contacting contracted Managed Care Organizations (MCOs) for their specific enrollment requirements is also advised.

Fee-for-service providers marked with ¹ in the lists below do not receive direct payments and must bill through an organization. Providers marked with ² are ineligible for MCO-only enrollment.

Eligible Provider Types:

| Organization Providers ## Understanding Minnesota Health Care Programs: A Comprehensive Guide

Minnesota Health Care Programs (MHCP) stand as a cornerstone of the state’s commitment to ensuring health coverage for its residents. These publicly funded initiatives are designed to provide access to essential health services for a wide range of individuals and families who might otherwise face barriers to care. Administered by the Minnesota Department of Human Services (DHS), MHCP encompasses various programs tailored to meet the diverse needs of Minnesotans, including those with low incomes, children, pregnant individuals, seniors, and people with disabilities. For both those seeking healthcare coverage and providers aiming to deliver services, a thorough understanding of what Minnesota Health Care Programs are is paramount.

This guide aims to provide an in-depth exploration of Minnesota Health Care Programs. We will delve into the core aspects of MHCP, covering eligibility criteria, enrollment procedures for providers, and the scope of services offered. Our goal is to create a resource that is not only informative and accurate but also optimized for search engines, making this critical information readily accessible to those who need it most.

Provider Enrollment in Minnesota Health Care Programs: A Step-by-Step Guide

For healthcare providers, becoming an enrolled provider with Minnesota Health Care Programs (MHCP) is a vital step in serving MHCP members and ensuring financial reimbursement for their services. The gateway to MHCP enrollment is the Minnesota Provider Screening and Enrollment (MPSE) portal, an online system designed to streamline the application process and ongoing management of provider information.

Step 1: Initial Screening – Checking Excluded Provider Lists

Before embarking on the enrollment journey, the first critical action is to verify your status against both federal and state excluded provider lists. This preliminary check is not just a procedural formality; it’s a compliance necessity.

The federal Health and Human Services Office of Inspector General (OIG) maintains the List of Excluded Individuals and Entities (LEIE). Inclusion on this list carries significant weight, barring individuals and entities from participating in Medicare, Medicaid, and all other federal health care programs. Minnesota Health Care Programs strictly adheres to these federal stipulations, and additionally, maintains its own state-level excluded provider list.

Prospective MHCP providers bear the responsibility of ensuring that neither they, their employees, nor their contractors appear on these exclusion lists. This verification process is crucial at several junctures:

Pre-Enrollment: As the very first step in initiating your application.
Pre-Hiring/Contracting: Before bringing any new personnel onboard, whether as employees or contractors.
Ongoing Monthly Monitoring: To proactively track any changes to the exclusion lists and maintain continuous compliance.

Should any exclusion be identified during these checks, it must be promptly reported to MHCP Provider Eligibility and Compliance via fax at 651-431-7462. For more detailed information, refer to the Excluded Provider Lists page within the MHCP Provider Manual.

Step 2: Meeting Essential Rules and Requirements for MHCP Participation

Eligibility for enrollment in Minnesota Health Care Programs is contingent upon meeting a defined set of requirements and possessing the necessary certifications specific to the healthcare services you intend to provide. Prior to submitting any enrollment information to MHCP, providers must confirm they fully satisfy these prerequisites.

To accurately determine the applicable requirements, providers should undertake the following:

Consult the “Eligible Providers” Section: Located later in this guide, this section provides a comprehensive breakdown of licensure and certification mandates for various provider types.
Review the Provider Screening Requirements Page: The Provider Screening Requirements page of the MHCP Provider Manual offers an exhaustive overview of the screening criteria that providers must adhere to.

Step 3: Acquiring Your Provider Identification Number: NPI or UMPI

A pivotal step in the enrollment process is obtaining the correct provider identification number. For the majority of provider types, this is the National Provider Identifier (NPI). However, certain categories may utilize a Unique Minnesota Provider Identifier (UMPI).

