MHCP Provider News

Aug. 25, 2014 News

  • • The DHS Disability Services Division (DSD) presents the following VirtualPresence opportunity for Positive Support Community of Practice: Valued Community Members, with guest speaker Dr. Angela Amado. The session is Tuesday, Sept. 16, 2014, from 10 a.m. to noon. View the flier for registration and session details. (Added 8/29/14)
  • • Refer to Retroactive Medical Assistance Eligibility for information about how MHCP is handling requests for retroactive eligibility determination from people who apply for health coverage through MNsure.
  • • Aging and Adult Services at DHS will hold a video conference session Tuesday, August 26, 2014, 2:30 p.m. to 4:00 p.m. to obtain provider input on Minnesota's compliance and transition plan for providers of services for persons with mental illness. The conference is held at multiple sites across the state. Pre-registration is required for each attendee.
  • • Aging and Adult Services will hold a video conference session Thursday, August 28, 2014, 10:00 a.m. to noon to obtain provider input on Minnesota's compliance and transition plan for person-centered planning. The conference is held at multiple sites across the state. Pre-registration is required for each attendee.
  • • Visit the new Community First Services and Supports(CFSS) Web page on the DHS website.
  • • Review recent Provider Updates:

  • MN–ITS

    Functionality changes to claim status responses in MN–ITS from validation, submission or a Request Claim Status (276) search that were effective June 2014 are:

  • • 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 Oct. 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.

    Rate Changes for September 1, 2014

    MHCP has not yet completed the systems work necessary to correctly process claims with the rate increases scheduled for September 1, 2014. Do not replace or resubmit claims. Once the system work is complete, MHCP will replace previously submitted claims with dates of service on or after September 1, 2014. (Added 8/29/14)

    For dates of service on and after Sept. 1, 2014, MHCP will increase the payment rate by 5% for the following services:

  • • Physician and professional services
  • • Physical therapy
  • • Occupational therapy
  • • Speech language pathology
  • • Mental health services

  • MHCP will increase rates by 3% for the following services:

  • • Ambulatory surgery centers facility fees
  • • Medical supplies and durable medical equipment not subject to a volume purchase contract
  • • Prosthetics and orthotics
  • • Hospice services
  • • Renal dialysis services
  • • Laboratory services
  • • Public health nursing services
  • • Eyeglasses not subject to a volume purchase contract
  • • Hearing aids not subject to a volume purchase contract
  • • Outpatient hospital facility fees

  • The increased rates do not apply to payments made to:

  • • Federally Qualified Health Centers (FQHC)
  • • Rural Health Clinics (RHC)
  • • Indian Health Service (IHS) providers
  • • Managed care organizations (MCOs)
  • • County-based purchasing plans (CBPs)
  • • Assertive Community Treatment (ACT)
  • • Youth Assertive Community Treatment (YACT)
  • • Intensive Residential Treatment Services (IRTS)
  • • Crisis Residential

  • These rate increases apply to MHCP fee for service (FFS) payments made to providers. Payments from MCOs to providers are based on the provider’s agreement or contract with the MCO.

    Refer to 2013 Legislative Changes for the original communication on these rate changes.

    Chemical Health

    Medicated Assisted Therapy (MAT) Services
    Effective Aug. 1, 2014, the primary care provider (PCP) must submit a medical referral form for recipients in the Minnesota Restricted Recipient Program (MRRP) and in need of Medicated Assisted Therapy (MAT) services. Verify eligibility and contact the PCP listed on the recipient’s response page. For additional details about the eligibility verification process for an MRRP recipient seeking MAT services please refer to CCDTF E-MEMO on the Alcohol and Drug Abuse home page.

    Continuing Care

    The 2014 Minnesota Legislature authorized a 5% rate increase for continuing care providers and other services that was effective July 1, 2014. The Continuing Care Administration (CCA) developed a Web page to answer questions about the rate adjustment, as well as the requirements associated with the increase.

    Visit the Continuing care provider rate and grant changes Web page for more information.

    DME Codes Capped Rental Payment

    The Centers for Medicare and Medicaid Services (CMS) reclassified 63 DME codes to the Capped Rental payment category effective April 1, 2014. A second modifier is required with modifier RR, such as KH, KI, and KJ. If these appropriate modifiers are not billed, the claim line will deny. MHCP will follow Medicare guidelines and will pay claims retroactively back to April 1, 2014.

    All Capped Rentals with a prior authorization (PA) and modifiers RR KJ that were overpaid due to bypass of a PA, will be reproccessed and paid correctly at the 75%. MHCP will make a mass adjustment in the next month.

    Refer to CMS MLNMatters for any questions.

