MHCP Provider News

July 14, 2014 News

  • • Secure FTP client users only: Secure FTP transactions will be available on Monday, July 28, 2014. The previously scheduled maintenance will be rescheduled at a later date. (Revised 7/23/14)
  • • The public comment period for Employment First Policy has been extended. DHS will receive comments from Monday, July 7, 2014, at 8:00 a.m. through Thursday, July 31, 2014, at 4:00 p.m. View a copy of the draft on the Employment Learning Community (ELC) Web page. Submit comments to (Added 7/17/14)
  • • On Friday July 25, 2014, the MHCP Provider Call Center voice response system, including telephone eligibility verification, will be unavailable due to maintenance for several hours starting at 7:00 p.m. Intermittent outages may occur through Monday July 28, 2014. During this time, verify MHCP recipient eligibility through MN–ITS. (Added 7/16/14)
  • • New background studies laws to be discussed statewide at information sessions: DHS is hosting a series of information sessions throughout Minnesota to provide information about the changes to the background study program. The new law requires fingerprints and a photograph of the background study subject. The law also requires implementation of new software that supports multiple changes designed to improve the accuracy and completeness of background studies. The information sessions will take place in eight locations; no registration is required. Providers and other stakeholders are encouraged to attend a session to learn more about the new background studies requirements that will be implemented in early 2015.
  • • New direct and indirect support public comment period: DHS is seeking a 30-day public comment period on the new direct and indirect support policy section for HCBS waiver programs. Review the new language on the Draft of the BI, CAC, CADI and DD waiver general process and procedures page. Submit comments to no later than 4 p.m. on Friday August 1, 2014.
  • • MHCP is replacing all claims that were incorrectly reduced by the 2% Sequestration payment reduction. MHCP will process the replacement claims on the June 17, 2014, and July 1, 2014, payment dates. Refer to Sequestration - 2% Payment Reduction (MHP-14-02) for more information.
  • • Review recent Provider Updates:

  • MN–ITS

    On June 2, 2014, we made the following functionality changes to claim status responses in MN–ITS from validation, submission or a Request Claim Status (276) search:

  • • The Replace, Void and Copy buttons are disabled for claims where MHCP has taken money back (the Void button is also disabled for claims that are denied).
  • • Provider names now display in the Receiver and Provider name fields.
  • • Information that displays in the accordion panel headings has changed. See Accordion Panel Changes for information.
  • • A Request Claim Status (276) search will now return up to 20 claims.

  • MHCP is reviewing claim status responses to ensure they include all required information. We will continue to communicate if we make any additional changes.

    Continue to refer to the 5010/D.0 Announcements page for additional information about MN–ITS functionality.

    Industry Initiatives

    This Industry Initiatives section gives you quick, easy access to current federal and state industry initiatives that potentially impact your business. Please review these pages on a regular basis. We will note changes to the right of the initiative as we update the pages.


    Review the updated 5010/D.0 page for announcements about both direct data entry (DDE) and batch transactions.

    Behavioral health home

    Review the Behavioral health home page.

    Electronic health records




    Integrated Health Partnerships demo


    Health care homes

    Refer to the Health Care Homes Eligible Providers section in the MHCP Provider Manual about notifying MHCP of your HCH certification.


    The Protecting Access to Medicare Act of 2014 (HR 4302) delayed implementation of ICD-10 until at least October 1, 2015. The Centers for Medicare & Medicaid Services (CMS) has not yet given an exact date. Watch the ICD-10 page for updates.


    The Centers for Medicare and Medicaid Services (CMS) is reinstating Procedure to Procedure (PTP) NCCI edits that pair immunization administration codes (CPT 90460-90474) with the preventive medicine Evaluation and Management (E/M) service codes (99381-99397) to be effective April 1, 2014. The edits apply to claims with dates of service on or after Jan. 1, 2013, that are submitted on or after April 1, 2014. The edits may be bypassed if a PTP-associated modifier is correctly appended to the preventive medicine E/M code.


    Pay-for-Performance (P4P) program providers may earn up to two payments of $250 in 12 months for providing optimal diabetes and cardiovascular disease care to eligible fee-for-service (FFS) recipients.

    Adult Day Treatment (ADT) Clinical Supervision

    Effective July 1, 2014, all Adult Day Treatment providers are required to comply with the method of clinical supervision specified in Minnesota Rules 9505.0371, subpart 4. Clinical supervision (Rule 47) for purposes of complying with medical assistance requirements. A statewide training will be held by videoconference on August 11 from 10:00 a.m. until 1:00 p.m. Find more information on the Adult Mental Health Training Web page.

    Chemical Health

    Residential room and board services
    Effective for dates of service on and after July 1, 2014, bill free standing residential room and board (R&B) services directly to MHCP. Managed Care Organizations (MCO) will continue to authorize room and board (R&B) services, but are no longer obligated to pay these services. For additional details and billing instructions please refer to Chemical Health Room and Board Billing Change for MCO Enrollees CHM-14-01.Refer to the Provider Training page for upcoming training opportunities.