National Provider Identifier (NPI)

The NPI is a standardized, unique 10-digit number assigned to health care providers. It serves as a crucial identifier in administrative and financial transactions across the healthcare system, including the processing of claims. Providers who are classified as HIPAA-covered entities and are eligible for an NPI must obtain it from the National Plan and Provider Enumeration System (NPPES) before initiating their enrollment with MHCP. You can apply for and manage your NPI via the NPPES website.

Unique Minnesota Provider Identifier (UMPI)

While most providers require an NPI, certain provider types are exempt from this federal requirement. For these providers, while they may have the option to use an NPI if they possess one, it is not mandatory. If these specific provider types do not have an NPI, they can still proceed with enrollment, and MHCP will assign them a UMPI during the application processing stage. These provider types generally include:

Providers of Home and Community-Based Services
Personal Care Provider Organizations
Day Training and Habilitation Providers
Individuals offering Early Intensive Developmental and Behavioral Intervention (EIDBI) at Levels II and III
Non-Emergency Medical Transportation (NEMT) Organizations
Doula Providers (both individual practitioners and organizations)

It is important to note that individuals or entities that do not meet the federal definition of a health care provider under HIPAA may not be eligible to receive an NPI. If a provider finds themselves in this category and is unable to obtain an NPI, they can still apply for MHCP enrollment. Upon successful processing of their application, MHCP will confirm their enrollment via a Welcome letter and assign them a 10-digit UMPI.

Conversely, specific provider types are not eligible to obtain an NPI before submitting their enrollment forms and will be assigned a UMPI directly by MHCP. These include:

Approved Day Treatment Centers
Children’s Residential Services Providers
Clearinghouses and Billing Intermediaries (when enrolling as non-MCO providers)
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 (when enrolling as non-MCO providers)
Non-Emergency Medical Transportation (NEMT) Drivers

Whether it is an NPI or a UMPI, this provider identification number is mandatory on all fee-for-service claims submitted to MHCP. This number is essential for MHCP to accurately identify the billing provider and process payments for MHCP-covered services delivered to eligible members.

Step 4: Submitting Your Enrollment Application to MHCP

Providers seeking to enroll with Minnesota Health Care Programs have two distinct avenues for submitting their enrollment documents:

Online Submission via the MPSE Portal: The most efficient and recommended method is to Register and access the Minnesota Provider Screening and Enrollment (MPSE) portal to complete your enrollment online through the MPSE portal. This online system offers significant advantages:
- Guided Application Process: The portal provides built-in prompts and instructions, simplifying each step of the application.
- Error Prevention: The system can identify common errors in real-time, allowing for immediate corrections and reducing processing delays.
- Application Tracking: Providers can monitor the status and progress of their application directly through the portal.
Fax Submission of Documents: Alternatively, providers can opt to complete all required documents offline and submit them via fax to MHCP’s Provider Eligibility and Compliance division. The specific documents required will vary based on the services you intend to provide and are detailed in the Eligible Providers section of this guide.

Important Note: It is crucial to understand that MHCP does not accept enrollment documents submitted via email. All enrollment materials must be submitted through one of the two methods outlined above: the MPSE portal or fax.

Understanding Application Fees

For certain MHCP provider types, a nonrefundable application fee is required. This fee applies to providers who are newly enrolling, reenrolling, or revalidating their enrollment. If your provider type is subject to this fee, it is imperative that you pay the fee before submitting your enrollment application. Comprehensive details regarding application fee requirements, including which provider types are affected and the fee amounts, can be found in the Application Fees section within the Provider Screening Requirements page of the MHCP Provider Manual.

Electronic Funds Transfer (EFT) for Direct Deposit Payments

MHCP strongly recommends that all fee-for-service providers enroll in Electronic Funds Transfer (EFT), also known as direct deposit, for receiving payments. EFT offers a more efficient, secure, and convenient alternative to traditional paper checks. Providers can enroll in EFT during the application process itself; there is no need to wait until your enrollment is fully approved.

The advantages of EFT payments are numerous:

Faster Access to Funds: EFT payments are processed and deposited directly into your bank account more quickly than paper checks, eliminating mail delays.
Enhanced Payment Security: EFT eliminates the risks associated with paper checks, such as loss, theft, or misdirection.
Streamlined Cash Flow Management: EFT reduces paperwork and simplifies reconciliation, making cash flow management easier.

