MHCP Provider News

August 7, 2017

  • Submit all claims electronically: Minnesota Health Care Programs (MHCP) cannot accept claims or claims appeals by fax or mail. According to the MHCP billing policy, you must submit all claims electronically through MN–ITS, including claim voids and claim replacements. Submit only the AUC Fax Cover Sheet for Health Care Claims as found on the Electronic Claim Attachments webpage. Do not use the AUC Appeals Cover Sheet. Beginning August 1, 2017, the MHCP claims processing staff will no longer contact you to request your claims electronically. We will no longer research and process the appeal form. The appeal form and other correspondence will be destroyed if faxed or mailed to us. Call the Provider Call Center with any questions about claim denial or submit a new claim and attach the appropriate documentation. (pub. 7/20/17)
  • Home health services documentation requirements: Effective July 1, 2017, requirements for Minnesota Health Care Programs payment of home health services are amended to comply with the federal regulation that requires documentation of a face-to-face encounter (including via telehealth) with a physician or a non-physician practitioner. The encounter must be related to the primary reason the person requires home health services and must occur within the 90 days before or the 30 days after the start of home health services. Home health services include skilled nurse visits, home health aide visits, and all rehabilitation therapy services provided by a Medicare-certified home health agency. This requirement applies to people receiving home health services through fee-for-service Medical Assistance and through waivers and Alternative Care. It will apply to managed care enrollees effective January 1, 2018. Medicaid home health services are not limited to home settings and may be provided in the community where normal life activities take the person other than an institutional setting. (pub. 7/13/17)
  • • See grants and requests for proposal (RFPs) for current grants available or RFPs in which you may be interested.
  • MN–ITS and other system information

    Announcements and availability: Watch this space for information about MN–ITS functionality, technical information, scheduled downtimes and other systems notifications.

    August 16, 2017: We are continuing to experience some technical issues; however, the issue with batch submissions has been resolved. We are working to resolve the following remaining issues as soon as possible:

  • • Last Check (Option 2 of the interactive voice response (IVR) phone system): If you call the IVR to learn the amount, date and check number of your most recent check, your call may be disconnected. You may log in to your MN–ITS account and use the Last Check application, located on the left navigational menu, to find this information, instead.
  • • Taxonomy codes in MN–ITS: Some MN–ITS transactions involving consolidated providers are experiencing issues, including:
  • • Eligibility Request (270)
  • • Authorization Request (278)
  • • Service Agreement Request (278)
  • Consolidated providers who need to check eligibility may call the Provider Call Center at 651-431-2700 or 800-366-5411.

    We will update this message when these issues are resolved.

    Chemical health

    Minnesota's First Searchable Online Tool for Statewide Substance Use Disorder Services

    On June 1, 2017, the Alcohol and Drug Abuse Division started work with Fast-Tracker (, to implement Minnesota’s first searchable online tool for statewide Substance Use Disorder (SUD) services. Fast-Tracker for SUD services provides the ability to track real-time availability of statewide SUD services, which is a critical element of a modern SUD system of care. Its implementation will save lives. In July, staff from Fast-Tracker will begin calling every licensed SUD treatment and detoxification program in Minnesota to gather information to build the site, and explain how to update your program openings daily. 

    Share this article with colleagues. Inform pertinent staff that Fast-Tracker will be calling your program this summer to gather current information about your organization and the services you provide. Decide who within your organization should speak with Fast-Tracker staff, provide program information, and learn details of how to update your bed or slot openings. If you have any questions or would like to request a presentation from DHS on Fast-Tracker, contact Cindy Swan-Henderlite at or 651-431-2463. For more information see Fast-Tracker Information (PDF). (pub. 7/26/17)

    Clinics and physicians

    Gender-related processing edits: Beginning July 1, 2017, MHCP will follow Medicare guidelines for processing claims that may deny due to gender-related edits. These edits include conflicts between sex and diagnosis or sex and procedure.

    Institutional providers (837I) may report condition code 45 (ambiguous gender) to identify claims for inpatient or outpatient services that can be subjected to gender-specific editing (that is, services or diagnoses that are considered female or male only). This condition code will allow gender-specific edits to be bypassed and the claims to process correctly. Refer to the 837I MN–ITS user guide for help identifying where to enter the condition code.

    Use the KX modifier when submitting professional claims to identify services that are gender specific (considered female or male only). The KX modifier will allow gender-specific edits to be bypassed and the claim to process correctly.

