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Minnesota Department of Human Services Provider Manual
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IEP Providers

Revised : 02-06-2017

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Overview

To bill MHCP for covered IEP services, districts must enroll as a Minnesota Health Care Programs (MHCP) IEP provider. Employees and contractors of the district who perform the service do not have to enroll with MHCP separately. It is the responsibility of the districts to ensure individuals performing the service are properly trained, licensed, certified and qualified.

MHCP cannot enroll or pay for services provided by individuals or entities that are identified on the OIG List of Excluded Individuals/Entities (LEIE) or on the MHCP Excluded Providers List. School districts are required to conduct a search of the excluded providers lists before they hire staff who will work with children on MHCP and on a monthly basis thereafter. Do not allow an individual or entity that is on the list to provide services to children on MHCP.

Eligible Providers

To bill Medical Assistance for the federal share of covered IEP health-related services, districts and tribal schools must be enrolled with MHCP.

The following Minnesota districts and tribal schools can enroll as IEP services providers and bill for IEP covered services (Out-of-state schools and districts cannot enroll as Minnesota IEP services providers):

  • • Charter schools
  • • Education districts
  • • Intermediate districts
  • • Public school districts
  • • Tribal schools (schools that receive funding from the Bureau of Indian Affairs-BIA)
  • • Service cooperatives
  • • Special education cooperatives
  • • State academies
  • Note: Private schools are not directly reimbursed for covered IEP services. IEP services provided to children who attend private schools are billed by and payments are made to the public school district that provides the IEP services.

    Billing Agents and Consultants

    Minnesota Rule allows billing MHCP through a billing agent or business agent only if the agent’s compensation:

  • • Is related to the cost of processing the billing and is not related on a percentage (or other basis) to the amount that is billed or collected
  • • Is not dependent on collection of the payment.
  • Payment for any covered service given to a child or youth may not be made to or through a factor, either directly or indirectly. (A Factor is an individual or organization that advances money to a provider for their accounts receivable for an added fee or a deduction of the accounts receivable worth).

    For additional information, see Billing Organizations/Responsibilities.

    Districts that use a billing agent must also complete the Provider Setup Form (DHS-4087) (PDF). Fax the signed completed form to the Provider Enrollment unit to add or delete billing agent in the district’s provider file.

    Enrolled IEP services providers must bill covered IEP services as IEP services and are responsible for the non-federal share of Medicaid payments.

    Tribal schools that receive funds from the Bureau of Indian Affairs (BIA) may use the BIA funds to match other federal funds. This means that tribal schools that receive BIA funds can use those funds as the non-federal match for federal Medicaid funds. (U.S. Code, Title 25, Chapter 22, Section 2010 (h))

    National Provider Identifier (NPI)

    NPI numbers are the standard unique identifiers used in submitting and processing health care claims and other transactions. To enroll with MHCP as a provider, you must obtain an NPI from the National Plan and Provider Enumeration System (NPPES).

    MHCP Provider Enrollment

    To bill covered IEP services, districts must enroll as MHCP IEP services providers. School employees and contractors providing the IEP services do not enroll separately.

    Review the MHCP Data Privacy Notice (DHS-6287) (PDF).

    To enroll with MHCP, complete the following forms:

  • Application and Instructions for IEP, Independent School Districts (ISD), Regional Cooperatives, and Charter Schools ((DHS-4215) (PDF)
  • MHCP Provider Agreement (DHS-4138) (PDF),
  • • Review Provider Agreement, sign, and date
  • • The person authorized to sign the agreement assures district or school will follow the terms and conditions
  • Disclosure of Ownership and Control Interest of an Entity (DHS-5259) (PDF) must be completed for “managers” that work with the special education program and fit the definition on page 5 of the form. Social Security numbers must be provided for these individuals.
  • • Complete the “Managing Employee” section for general managers, business managers, administrators, directors, or others who exercise operational or managerial control over or who directly or indirectly conduct the day-to-day operations. Enter residential addresses and Social Security numbers for individuals listed.
  • • Enter main business location for business address, not a U.S. Postal Service box or private company mailbox (such as, Mail Boxes, Etc.) address. Complete and fax all documents to 651-431-7462.
  • Tribal schools that receive funding from the Bureau of Indian Affairs (BIA) must also complete and sign the “Provider Agreement Addendum IEP/Tribal” and return it with the application. Tribal schools may use BIA funds as matching funds for federal Medicaid funds. (US Code, title 25, Chapter 22, Section 2010 (h))

    The district will be notified of their active status after they successfully complete the enrollment process.

