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| Minnesota Health Care Programs (MHCP) Provider Enrollment responds to provider and biller needs for DHS by: |
| • Enrolling health care providers so they can receive payment for serving MHCP recipients |
| • Verifying licensure for providers |
| • Maintaining provider agreements and other legal arrangements |
| • Get a Provider Identification Number |
| • Screen Employees and Contractors |
| 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. |
| 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: |
| • Health care case coordinators |
| 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 number is required on all claims submitted to MHCP, and allows you to be paid for MHCP-covered services provided to eligible MHCP recipients. |
| • Refer to the appropriate service section in MHCP Provider Manual for licensure or certification requirements for your provider type |
| Contact the managed care organization with which you contract for their enrollment requirements. |
| 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: |
| • Verify active provider enrollment status |
| • Submit service agreement (SA) requests for home care services |
| • Submit claims (including claims with third party insurance or Medicare) |
| • Copy previously submitted MN–ITS claims or replace incorrectly submitted paid claims |
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:
| • Before you hire new employees/enter into a contract with a contractor |
| • Monthly, to see changes since your last search |
| Report any new exclusions you find in your search to MHCP Provider Enrollment at fax (651) 431-7462. Use a cover sheet. |
| Minnesota providers are approved retroactively: |
| • To the first day of the month of application |
| • For up to 90 days to the effective date of Medicare certification of the provider |
| • To the date of the recipient's established retroactive MHCP eligibility |
| Complete, sign and return to MHCP the following forms: |
| 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: |
| • Comply with the licensing and certification requirements of the state where the provider is located, except for home and community-based waiver services providers who must meet the licensing and certification requirements of Minnesota’s federally approved waiver plan |
| • Complete, sign and return the MHCP Provider Enrollment Application and Provider Agreement to MHCP |
| • Enroll with DHS as a billing organization |
| • Notify MHCP of any changes to this list |
| • Register for the Web-based MN–ITS. (Provider/biller enrollment and MN–ITS registration are two separate processes) |
| • Ensure that every provider for whom claims are submitted is also registered for MN–ITS |
| • Bill MHCP electronically via MN–ITS |
| 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). |
| For a provider to be reimbursed for other state-sponsored health care programs, the provider must also meet Rule 101 participation requirements. |
| Return completed forms to: |
Fax (preferred):
(651) 431-7462 |
Mail:
DHS-MHCP Provider Enrollment
PO Box 64987
St. Paul, MN 55164-0987 |
| For more information, refer to Provider Requirements of the MHCP Provider Manual. |
| • 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 |
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