    You must include the KX modifier on each additional claim line. (pub. 8/7/17)

    Child & Teen Checkups

    Child & Teen Checkups (C&TC) billing lab: MHCP will offer a billing lab for Child & Teen Checkups on September 15, 2017.  For more information or to register see the MHCP enrolled provider training page. (pub. 8/7/17)

    Early Intensive Developmental and Behavioral Intervention (EIDBI)

    Informational session about billing and enrollment policy: Join an informational session for currently enrolled and prospective Early Intensive Developmental and Behavioral Intervention (EIDBI) providers on August 29, 2017, from 1:30 – 3:30 p.m. At this session, we will review recent changes in MHCP billing policy and talk about the procedures to enroll as an EIDBI provider. We will allow time for you to ask questions or share your experiences about this with other providers and DHS staff.

    You can attend in person or online via WebEx. For more information or to register see the session announcement (PDF). (pub. 8/14/17)

    UMPI number required for Level III providers: As of January 1, 2018, all Early Intensive Developmental and Behavioral Intervention (EIDBI) Level III providers must enroll with Minnesota Health Care Programs (MHCP). MHCP will assign the Level III providers a Unique Minnesota Provider Identifier (UMPI) number at the time of enrollment. The UMPI number is required when submitting a claim for EIDBI Level III services.

    New Autism 101 training available: All Early Intensive Developmental and Behavioral Intervention (EIDBI) Level III providers are required to take Autism 101 training. As of July 1, 2017, ASD Strategies in Action replaces the current Autism 101 training curriculum. DHS has partnered with the Ohio Center for Autism and Low Incidence (OCALI) to offer this training for providers, found at This is an online video training program that describes characteristics of autism spectrum disorder (ASD) and highlights simple strategies and skills for families and service providers.

    Contact for free subscription access to all courses for the Level III service providers at your EIDBI agency. A 90-minute free course titled “Many Faces of Autism” is available to families and community members.

    EIDBI agencies currently enrolled as Children’s Therapeutic Services and Supports (CTSS) agencies, will still be allowed to submit their current CTSS training curriculum to DHS for consideration as a replacement to the required training until March 1, 2018. If DHS approves the agency’s CTSS training curriculum based on the outlined requirements, all Level III providers must complete the training by June 30, 2018. After June 30, 2018, all EIDBI Level III providers must complete the ASD Strategies in Action training as a part of the EIDBI individual provider training requirements.

    Equipment and supplies

    Enteral nutrition claims reprocessing: MHCP will reprocess enteral nutrition claims due to the 2016 legislation that mandates enteral nutrition products be manually priced. Reprocessing will be for HCPCS code B4149 through B4155 for services provided on or after July 1, 2015, that providers have not already replaced. MHCP will reprocess and pay the enteral nutrition lines based on the narrative description on the enteral nutrition claims; however, claims on which there is no description of the enteral nutrition provided will be denied.

    You will see these payments taken back on your August 22, 2017, remittance advice (RA). You will be able to replace or resubmit these denied claims for payment. Include the enteral nutrition description and the following information in an attachment if needed.

  • • Pricing documentation must include the following:
  • • Product code (the UPC or NDC)
  • • Package size (amount per case or individual)
  • • Total calories per can or packet
  • • Information that identifies whether pricing attachment is manufacturer’s suggested retail price (MSRP) or invoice
  • The deadline for resubmitting these enteral nutrition claims is October 31, 2017. For dates of service over one year old, you must print and attach a copy of this notice for the claim to reprocess correctly. Claims that are past the timely filing guidelines will not be paid if you do not include this notice. (pub. 8/9/17)

    Group Residential Housing (GRH) – Housing Support

    Group Residential Housing (GRH) program name changed to Housing Support: The GRH program name change to Housing Support better reflects that people could receive room and board and supplemental services in their own home and not just in group settings. This change was effective July 1, 2017. We will update the Minnesota Health Care Program (MHCP) Provider Manual with the new name as soon as possible. (pub. 8/9/17)

    Institutions for Mental Diseases (IMD) Rule 31 program scheduling survey

    The federal government does not allow federal funds to be used in any substance use disorder treatment program that is determined to be an Institution for Mental Diseases (IMD). DHS is responsible for determining which programs are IMDs and ensuring alignment with the federal requirements for reimbursement for treatment services. We completed a first round of IMD determinations in 2015 for stand-alone Rule 31 residential substance use disorder treatment programs with more than 16 beds (E-Memo #15-57). View the frequently asked questions (FAQ’s) (PDF) and the recently updated list of Institutions for Mental Diseases (PDF).

    We are beginning the process of scheduling for the next round of IMD determinations for complex arrangements and have developed a survey to gather information from providers. We will do the reviews in four phases over the course of one year. The survey responses will help determine under which protocols the provider needs to be reviewed and during which phase of the reviews a program will be scheduled.

