Limited authorization (LA) dental hygienists must be employed or retained by one of the following MHCP-enrolled groups:
Individual LA dental hygienists are not eligible for direct MHCP reimbursement.
Individual LA dental hygienists must enroll with a group affiliation to receive reimbursement at the group level for all dental hygiene services rendered to MHCP enrollees. As part of this process, MHCP requires individual NPIs and affiliation with one or more of these enrolled group providers.
For LA dental hygienists providing services to enrollees in a managed care organization (MCO), contact the MCO for enrollment requirements and coverage.
LA dental hygienists must be licensed by the Minnesota Board of Dentistry and have a collaborative agreement registered with the Board of Dentistry.
LA dental hygienists must complete, sign and fax the following forms to MHCP Provider Enrollment at (651) 431-7462:
MHCP will notify applicants of the enrollment status within 30 days of receiving the completed and signed documents.
MHCP reimburses for covered dental services within the scope of practice of the LA hygienist as identified in Minnesota Statute 150A.10 Subd. 1a.
Bill all services completed in a limited authorization capacity using the following:
Minnesota Statutes 150A.10 subd. 1a Limited authorization for dental hygienists