Minnesota Health Care Programs (MHCP) Provider Enrollment responds to provider and biller needs for DHS by:
To participate as an MHCP provider, you must meet professional, certification and/or licensure requirements according to state and federal laws and regulations. After an individual (e.g., physical therapist) or group provider (e.g., hospital) meets these requirements and applies to be an enrolled MHCP provider, MHCP sends you a Welcome Letter to confirm your enrollment.
Get a Provider Identification Number
National Provider Identifiers (NPIs) are the standard unique identifiers to use in submitting and processing health care claims and other transactions. If you are a provider eligible for an NPI, you must obtain your NPI number(s) from the National Plan and Provider Enumeration System (NPPES) before you enroll with MHCP.
Some providers do not meet the federal definition of a health care provider under HIPAA and may not be eligible to receive an NPI. These providers include:
If you are not eligible for an NPI and apply for enrollment, MHCP will assign you a 10-digit Unique Minnesota Provider Identifier (UMPI) and send you a Welcome Letter to confirm your enrollment.
Your NPI/UMPI is required on all claims submitted to MHCP, and allows you to be paid for MHCP-covered services provided to eligible MHCP recipients.
Contact the managed care organization with which you contract for their enrollment requirements.
Register for MN–ITS
Minnesota law requires all persons or entities that provide health care services or supplies within Minnesota for a fee, and are eligible for MHCP reimbursement, to submit all claims electronically by July 15, 2009. By 7/15/09, providers and their affiliated clinics or billing services must register for MN–ITS. MHCP will not process paper claims starting 7/15/09. As a registered MN–ITS user, you can:
Your MHCP enrollment Welcome Letter includes a MN–ITS initial User ID, Password and registration instructions.
Screen Employees and Contractors
MHCP cannot enroll and pay providers that are excluded from participation in Medicare, Medicaid or other federal health care programs. The Office of Inspector General (OIG) may impose civil monetary penalties against providers who employ or enter into contracts with excluded individuals or entities to provide services or items to recipients.
OIG makes a List of Excluded Individuals/Entities (LEIE) available to the public. As enrolling or enrolled MHCP providers, you must make sure you, your company, owners, managers, employees and contractors are not on the list. Search LEIE by the individual’s or entity’s name:
Report any new exclusions you find in your search to MHCP Provider Enrollment at fax (651) 431-7462. Use a cover sheet.
Also see MHCP Provider Screening Requirements.
MHCP Provider/Biller Enrollment Process
Minnesota providers are approved retroactively:
Complete, sign and return to MHCP the following forms:
Providers Located Outside of Minnesota
Out-of-state providers may apply for MHCP enrollment for the date(s) of service to an MHCP recipient. To be eligible for payment under MHCP, an out-of-state provider must:
Clearinghouses and billing intermediaries sending MHCP claims and other transactions on behalf of enrolled providers must:
Enrollment Applications and Agreements
Use standard enrollment application and related documents for all providers:
The following providers must also complete additional forms:
Notify MHCP Provider enrollment in writing of any changes to your enrollment application. Use one of the following forms:
MHCP sends enrollment status letters to providers, including when changes in provider participation occur (such as when providers expand or reduce the services they provide).
Fax completed forms to: 651-431-7462
For more information, refer to Provider Requirements of the MHCP Provider Manual or contact us.