To enroll in EFT and receive payments directly 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). The process for establishing EFT payments involves these steps:

Register on the Minnesota Supplier Portal: Visit the Minnesota Supplier Portal website. If you do not already 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 your banking information, you can do so through the Supplier Portal. Refer to the guide Update Supplier Profile for step-by-step instructions. Alternatively, you can submit the MMB EFT Bank Change Request form (PDF). If you have questions about the status of your supplier ID for direct deposit, contact MMB directly at 651-201-8106.
Activation Period: It takes approximately 10 business days after you add your banking information for your supplier ID to become active for EFT. After this activation period, you will need to enter your EFT supplier ID and supplier location code within the MPSE portal. Instructions for adding this information can be found in the MPSE user manual page for Enrollment Record Information. Alternatively, you can fax a completed EFT Supplier ID Notification form (DHS-3725) (PDF) to Provider Eligibility and Compliance at 651-431-7462.

Enrollment Considerations for Managed Care Organization (MCO) Providers

Federal legislation, specifically the 21st Century Cures Act, mandates that state Medicaid agencies, including DHS in Minnesota, enroll all Medicaid providers. This requirement extends to both providers participating in the traditional Medicaid fee-for-service system and those within Managed Care Organization (MCO) networks. The enrollment process for MCO in-network only providers commenced on July 17, 2023. These providers are required to follow the general Enrollment Process outlined in this guide.

For further details and specific guidance, please refer to Enrollment process for MCO network providers. You can also consult the Eligible Providers section of this guide for a list of provider types enrolled by DHS and the specific enrollment requirements for each type.

It’s important to note that providers who are already actively enrolled as fee-for-service providers with MHCP and who also contract with an MCO are not required to undergo the screening and enrollment process again for their MCO participation.

Providers who choose to participate in the network of an MHCP managed care organization must also directly contact the relevant health plan for information on participation and contracting. Additional information about MCOs can be found on the MCOs page within the MHCP Provider Manual.

Providers enrolling specifically as MCO in-network providers should follow the instructions provided on the MCO In-Network Provider Enrollment page of the MPSE User Manual.

Enrollment Approvals: Understanding Effective Dates

Approval Processes for Minnesota-Based Providers

Providers located within Minnesota may be eligible for retroactive enrollment approvals. If a provider meets all enrollment requirements for their specific provider type, the enrollment application may be approved with an effective date determined by the most favorable of the following criteria:

The effective date specifically requested by the provider in MPSE or on their enrollment application.
The first day of the month in which MHCP receives a complete enrollment request or application.
Up to 90 days prior to the effective date of the provider’s Medicare certification (if applicable).
The retroactive date on which the member is confirmed to be eligible for MHCP coverage.
The date on which the provider is confirmed to have met all applicable MHCP provider requirements.

For Minnesota providers whose provider type requires additional screening methods, such as mandatory site visits and background checks (typically provider types categorized as moderate-risk or high-risk levels, as detailed on the Risk Levels section of the Provider Screening Requirements page), DHS will grant enrollment approval upon the successful completion of these additional screenings.

Approval Processes for Out-of-State Providers

Providers located outside of Minnesota may apply for MHCP enrollment specifically for the date(s) of service they provided to an MHCP member in Minnesota. To be eligible for payment from MHCP for these services, out-of-state providers must meet specific conditions:

Licensing and Certification Compliance: They must comply with all licensing and certification requirements of the state in which they are physically located. An exception to this is for home and community-based waiver services providers, who must meet the licensing and certification requirements as defined in Minnesota’s federally approved waiver plan.
Application Submission: They must submit an enrollment request to MHCP using the MPSE portal. This submission must include a copy of the Provider Agreement and any other required assurance statements and professional credentials. Alternatively, they can fax the required documents to Provider Eligibility and Compliance at the fax number provided on the MHCP forms.

For further information on billing policies and requirements for out-of-state providers, refer to the Billing Policy Overview and Out-of-State Providers sections in the MHCP Provider Manual.