    CCDTF providers Annual Financial Statement needed
    (Added 7/21/14)

    Minnesota Statues, section 254B.05 subd.1b, requires Chemical Dependency (CD) providers receiving Consolidated Chemical Dependency Treatment Fund (CCDTF) to submit an Annual Financial Statement-Functional Expense Report. The Alcohol and Drug Abuse Division (ADAD) identified providers for whom we have not received a report for calendar year 2012. MHCP placed a Compliance Letter, another copy of the Annual Financial Statement-Functional Expense Report Excel Sheet that was previously emailed to you and an instruction sheet into your MN–ITS mailbox. Complete and return the report using the information on the instruction sheet.

    Child and Teen Checkups

    Effective for dates of service on or after October 1, 2014, providers may bill only for services they provided. Do not include lab services sent to a reference or outside lab on your claim form. Refer to the Child and Teen Checkups, Billing section of the MHCP Provider Manual for more details.

    Continuing Care

    DHS has posted a new Web page, 2014 Rate Changes Frequently Asked Questions. This page explains some of the changes resulting from recent legislation. Review this page for more information.

    Day Treatment and Habilitation (DT&H)

    (Added 7/17/14)
    Video conference sessions will be held on Thursday, July 24, 2014, at 10:00 a.m and 1:30 p.m to obtain provider input on Minnesota's compliance and transition plan for HCBS Employment and Day Supports (DT&H, Provocational Services, Structured Day Program and Adult Day Services). The conference is offered at multiple sites across the state. Pre-registration is required for each attendee.

    Dental Services

    Adult Prophylaxis
    Authorization is required for adult prophylaxis if more than one prophylaxis is necessary in a calendar year. Submit authorization requests for additional adult prophylaxis visits at the time the patient is seen. Authorization requests must specify the number of visits and the date span being requested. Refer to the Non-Pregnant Adult Authorization Chart for authorization criteria information.

    Durable Medical Equipment

    Two new factor codes X (Rental DME Competitive Bid fee) and W (General DME Competitive Bid fee) will be added to the fee schedule. Factor codes X and W are the CMS DMEPOS Competitive Bidding Rate single payment amount. These two factor codes do not apply to the fee-for-service program. The codes apply only to Medicare cross over claims for which CMS DMEPOS competitive bidding program have set criteria.

    Eyeglass & Vision Care Services

    Backordered Frames
    Refer to the Korrect Optical website for information about backordered frames.

    Family Planning

    Do not use CPT code 55400. MHCP does not cover vasectomy reversals. This code has been removed from the Family Planning Procedure Codes with Increased Rates and the MFPP Procedure Code List.

    Hearing Aids

    MHCP added Phonak CROS models back onto the 2013 Hearing Aid Volume Purchase Contract with new model numbers and revised prices. These CROS systems now include a compatible hearing aid.

    Hospital Presumptive Eligibility (HPE)

    Hospital staff will be able to begin making eligibility determinations under the HPE program July 1, 2014. Hospitals who want to participate in this program must first complete the Hospital Presumptive Eligibility Applicant Assurance Statement (DHS-3887). Then at least two staff from each hospital must take and pass the HPE training. Access to the training and other information is available through the HPE Web page. Each person who will be taking the training needs to request a Unique Key, which they will use to access the training. Refer to the HPE Training Web page for instructions to request a Unique Key.

    ICF/DD Day Training and Habilitation (DT&H)

    Nursing Portal
    Effective July 1, 2014, MHCP providers of ICF/DD Facilities will use the Nursing Portal to retrieve rate notifications.

    Video conference
    Video conference sessions will be held on Thursday, July 24, 2014, at 10:00 a.m and 1:30 p.m to obtain provider input on Minnesota's compliance and transition plan for HCBS Employment and Day Supports (DT&H, Provocational Services, Structured Day Program and Adult Day Services). The conference is offered at multiple sites across the state. Pre-registration is required for each attendee.

    IEP Mental health spring Make up session

    A make up session for IEP mental health spring training will be held on August 14, 2014. Refer to Provider Update, IEP Mental Health Spring Make up Session.

    IMD Providers

    Refer people who reside in an IMD facility to apply for MHCP coverage directly through their county. Do not refer people who have already applied or already have MHCP coverage. MHCP is working to resolve a system issue to allow submission of these applications online through MNsure. We will communicate additional instructions in a provider update when we have more information.

    Laboratory Services

    Effective for dates of service on and after October 1, 2014, submit claims only for services you or your provider organization actually perform. Do not include lab services sent to a reference lab or outside provider on your claim form.

    When billing unlisted codes, attach documentation justifying the code. When billing services defined as multiple treatments or units of services, do not bill a date span.

    Refer to the Laboratory/Pathology Services, Billing section of the MHCP Provider Manual for more details.

