Revised : 02-06-2017
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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.
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):
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.
Minnesota Rule allows billing MHCP through a billing agent or business agent only if the agent’s compensation:
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))
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).
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:
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.
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.
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).
The MHCP Enrolled Providers – Individualized Education Program (IEP) Homepage will provide links to forms, documents and other information specific to IEP services.
Call the Provider Call Center at 651-431-2700 or 800-366-5411 to get answers to billing, payment and enrollment questions.
If you enter an invalid NPI/UMPI or do not have an NPI/UMPI, select Option 3 for IEP Services.
TEFRA (Tax Equity Fairness and Responsibility Act) Parental Fees 651-431-2670 or 800-657-3729
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:
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.
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
State Medicaid Director Letter (SMDL #09-001)Report/Rate this page