Consolidated Providers and the Use of Taxonomy Codes

A “consolidated provider” in the context of MHCP is defined as a provider entity that has multiple enrollment records linked to a single National Provider Identifier (NPI).

This situation can arise when a provider offers multiple types of healthcare services. It is important to understand that not all services can be billed under a single enrollment record. Depending on the nature and type of services offered, it may be necessary to create multiple enrollment records for a single provider entity. Provider Eligibility and Compliance within MHCP regularly reviews providers who hold multiple, active professional credentials across different enrollment records to determine if consolidation of these records is necessary and appropriate.

MHCP’s Utilization of Taxonomy Codes (Excluding MCO In-Network Only Providers)

A taxonomy code is a standardized code that precisely describes a health care provider or organization’s type, classification, and area of specialization. A comprehensive list of provider taxonomy codes and their detailed descriptions can be found on the X12 External Codes List webpage.

When a provider chooses to use a single NPI for billing across multiple enrollment records (for instance, due to having multiple service locations or offering multiple distinct types of services), MHCP will consolidate all of these records under a single overarching Provider Type (PT) 33 record. The individual original records will remain active and will be linked to this consolidated PT33 record.

Shared Physical Address Scenario: If an NPI represents multiple enrollment records that share a common physical address or zip code, the provider is required to submit taxonomy codes for each individual record. This submission must occur following the completion of enrollment and MN–ITS registration. In cases where multiple records are limited to and share the exact same taxonomy code, the provider has the option to enter a custom taxonomy code to differentiate them. It is important to note that MHCP uses these taxonomy codes strictly for billing and claims processing purposes.
Unique Physical Address Scenario: If an NPI represents multiple enrollment records, and each of these records has a unique and distinct physical address, then the provider is required to submit the specific service facility location where the health care service was actually provided on each claim submitted to MHCP.

Providers are required to submit taxonomy codes, including custom taxonomy codes when necessary, to MHCP through the MN–ITS system. For a step-by-step tutorial on how to perform this process, providers can watch the instructional video Adding Taxonomy Codes specifically created for consolidated providers.

MN–ITS Registration: Mandatory for Fee-for-Service Providers

MN–ITS, the Minnesota Information Transfer System, is a free, web-based, and HIPAA-compliant system essential for providers participating in Minnesota Health Care Programs. Once Provider Eligibility and Compliance approves a provider’s enrollment application, they will send a formal Welcome letter to the provider to officially confirm their enrollment. This Welcome letter is crucial as it includes the provider’s initial MN–ITS User ID and Password.

For providers who completed their enrollment application via fax, it will be necessary to register for MN–ITS separately using the registration instructions provided in the Welcome letter. If the provider enrolled using the MPSE portal, they can directly log in to MN–ITS using the login credentials provided in their Welcome letter.

Minnesota state law mandates that all health care providers and suppliers who are eligible for reimbursement from MHCP must submit all claims electronically. Therefore, registration for MN–ITS is not optional; it is a mandatory requirement for all providers and their affiliated clinics or billing services. MHCP does not process any paper claims; electronic submission through MN–ITS is the sole method for claim submission.

As a registered MN–ITS user, providers gain access to a wide range of functionalities, including:

Eligibility Verification: Real-time verification of program eligibility for MHCP members.
Enrollment Communication Retrieval: Access and retrieve important letters or notices pertaining to your enrollment status and any updates.
Authorization Request Submission: Submit prior authorization requests for various medical, dental, or medical supply services requiring pre-approval.
Service Agreement (SA) Requests: Submit service agreement requests, primarily used for home care services requiring specific agreements.
Authorization and Service Agreement Retrieval: Retrieve authorization letters, service agreement letters, and other important communications directly through the MN–ITS mailbox.
Claim Submission: Submit claims for services provided, including original claims, claims with third-party insurance information, or Medicare crossover claims.
Claim Management: Copy previously submitted MN–ITS claims for resubmission or replace incorrectly submitted claims that have already been paid.
Claim Status Inquiry: Check the real-time status of submitted claims, determining if they have been paid or denied and understanding denial reasons if applicable.
MN–ITS Mailbox Access: Secure mailbox for receiving important information, including Remittance Advices (RAs) detailing payment breakdowns.
MPSE Access: Seamlessly access the MPSE portal directly through MN–ITS to view and manage your provider enrollment records, update information, and complete other enrollment-related tasks.