    FQHC and RHC Changes

    For dates of service on or after Jan. 1, 2015, MHCP fee-for-service (FFS) pays for federally qualified health center (FQHC) and rural health clinic (RHC) services provided to members enrolled in Managed Care Organizations (MCO). We will communicate additional billing instructions when we have more information.

    MHCP will continue to calculate and pay supplemental payments for MCO or county-based purchasing plan claims for clinic services provided before Jan. 1, 2015. Clinics must review payment calculation data and report payment issues to MHCP by Jan. 1, 2017. MHCP will not pay supplemental payments after June 30, 2017.

    Hearing Aid Providers

    (Added 8/29/14)

    The volume purchase contract expires 8/31/14. MHCP allows a 30-day grace period for instruments purchased, but not delivered, before the contract expires. Hearing aids obtained from the 2013 contract must be dispensed before the end of the grace period, on or before 9/30/14, even those with approved authorizations. The 2014 Hearing Aid Volume Purchase Contract, effective 9/1/14, is now available online.

    Hospital Presumptive Eligibility (HPE)

    Qualifed hospital staff began making eligibility determinations under the HPE program July 1, 2014. Access to the training, forms and other information about HPE is available on the HPE Web page.

    IMD Providers

    Tell people who reside in an IMD facility that they need to apply for MHCP coverage directly through their county. People who have already applied or already have MHCP coverage should not complete another application. MHCP is working to resolve a system issue to allow submission of these applications online through MNsure. Refer to the Provider Update, IMD Eligibility and Claims Payment (MHP-14-04) for complete information.

    Mental Health

    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 for adults beginning Oct. 1, 2014. The WHODAS replaces the Global Assessment of Function (GAF). Providers may use either the 12-item or 36-item WHODAS. DHS requires the use of the simple scoring method. Refer to the following resources for the forms and more information:

    Outpatient Hospital

    Laboratory Tests
    As of Jan. 1, 2014, providers were instructed to bill separately billable laboratory tests using TOB 14X.

    On July 1, 2014, CMS made an operational change to their policy and are now instructing providers to bill separately billable lab tests using TOB 13X adding modifier L1 (separately payable lab test) to the procedure code for dates of service on or after Jan. 1, 2014.

    Claims using TOB 14X submitted before July 1, 2014, do not require replacement. Refer to MLN Matters® Number: SE1412 for more information.

    Non-patient Laboratory Specimen
    Since July 9, 2014, MHCP processed outpatient claims billed with type of bill 14X and dates of service on or after Jan. 1, 2014, following APC pricing. MHCP is currently working on programming that will allow these claims to be priced using the Clinical Laboratory Fee Schedule (CLFS)

    MHCP will identify and reprocess all claims that were priced incorrectly when the programming is complete. Watch for an updated message indicating the remittance advice payment date for the reprocessed claims.

    Rule Change - Definition of “Investigative”

    DHS proposes to repeal obsolete language from Minnesota Rule 9505.5005 which defines “investigative” for the purpose of health care program payment. The proposed change will remove a reference to the National Blue Cross and Blue Shield Association Medical Advisory Committee because the committee no longer exists. The department will publish the Notice of Intent to Repeal Obsolete Rule in the State Register on August 18, 2014; the comment period will remain open until October 20, 2014. See the Web page on the Proposed Repeal of Obsolete Rule for more information.

    Targeted Case Management Rates

    ​Due to a calculation error, MHCP paid claims for Adult Mental Health, Vulnerable Adult and Developmental Disability Targeted Case Management (TCM) services based on incorrect rates for dates of service on or after July 1, 2014. We have recalculated the appropriate rates and will publish the revised Fiscal Year 2015 TCM rates on the County Link Fiscal Reporting and Accounting page. We will notify providers when we identify the incorrectly paid claims and determine a replacement date.

    Waiver/AC Program Providers

    Added 8/29/14

    The Rate Management System (RMS) will be unavailable from 2 p.m., Friday, Aug. 29, 2014, through 8 a.m., Tuesday, Sept. 2, 2014, because of an update installation.

    The Disability Services Division (DSD) is seeking public comments on amendments to the federal waiver plan. The 30-day public comment period began Aug. 28, 2014, and ends Sept. 27, 2014. Areas included are Customized Living/24-Hour Customized Living, Respite, Consumer-Directed Community Supports (CDCS), Tribal Standards, Adult Day Care Bath, Transportation, Extended Private Duty Nursing, and Environmental Accessibility Adaptations. For more information, view the DSD announcement and the federal waiver amendments draft.

    Providers of vehicle modifications and installations (Environmental Accessibility Adaptation), check your MN–ITS mailbox PRVLTR file for detailed information.

    Submit comments on the amendments no later than 4 p.m. on Saturday, Sept. 27, 2014, to

    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.

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