Updates cited below do not include minor grammatical or formatting changes that otherwise do not have bearing on the meaning of the policy contained herein. Refer to Provider Updates that may contain additional MHCP coverage policies or billing procedures. MHCP incorporates information from these updates into the Provider Manual on an ongoing basis. Sign up to get email notices of section changes.
Pharmacy Services – Removed reference to ICD-9.
Physician and Professional Services – Revised for ICD diagnosis code reference.
Dental Services (Overview) – Removed references to ICD-9 diagnosis code.
Pay-for-Performance Program (P4P) – Changed ICD-CM to ICD.
Elderly Waiver (EW) and Alternative Care (AC) Program – New HCPCs, definition and covered services, service names, adding more information.
Rehabilitative Services – Updated rehab services authorization policy and revised language to reflect recent changes to MN Rules, including enrollment requirements, definitions and review of the plan of care to at least once every 90 days.
Eyeglass and Vision Care Services – Corrected contact lens codes.
Acupuncture Services – Clarified the policy for Covered Services.
Immunization and Vaccinations – Qualifying enhanced primary care providers who administers Mn-VCF vaccines will be paid at the enhanced administration fee for calendar year 2013-2014. Refer to the Primary Care and VFC Incentive Program web page for more information.
Dental Services (Overview) – Multiple surgery section updated and new CMS Sleep Apnea guidelines.
Community Health Worker – Updated eligible providers to supervise CHW's to include mental health professionals. Included links to the mental health legislation and the CHW's Applicant Assurance Statement form.
Pharmacy Services – Added text to clarify that pharmacy provider must bill prescription drugs using their NCPDP D.0 (Point of Sale) software. Also added a reminder that pharmacies cannot bill for drugs administered in a clinic.
Community Paramedic Services – Programs HH and QM are not covered under Community Paramedic Services under Eligible Recipients.
Individualized Education Program (IEP) Services – Updated text for clarifications, fixed links. Removed references to Licensed Psychological Practitioner from mental health professional definition.
Child and Teen Checkups (C&TC) – Added the 6-21 mental health screen Fact Sheet under Developmental and Mental Health screening. Added information about the Fluoride Varnish consent form.
Hospital Services – Added Links to the Inpatient Hospital Authorization and Hospital In-reach Service Coordination sections.
Relocation Service Coordination—Targeted Case Management (RSC—TCM) – Removed Licensed Psychological Practitioner from Provider Type Home Page Links.
Immunization and Vaccinations – Fixed typo - code listed as G1010 Hep B (initial) was changed to G0010 under Vaccine Administration CPT Code.
Hospital Services - The Hospital Services section has been separated into:
Chiropractic Services – Clarified annual benefit limits and removed authorization information about additional E&M codes.
Billing Policy Overview – Added a link to the new Subrogation section.
Physician and Professional Services – Updated POS when inpatient status; deleted first sentence under Physician Services While Recipient is Inpatient Status. Deleted Additional Authorization Procedure Codes section – form was eliminated.
HCBS Waiver Services –.Multiple text clarifications through the entire manual section.
Health Care Programs and Services Overview – Updated information for designated provider spenddowns and updated EMA changes. Incarcerated recipients added recoupment of claims paid during an incarceration period and who to contact for billing information.
Laboratory/Pathology, Radiology & Diagnostic Services – Removed reference to GAMC
Child and Teen Checkups (C&TC) – Clarified text under Developmental and Mental Health Screenings to identify the instruments recommended by Minnesota and clarified text under TB Risk indicating all children should be screened for TB risk, but children at high risk for exposure should receive the TB test.
Relocation Service Coordination—Targeted Case Management (RSC—TCM) – Removed reference to the MnDHO program that ended at the end of 2010.
Chiropractic Services – Clarified covered subluxation x-ray information under Covered Services
Equipment & Supplies – Added information about NCCI. Remove information under billing policy indicating that the service lines note field could not be used if a model number was reported. Added links to the MN-ITS User Guide and the Minnesota Uniform Companion guide.
Anesthesia Services – Updated the Anesthesia Payment Formulas for 2013
Rehabilitative Services – Under Practitioners with Temporary License and Non-Covered Services to clarify that the temporary license or permit must be valid and to be paid services provided must be within the time span on the temporary license or permit.
Alcohol and Drug Abuse Services – Added code changes effective 3/1/13 to Outpatient Group (Non-residential) treatment and Non-residential Treatment - Medication Assisted Therapy (MAT) under Revenue & Procedure Codes section. Added clarifying information overall.
Child and Teen Checkups (C&TC) – Made changes to the billing portions, maternal depression, component exception, referral condition code. Fixed the language on billing when services are in two separate months.
Clinic Services – Updated chart under Billing for PHNC Services for Individual patient education, per AUC Best Coding Recommendations
Health Care Homes (HCH) – Under Eligible Providers - HCH certification/renewal - removed the word annual
Equipment & Supplies – Updated because of the new Orthotics section