MN–ITS Registration for MCO In-Network Only Providers

MN–ITS is also a mandatory system for providers who are enrolled as MCO in-network only providers with Minnesota Health Care Programs. Upon MHCP’s approval of an MCO in-network only provider application, a Welcome letter will be sent to the provider to confirm their enrollment. This Welcome letter contains essential information, including an initial MN–ITS user ID, a temporary password, and comprehensive registration instructions for completing the MN–ITS registration process.

MCO in-network providers primarily utilize MN–ITS to access the MPSE portal. Through MPSE, they can efficiently manage their MHCP enrollment information, ensuring it remains accurate and up-to-date. MN–ITS access also provides a secure channel for providers to retrieve important letters or notices related to their enrollment status and any program updates.

Managing Changes to Your Enrollment Information

It is the ongoing responsibility of every enrolled provider to ensure that all enrollment information remains current and accurate. Maintaining updated records is crucial for uninterrupted participation in Minnesota Health Care Programs and for timely and correct payment processing.

The most efficient and direct way to report any changes or to update information on your enrollment record is by submitting a request directly through the MPSE portal. To further assist providers in managing their enrollment information effectively, MHCP offers quarterly webinars specifically focused on making changes to MHCP enrollment information using the MPSE portal. Providers can find more details and register for these informative training sessions on the MPSE Training site.

In addition to the MPSE portal, providers also have the option to report certain changes by faxing specific forms relevant to their practice. The forms available for fax submission include:

Individual Practitioner MHCP Provider Profile Change Form (DHS-3535) (PDF): Use this form to report changes to an individual practitioner’s personal enrollment information, or to add or remove affiliations with other organizations or providers.
Organization MHCP Provider Profile Change Form (DHS-3535A) (PDF): Utilize this form to report changes to an organization’s contact information, enrollment details, or authorized representative information.
Disclosure of Ownership and Control Interest of an Entity (DHS-5259) (PDF): This form is used to report any changes in the management structure, board of directors composition, or ownership structure of an enrolled entity. (For changes specifically related to the sale or transfer of ownership, refer to the last bullet point below).
Electronic Remittance Advice (RA) Request Form (DHS-4087) (PDF) (not applicable to MCO in-network only providers): Use this form to add the option for electronic Remittance Advices (RAs) to a provider’s MN–ITS account, or to add or remove an RA affiliation with a billing organization. Further information on Remittance Advices can be found on the remittance advice page of the provider manual.
EFT bank change form (PDF): This form is specifically for reporting changes to your direct deposit banking information for Electronic Funds Transfer (EFT) payments. Note that this form is submitted to a different agency, Minnesota Management and Budget (MMB), not directly to DHS.
EFT Supplier ID Notification (DHS-3725) (PDF) (not applicable to MCO in-network only providers): Use this form to report changes to your MMB-issued EFT Vendor Number or Location Code, which are essential for EFT payment processing.
Provider Entity Sale or Transfer Addendum (DHS-5550) (PDF): This form is specifically designed to report a change in ownership of a provider entity due to a sale or transfer of the business. When reporting a change of ownership, you are required to submit completely new copies of all enrollment documents that are typically required for your provider type(s), including a new copy of the MHCP provider agreement, DHS-5259, and any other agreements and addendums that are specific to your provider type(s). It is critical to submit complete change of ownership documents at least 30 days prior to the effective date of sale to avoid potential billing interruptions. Note that a change in ownership requires meeting all current credentialing requirements as if it were a new enrollment. The processing time for a change of ownership is generally the same as for a new enrollment application. Be aware that a change in ownership may result in payment reversals for terminated providers.

Provider Eligibility and Compliance will carefully process all submitted change information. They will notify the provider if any additional documentation or clarification is needed to complete the requested changes. Provider Eligibility and Compliance routinely sends enrollment status letters to providers, including notifications when changes in provider participation occur, such as when providers expand or reduce the scope of services they offer under MHCP.

