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Risk Levels and Enrollment Verification Requirements

Revised: 01-04-2017

MHCP determines risk level for any items indicated with an asterisk (*). The Centers for Medicare & Medicaid Services determines all other risk levels.

Provider Types

Risk Level

Requires Site Visits

Requires Enrollment Fee

00 Nursing Facility

Limited

X

01 Hospital

Limited

X

02 Hospice

Moderate

X

X

03 Institution for Mental Disease

Limited

X

04 Renal Dialysis Center

Limited

X

05 ICF-DD

Limited

X

06 Children's Residential Treatment

Limited

X

08 Nursing Home Entity-Administrative Only

Limited

09 School District IEP Service

Limited;
Moderate if CTSS*

If providing CTSS

X

10 Community Mental Health Center

Moderate

X

X

11 Rehabilitation Agency

Limited;
Moderate if CORF

If CORF certified

If CORF

14 Licensed Ind Clinical Social Worker

Limited

15 Licensed Dietician or Licensed Nutritionist

Limited

16 Child & Teen Checkup Clinic

Limited

17 Regional Treatment Center

Limited

18 Home & Comm Based Svcs

Limited

X – Excludes those without an FEIN

19 Day Training & Habilitation

Limited

X

20 Physician Clinic

Limited;
Moderate if CTSS* or ARMHS*

If CTSS or ARMHS

If CTSS or ARMHS

20 Physician

Limited

22 Ambulatory Surgical Center

Limited

X

23 County Case Manager-Administrative Only

Limited

24 Managed Care Organization- Administrative Only

Limited

25 Licensed Marriage and Family Therapist

Limited

26 Certified Mental Health Rehab Prof

Limited

27 Health Care Case Coordinator- Administrative Only

Limited

28 EDI Trading Partner-Administrative Only

Limited

29 Occupational Therapist

Limited

30 Dental Clinic

Limited

30 Dentist

Limited

31 Dental Hygienist

Limited

31 Dental Hygiene Group

Limited

32 Ind Diagnostic Testing Facility

Moderate

X

X

33 Consolidated Provider Record

Limited

34 Mental Health Billing Entity

Limited;
Moderate if CTSS* or ARMHS*

If CTSS or ARMHS

If CTSS or ARMHS

35 Optometrist

Limited

36 Podiatry Group

Limited

36 Podiatrist

Limited

37 Chiropractors

Limited

37 Chiropractic Group

Limited

38 PCPO

High*

X

X

38 PCA Individual

Limited*

39 Physical Therapist

Moderate

40 Speech Language Pathologist

Limited

42 Licensed Psychologist

Limited

43 Audiologist

Limited

44 Targeted Case Management

Limited

X

45 County Human Service Agency

Limited;
Moderate if CTSS* or ARMHS*

If CTSS or ARMHS

If CTSS or ARMHS

46 Adult Day Treatment

Moderate*

X

X

48 Rehabilitation Billing Entity

Limited

49 Physician Billing Entity

Limited

50 Intensive Residential Treatment Service (IRTS)

Moderate*

X

X

51 Indian Health Service

Limited;
Moderate if CTSS* or ARMHS*

If CTSS or ARMHS

X

52 Federally Qualified Health Care Center

Limited

X

53 Rural Health Clinic

Limited

X

54 Family Planning Agency

Limited

55 Community Health Worker

Limited

56 Dental Lab

Limited

57 Public Health Clinic

Limited

58 Community Health Clinic

Limited

If CTSS or ARMHS

60 Home Health Agency

High for new enrollees;
Moderate for existing providers at revalidation.

X

X

61 Public Health Nurse

Limited

X

62 Chemical Health

Limited

X

63 Licensed Psych Clinical Counselor

Limited

64 Home Care Nursing (groups & individuals)

Moderate*

X

X (Groups only)

65 Nurse Practitioner

Limited

66 Nurse Midwife

Limited

67 Cert Reg Nurse Anesthetist Group

Limited

67 Cert Reg Nurse Anesthetist

Limited

68 Clinic Nurse Specialist

Limited

69 Physicians Assistant

Limited

70 Pharmacy
(IF DME COS = 032, 116, & 076)

Limited;
If providing DME: High for new enrollees; Moderate for existing providers at revalidation.

If DME

X

70 Pharmacist

Limited

72 Transportation Coordinator- Administrative Only

Limited

73 WIC

Limited

74 Head Start

Limited

75 Optical Supplier

Limited

76 Medical Supply

High for new enrollees;
Moderate for existing providers at revalidation.

X

X

77 Hearing Aid Dispenser

Limited

80 Independent Laboratory

Moderate

X

X

81 Independent X-Ray

Moderate

X

X

82 Medical Transportation

Moderate-Ambulance;
High-Transportation*

X

X

95 Clearing House-Administrative Only

Limited

98 Billing Intermediary-Administrative Only

Limited

AP Acupuncturist

Limited

B1 Birthing Centers

Limited

X

C1 Certified Professional Midwife

Limited

EI EIDBI – Group

Moderate*

X

X

EI EIDBI – Individual

Limited*

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