    IMD determinations are occurring parallel with the larger substance use disorder reform efforts. See E-Memo 17-28 for more information on Minnesota’s application for a section 1115 waiver of Title XIX of the Social Security Act to provide Medicaid payments for services provided in an IMD.

    In June, the DHS Health Care Administration and the Alcohol and Drug Abuse Division hosted four regional and one tribal listening sessions to discuss the SUD 1115 Waiver Demonstration Project. The sessions provided information to the public on the basics of a state application for the waiver. We also shared our findings following our internal exploration of the waiver requirements and opportunities. This project requires participating providers to comply with the American Society of Addiction Medicine (ASAM) criteria for placement in services. DHS is exploring the use of ASAM’s CONTINUUM software during the project for all assessments and placement into substance use disorder services. See and for information on the ASAM criteria and software. The demonstration project also includes the development of a substance use disorder benefit that guarantees a full continuum of evidence-based best practices designed to address the immediate and long-term physical, mental and SUD care needs of the individual.

    Please complete the survey by August 25 or sooner, if possible: (pub. 8/14/17)

    Mental Health

    Service plan development and the individual treatment plan: Beginning August 1, 2017, children’s therapeutic support service (CTSS) providers will be allowed to bill individual treatment plans (ITP) prior to completing the ITP, provided that the ITP meets all required elements of a completed ITP within the required timeframe. Requirements and timeframes are in the CTSS section of the MHCP provider manual. Also beginning August 1, 2017, CTSS service plan development will have a calendar year limit of 96 units. (pub. 8/7/17)

    CTSS services no longer part of discharge planning: After August 1, 2017, CTSS providers will no longer be eligible to provide CTSS services as a part of discharge planning for children residing in group homes. This does not include children’s mental health residential treatment programs. (Minnesota Rules 2960.0130 to 2960.0220 and 2960.0580 to 2960.0700.) (pub. 8/7/17)

    Intensive treatment in foster care training sessions: Are you interested in providing intensive treatment in foster care? If you are, you 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 through TrainLink. Session dates are August 22 and November 14, 2017, from 9:00 a.m.–12:00 p.m.

    Personal Care Assistance

    Rate changes for certain long-term services and supports: The 2017 Minnesota Legislature authorized a 1.642 percent rate increase for budgets in the Consumer Directed Community Supports (CDCS) and Consumer Support Grant (CSG) programs and personal care assistance services (PCA). See MN Legislature Authorizes Rate Changes for Certain Long-Term Services and Supports (DHS Bulletin 17-25-03) for rate and limit changes for services provided on or after August 1, 2017.

    PCA Choice and fiscal support entities (FSE) requirements: We added a new section under Personal care assistant on the Home and community-based services page for Requirements for PCA Choice and fiscal support entities (FSE). Review the resources available through this site.

    Transportation Services

    Reprocessing ambulance provider claims for enhanced rate: We have identified the ambulance providers who are eligible for the 5 percent enhanced rate for ground and air ambulance services. Beginning with the warrant dated June 27, 2017, we will reprocess and pay at the enhanced rate any eligible claims for dates of service on and after July 1, 2016. We will continue to pay ongoing claims at the enhanced rate.

    Waiver and Alternative Care Programs

    Public comment period for amendments to elderly waiver plan: The Minnesota Department of Human Services (DHS) requests public comments on proposed federal waiver amendments for Elderly Waiver (EW) before we submit the proposal to the Centers for Medicare & Medicaid Services (CMS) for approval. For more information, see Aging and Adult Services eList announcement dated July 12, 2017. (pub. 8/7/17)

    Housing information and resources mailed to people who receive waiver services: People who receive waiver services recently received letters from the Department of Human Services (DHS) about their choices in where they live. If people you serve ask you questions about this, the following is the information they received:

  • July 13, 2017, memo (PDF) listing available housing resources
  • My home. Creating the best home for me (PDF)
  • Public comment period for amendments to disability waiver plans: DHS seeks public comments for federal waiver plan amendments (PDF) before submitting to the Centers for Medicare & Medicaid Services (CMS) for approval. Comment period begins at 8 a.m., July 13, 2017, and ends at 4 p.m., Aug. 11, 2017. Submit comments to See full announcement at Public comment period for amendments to disability waiver plans. (pub. 7/13/17)

    Training and VideoPresence Opportunities

    Information about most new and ongoing training is on the MHCP enrolled provider training webpage.

    Grants and RFPs

    See the Grants and requests for proposals webpage for more information.

    Related Links

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

  • Latest Manual Revisions
  • • Previously published Provider News items
  • 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.

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