Processing Timelines and Actions for Enrollment Requests

Whether enrollment materials are submitted through the MPSE portal or via fax, Provider Eligibility and Compliance is committed to processing complete requests within 30 days of receiving the request. It is important to note that this 30-day processing timeline applies uniformly to all requests, including newly submitted applications, corrected applications, and resubmitted applications. Each submission is treated with the same priority as an initial request.

Understanding “Complete Requests”

A “complete request” signifies that all mandatory fields within the application have been fully completed and that MHCP has received all required supporting documents and information. If you have submitted your request via the MPSE portal, you can review the Request Submitted and Next Steps section of the MPSE user manual for detailed information regarding the various statuses and outcomes displayed within the MPSE system.

In the event that a new enrollment request is found to be incomplete, Provider Eligibility and Compliance will send the provider a formal request for more information (RFMI) letter. This RFMI letter will be delivered either through the provider’s secure MN–ITS mailbox or via standard U.S. postal mail, clearly outlining the specific information that is still needed to fully process the enrollment request. The provider is granted a 60-day timeframe to respond to the RFMI and return the missing information to MHCP. When replying to an RFMI, it is essential to use the same method that was used for the original application submission (either MPSE portal or fax). Providers should not switch between these two methods when responding to an RFMI. If Provider Eligibility and Compliance receives a partial response containing some, but not all, of the requested information, a subsequent RFMI will be issued to the provider, again requesting the remaining missing information. Providers will then have an additional 30 days to return the still-missing information to Provider Eligibility and Compliance. If the information remains incomplete after this extended timeframe, Provider Eligibility and Compliance will be compelled to deny the enrollment request due to incompleteness.

If providers submit enrollment documents that are not fully complete or contain errors and Provider Eligibility and Compliance must request additional information or corrections, providers should anticipate a processing time of up to 30 days from the most recent date on which the complete and correct materials were submitted.

Reactivating Inactive Enrollment Records

If a provider’s enrollment record becomes inactive for any reason, the provider will be required to formally re-enroll with MHCP to regain active participation status. To re-enroll, providers can utilize the MPSE portal to submit a new re-enrollment application online or choose to re-enroll by faxing a new application to Provider Eligibility and Compliance. The re-enrollment process is similar to the initial enrollment process and requires updated information and adherence to current requirements.

Billing Organizations: Facilitating Claims Processing (Non-MCO Providers)

MHCP-enrolled providers have the option to assign clearinghouses or billing intermediaries to act as their billing agents. These billing organizations can submit claims and other necessary healthcare transactions electronically to MHCP on behalf of the enrolled provider.

It is essential to note that clearinghouses and billing intermediaries that intend to send MHCP claims and other transactions on behalf of enrolled providers must themselves be formally enrolled with MHCP as a billing organization. This enrollment ensures proper authorization and compliance with MHCP’s electronic transaction standards.

Eligible Providers: Joining the MHCP Network

Providers who are interested in participating in Minnesota Health Care Programs must first meet specific professional certification and licensure requirements. These requirements are determined by applicable state and federal laws and regulations and are specific to the types of health care services the provider wishes to offer under MHCP. Once an individual provider or a provider organization has met these professional qualifications, they can formally apply to become an enrolled MHCP provider. The application process can be initiated either through the Minnesota Provider Screening and Enrollment (MPSE) portal for online submission or by submitting the required application materials via fax.

It is also recommended that providers, especially those intending to participate in managed care networks, contact any Managed Care Organizations (MCOs) with which they have a contract or intend to contract. MCOs may have additional or specific enrollment requirements that providers need to fulfill to participate in their networks.

Within the following lists of eligible provider types, certain fee-for-service providers are marked with the number “¹”. These providers, as indicated, do not receive direct payment for the services they provide under MHCP and must bill for their services through a larger organization or entity. Additionally, provider types marked with the number “²” are specifically noted as not being eligible to enroll as an MCO-only provider.

The following tables list the diverse range of health care provider types that may be eligible for enrollment with Minnesota Health Care Programs:

### 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 to come. 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 to come. Contact the MHCP Provider Resource Center for enrollment information.)