    Changing Enrollment Information

    It is the responsibility of the provider to keep all addresses and contact information updated.

    Use the Organization – MHCP Provider Profile Change Form (DHS-3535A) (PDF) to report changes and updated information. Only changes submitted on this form are accepted.

  • • Report district closings and changes to district name, number and contact information to Provider Enrollment immediately.
  • • Report closed districts and acting fiscal agents to the DHS IEP Services Coordinator immediately.
  • Electronic Funds Transfer (EFT)

    IEP services providers must have a vendor number from the Minnesota Management & Budget (MMB) Department to receive MHCP payments. MHCP uses EFT to pay providers for services.

    Go to MMB Vendor Payment Website to register for a vendor number and EFT online.

    When the vendor number and EFT activation notification arrives from MMB, fax a completed, signed EFT Vendor Number Notification (DHS-3725) (PDF) form to MHCP Provider Enrollment 651-431-7462 MHCP.

    MHCP Provider Enrollment staff will update the districts provider record with the vendor number within 30 days of receiving the completed EFT Vendor Number Notification form.

    To change banking information to an existing vendor number, use MMB’s EFT bank change form (PDF).

    Provider Information and Resources

    The MHCP Enrolled Providers – Individualized Education Program (IEP) Homepage will provide links to forms, documents and other information specific to IEP services.

    Provider Call Center

    Call the Provider Call Center at 651-431-2700 or 800-366-5411 to get answers to billing, payment and enrollment questions.

  • • Press 7 to verify a child’s eligibility
  • • Press 9 for MHCP phone numbers, addresses, websites and general information
  • • Press 1 to reach the MHCP Provider Call Center
  • • Press 1 to enter an NPI
  • • Press 2 to enter an UMPI starting with an A
  • • Press 3 to enter an UMPI starting with an M
  • If you enter an invalid NPI/UMPI or do not have an NPI/UMPI, select Option 3 for IEP Services.

  • • Press 5 for Provider Enrollment
  • • Press 6 for questions about MN–ITS Registration, MN–ITS Administrator or Password resets
  • • MN–ITS Users: Review the online MN–ITS Troubleshooting Guide for suggested resolutions
  • DHS IEP Services Contacts

  • • Provider Call Center: 651-431-2700; 800-366-5411
  • • Jeri Boomgaarden, Provider Relations IEP Services Trainer, 651-431-3242
    jeri.boomgaarden@state.mn.us
  • • Jenny M. Roth, IEP Services Coordinator 651-431-2622
    jenny.m.roth@state.mn.us
  • • Jesusa Williams, IEP Services Rates, 651-431-2538
    jesusa.williams@state.mn.us
  • TEFRA (Tax Equity Fairness and Responsibility Act) Parental Fees 651-431-2670 or 800-657-3729

    IEP Provider Contact List

    DHS maintains the IEP Provider Contact list to distribute IEP updates and other important information. To be added to this list or update information email Elizabeth.A.Bonnell@state.mn.us with the following information or updates to the information previously submitted for your district:

  • • District name and school district number, NPI, address, phone and fax numbers
  • • Superintendent or administrator name, phone number and email address
  • • Special Educations directors name, phone number and email
  • • Third Party Billing Coordinators, phone number and email
  • If your district uses a billing agency, software vendor, or person that submits claims on behalf of your district, and you want them to be added to the contact list, provide the name of the billing agency, vendor or person, the address, the name of a contact person, their email address and phone number.

    Legal Reference

    Minnesota Statute 125A.08 (Individualized Education Programs)
    Minnesota Statute 125A.21 (Third Party Payment)
    Minnesota Statute 125A.74 (Medical Assistance Payment to School Districts)
    Minnesota Statute 125A.744 (Statewide Data Management System to Maximize Medical Assistance Reimbursement)
    34CFR 300.154
    Title 34: Education Part 300 - Assistance to States for the Education of Children with Disabilities - Methods of ensuring services
    42 CFR 1001.1901
    (b) Effect of exclusion on excluded individuals and entities
    42 U.S.C. 1320
    C-5 and 1320a-7 Review of Utilization and Quality of Health Care Services and Exclusion of certain individuals and entities from participation in Medicare and State health care programs
    42 CFR 1003.102
    (a)(2) Basis for civil money penalties and assessments

    Resources

    State Medicaid Director Letter (SMDL #09-001)

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