    Medical Transportation

    (Added 7/16/14)
    The Centers for Medicare and Medicaid Services (CMS) offers educational resorces to promote awareness of Medicaid fraud, waste and abuse. Refer to the CMS Medicaid Program Integrity Education website for resources including the following, newly added materials:

    Mental Health

    (Added 7/16/14)
    With the transition to DSM-5, MHCP requires all mental health providers to use the World Health Organization's Disability Assessment Schedule (WHODAS) when completing a Diagnostic Assessment beginning October 1, 2014. The WHODAS replaces the Global Assessment of Function (GAF). Providers may use either the 12-item or 36-item WHODAS. Refer to the following resources for the forms and more information:

    Outpatient Wound Care Procedure Codes

    Effective for dates of service on or after Jan. 1, 2014, MHCP reimburses wound care procedure codes (97597, 97598, 97605 and 97606) according to the CMS Ambulatory Payment Classification (APC) policy and fee schedule, when reported on an 837I Outpatient claim. MHCP has identified and replaced outpatient claims submitted for dates of service on or after 01/01/14, through the effective date of this change 06/17/14. They will appear on the providers remittance advice for payment date 07/01/14.

    Outpatient Hospital APC Payments

    MHCP identified a payment error on claims when two or more procedure codes are from the same CMS Ambulatory Payment Classification (APC) composite family. We reprocessed claims with dates of service on or after Nov. 1, 2011, through May 8, 2014. Replaced claims will be on the remittance advice for July 1, 2014, payment date.


    Required PCA training
    The June 2014 letter that MHCP expected to drop into the MN–ITS PRVLTR folder of any agency who has affiliated PCAs whose file indicates they have not yet completed PCA training was delayed. The letter will give agencies instructions for updating the files of any PCA the agency verifies has completed the training. Agencies must ensure that individual PCA providers completed the mandatory training and passed the competency test before May 1, 2014, to continue to work as a PCA.

    Public Comment on Draft CFSS Waiver
    DHS is accepting public comments from 8 a.m. Monday, July 7 through 4 p.m. Wednesday, Aug. 6, 2014, on the proposed Community First Services and Supports (CFSS), 1915(b)(4) Waiver. If federally approved, the 1915 (b)(4) waiver would allow DHS to selectively contract for two types of service providers to support individuals in the new CFSS program. For more information, refer to Draft CFSS Waiver 30-day Public Comment.


    Pharmacy providers may now go into MN–ITS and do a request claim status to copy or to do a claim reversal on previously submitted claims.

    Private Duty Nursing

    Legislation passed during the 2014 legislative session changed the name of the service called Private Duty Nursing to Home Care Nursing effective July 1, 2014. The legislation also provided clarification on the definition of the service and the difference between the Complex and Regular levels of the service. (2014 Session Laws Chapter 291, Article 9, Section 2)

    Radiology/Diagnostic Services

    Procedure code 72100
    Due to a system error, MHCP incorrectly denied some claims for procedure code 72100. We have fixed this error and claims submitted on or after June 22, 2014, are processing correctly. We are identifying claims that denied incorrectly and will notify providers when we determine a replacement date.

    Waiver/AC Program Providers

    Video conference
    Video conference sessions will be held on Thursday, July 24, 2014, at 10:00 a.m and 1:30 p.m to obtain provider input on Minnesota's compliance and transition plan for HCBS Employment and Day Supports (DT&H, Provocational Services, Structured Day Program and Adult Day Services). The conference is offered at multiple sites across the state. Pre-registration is required for each attendee.

    Additional Services Under CAC Waiver
    Effective July 1, 2014, MHCP is adding the following services to the Home and Community Based Services (HCBS) program CAC Waiver:

  • • 24-hour emergency assistance
  • • Behavioral support
  • • Caregiver living expenses
  • • Chore services
  • • Housing access coordination
  • • Independent living skills (ILS) training
  • • Supported employment services

  • Conversion of Corporate Adult Foster Care License
    If you indicated on your 245D application you want to convert your corporate Adult Foster Care (AFC) license to a 245D Community Residential Setting (CRS) license, your authorized agent will receive an email. The email gives instructions on what you need to do if you need to change or correct anything on your 245D CRS license.

    245D licensing will provide the license number for the 245D CRS directly to Provider Enrollment.

    Related Links

    Visit our Provider website for more comprehensive information, including these pages:

  • • Latest Manual Revisions
  • • Previously published Provider News items
  • • Provider Updates (we also place newly published Provider Updates in your MN–ITS Mailbox, as appropriate)

  • This page includes news and resources for providers enrolled to serve Minnesota Health Care Programs (MHCP) recipients. Get notices of Provider News through our free Provider Email Lists.

    If you have questions about this information, call the MHCP Provider Call Center at 651-431-2700 or 1-800-366-5411.

    Sign up to receive Provider Updates and other MHCP notices in your email account.

    Rate/Report this page   Report/Rate this page