MHCP Provider News

March 20, 2017

  • Proposed rule amendment about retroactive billing: The Department of Human Services (DHS) is considering a possible amendment to its Medical Assistance (MA) rules governing retroactive billing for MA providers and reimbursement of MA recipients. Read more information and view the official Notice of Request for Comments and draft amendment on the rulemaking docket web page. Submit comments on the possible amendment to the rules until 4:30 p.m. on May 15, 2017, by emailing, by mailing to Vanessa Vogl, Rulemaking Attorney at the Minnesota Department of Human Services, PO Box 64254, Saint Paul, MN 55164-0254, by posting on the Office of Administrative Hearings website, or by calling 651-431-3168. TTY users may call DHS at 800-627-3529.
  • • See grants and requests for proposal (RFPs) for current grants available or RFPs in which you may be interested.
  • Training and VideoPresence Opportunities

    Refer to the Provider Training page for information about new and ongoing training or to the list below for details on additional training sessions on special topics.


    Announcements and availability: Watch the 5010/D.0 Announcements page for information about MN–ITS functionality, technical information, scheduled downtimes and other notifications.

    Child and Teen Checkups

    Maternal depression billing change: On January 1, 2017, a new NCCI procedure-to-procedure (PTP) edit became effective that pairs immunization administration codes with maternal depression screening. You may receive the NCCI edit when submitting claims for maternal depression screening with CPT code 96161. These edits have a Correct Coding Modifier Indicator of “1” and, therefore, the PTP edit will be bypassed if you correctly add a PTP-associated modifier. See Minnesota NCCI FAQs page for information about modifiers and the Child and Teen Checkups section of the MHCP Provider Manual.

    Early Intensive Developmental and Behavioral Intervention (EIDBI)

    EIDBI policy manual updates: DHS updated several sections of the Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit Policy Manual. For a list of updates and links to new pages, see Updates to the EIDBI Benefit Policy Manual. We are re-organizing the manual and will continue to add and update content as the legislation for the EIDBI benefit progresses.

    EIDBI advisory group: DHS has reviewed all applications and finalized all appointments to the EIDBI Advisory Group. We will notify all applicants of their status in mid-March. Selected candidates will receive an invitation to the first meeting that is scheduled for March 31, 2017, from 10 a.m. to noon. Watch this space – we will update this message if any other changes are necessary. Email questions to


    Outpatient Hospitals

    Off-campus provider-based hospital department services: Beginning January 1, 2017, off-campus provider-based hospital department services must identify nonexcepted service lines on their claims using modifier PN (nonexcepted off-campus service). MHCP is working on the system change to price service lines modified with PN using the physician fee schedule following CMS guidelines in MLN Matters 9930. We will notify providers when the programming is completed and will retroactively reprocess claims.

    Observation and extended assessment and management (E&M) composite: MHCP has completed the programing for the Ambulatory Payment Classification (APC) observation procedure code G0438 when performed with E&M services. Effective for dates of service on or after July 1, 2015, E&M services will be priced using a composite rate when there are eight or more hours of observation. Refer to CMS MLN Matters MM8653 and MM9486. Reprocessed claims will be on the March 22, 2017, remittance advice (RA). After reviewing your RA for the corrected claims, if you find additional claims that need to be replaced, notify the MHCP Provider Call Center with the claims payer claim control number.

    Laboratory Services

    Genetic testing for breast cancer: Genetic testing for breast cancer aims to help breast cancer patients and their physicians determine whether adjuvant chemotherapy would be beneficial. Refer to the Laboratory and Pathology Services section of the MHCP Provider Manual for specific information about when genetic testing is considered medically indicated. We updated the manual section to clarify that MHCP allows payment for one of the following tests:

  • • Oncotype DX – bill this test using HCPC S3854
  • • EndoPredict – bill this test using HCPC S3854 on and after January 1, 2017
  • Mental Health

    Dialectical behavior therapy intensive outpatient program (DBT–IOP) skills group: Certified providers of DBT-IOP can reduce the minimum amount of hours required for skills group training. Skills group training must last a minimum of two hours. This change is effective March 1, 2017. Continue to follow guidelines for providing skills training with this requirement reduction in mind. Billing for this service has not changed.

    Intensive Treatment in Foster Care Training Sessions: Providers who are interested in providing intensive treatment in foster care need to be certified and attend one of the “Intensive Treatment in Foster Care (ITFC) Applicant Provider Information Sessions.“ You can read more in the bulletin Children’s Mental Health Announces New Service: Intensive Treatment in Foster Care.

    Sign up for the training though TrainLink. Session dates are March 28, May 16, August 22 and November 14, 2017, from 9:00 a.m.–12:00 p.m.

    Waiver and Alternative Care Programs

    Public comments requested on developmental disabilities waiver application: DHS is requesting comments on proposed policy changes for the Developmental Disabilities (DD) Waiver application (PDF). The comment period began March 2, 2017, at 8:00 a.m. and ends March 31, 2017, at 4:00 p.m. For more information about the 30-day public comment period, see the DSD eList announcement, DHS requests public comments on Developmental Disabilities Waiver application.  

    Attestation for HCBS Rule Settings: All MHCP enrolled providers who currently provide the following home and community-based waiver services must complete an attestation online form for each setting in which they deliver services: adult day services, day training & habilitation (DT&H), structured day, prevocational, customized living, adult and child foster care, and supported living services (provided in a licensed setting). You will receive notice to complete the form through your MN–ITS mailbox and US postal mail during March and April 2017.

    Training and VideoPresence Opportunities

    Information about most new and ongoing training is on the Provider Training page. Any information listed in this section is for additional training sessions on special topics.

    Grants and RFPs

    See the Grants and requests for proposals web page for more information.

    Related Links

    Visit our Provider website for more comprehensive information, including these pages:

  • Latest Manual Revisions
  • • Previously published Provider News items
  • Provider Updates (we also place newly published Provider Updates in your MN–ITS Mailbox, as appropriate)
  • This page includes news and resources for providers enrolled to serve Minnesota Health Care Programs (MHCP) recipients. Get notices of Provider News through our free Provider Email Lists.

    If you have questions about this information, call the MHCP Provider Call Center at 651-431-2700 or 800-366-5411.

    Sign up to receive Provider Updates and other MHCP notices in your email account.

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