MHCP Provider News

Jan. 12, 2014 News

  • • Background Study Process Changes: The Department of Human Services' (DHS) Office of Inspector General is implementing changes to the background study process.Changes include requiring fingerprints and photographs of background study subjects, and use of a new portal, NETStudy 2.0, to submit background study requests. Information about the rollout plan is on the DHS Background Check website. DHS will gradually rollout the new system by provider type. The rollout schedule will be paced according to the feedback DHS receives from users. DHS is committed to positive experiences by users, and this commitment takes precedence over adherence to specific timelines. In advance of a provider being transitioned to the new system, DHS will contact each providers’ authorized agent, license holder, or other person in authority to provide specific information about the transition. This will include information to access NETStudy 2.0 and training resources. (Added 1/14/15)
  • • New funding mechanism will help continue MinnesotaCare: The groundbreaking MinnesotaCare health care program will become the first state program funded under the federal Basic Health Plan (BHP) on Jan. 1, 2015, after Minnesota became the first state to win approval for this option under the Affordable Care Act. The Centers for Medicare and Medicaid Services approved Minnesota’s BHP Blueprint on Dec. 15, allowing the Department of Human Services to receive funding under a new federal authority to help pay for MinnesotaCare. MinnesotaCare enrollees shouldn’t see any changes to their coverage as a result of the funding change. MinnesotaCare was revamped on Jan. 1, 2014, as Gov. Mark Dayton and the Legislature brought the program into line with the federal requirements for the BHP. Changes included eliminating a 4-month waiting period and an inpatient hospital coverage limit.
  • • As part of its commitment to more person-centered supports, DHS contracted with the Institute on Community Integration at the University of Minnesota to offer a year-long training and technical assistance program. The intent of this program is to help agencies implement organizational changes for more person-centered supports. Review the Summary of Opportunity for details. The anticipated start date is April 2015. Applications are open to lead agencies (counties and tribes) and provider agencies. The application deadline is Jan. 30, 2015. For questions email Anne Roehl at
  • Review recent Provider Updates:

    State Register Notices

  • • Positive support strategies and person-centered planning techniques
  • The Department of Human Services will publish an Amended Notice of Hearing along with a copy of the proposed rules in the State Register on Jan. 12, 2015. The title of the notice is Proposed Rules Governing Positive Support Strategies, Person-Centered Planning, Limits on Use of Restrictive Interventions and Emergency Use of Manual Restraint, and Repeal of Rules Governing Aversive and Deprivation Procedures in Minnesota Rules, 9525.2700 to 9525.2810;  Revisor’s ID No. R-04213.

    The Amended Notice of Hearing describes how to comment on the rule and attend the public hearing. Follow the procedure described in the Notice of Hearing if you would like to comment or attend the public hearing on the rule.  

    Refer to the rulemaking web page for more information and documents, including a copy of the proposed rules.

  • • Autism Respite services
  • The Minnesota Department of Human Services (DHS) is gathering information and ideas for the development of respite services for individuals with autism. Responses submitted from this request for information must be received no later than 4 p.m. Central time on Friday, Feb. 20, 2015. Late proposals will not be considered. Please view the State Register (PDF) for Monday, Jan. 5, 2015, page 1012. The request for information is also posted on the DHS Grants and RFPs web page.


  • • Batch Claims Submitter ID Field (L1000A/NM109) Change
  • Claims submitted through X12 batch transactions are required to have a valid ten character NPI or UMPI number in the submitter ID field (Loop 1000A/NM109). Effective Jan. 9, 2015, MHCP is implementing system programming for recent legislative changes. Claims submitted on or after this date without a valid NPI or UMPI in this field will deny. If your claim denies with remittance advice remark code (RARC) N282, indicating invalid pay-to provider secondary identifier, submit a new claim with a valid submitter ID. If you use a clearinghouse or billing intermediary to submit batch claim files, work with them to make sure they submit valid information in this field.

  • • New modifiers (Rev. 1/14/15)
  • Effective for dates of service on and after Jan. 1, 2015, four new modifiers are available to report distinct services. Modifier 59 will remain valid; however, you should use one of the new modifiers in the following situations:

  • • XE: Separate encounter – The service is distinct because it occurred during a separate encounter
  • • XP: Separate practitioner – The service is distinct because it was performed by a different practitioner
  • • XS: Separate structure – The service is distinct because it was performed on a separate organ or structure
  • • XU: Unusual non-overlapping service – The use of the service is distinct because it does not overlap usual components of the main service
  • Training and VideoPresence Opportunities

    Refer to the session for registration and session details.

  • College of Direct Support: Upcoming Information Sessions –Tuesday, Jan. 27, 2015, 10 a.m. – 11 a.m.
  • Pediatric Obesity Services: What’s Covered: The Minnesota chapter of the American Academy of Pediatrics (MNAAP) and the Minnesota Partnership on Pediatric Obesity Care and Coverage (MPPOCC) are hosting this informational webinar about insurance coverage and coding issues for services related to pediatric obesity, weight managment and prevention on Jan. 30, 2015, starting at noon.
  • Systems Upgrade – Forms Issues

    If you are not able to open MHCP forms and documents, it may be because eDocs (our forms management system) recently underwent a system upgrade. As a result, the browser requirements have changed. If your browser does not meet these requirements, you will not be able to open PDFs in eDocs and need to update your browser.

    As of Nov. 18, 2014, to access forms in eDocs, you must have one of the following supported browsers:

  • • Microsoft Internet Explorer 9.x-11.x (We recommend that Compatibility View settings be disabled. To disable Compatibility View, go to Tools > Compatibility View Settings. Then uncheck Display intranet sites in Compatibility View. In Internet Explorer 9.x, also uncheck Display all websites in Compatibility View.)
  • • Mozilla Firefox 4.x or later
  • • Apple Safari 5.x or later
  • • Google Chrome 9.x or later

  • If you have more questions, refer to eDocs Frequently asked questions. We understand that changing or upgrading browsers can be difficult. Our IT area is actively looking for solutions that will allow older browsers to continue to work. Please contact the eDocs helpdesk ( if you have questions or problems with this change. We hope to minimize the impact in any way we can.

    If you have more questions, please call the MHCP Provider Call Center at 651-431-2700 or 800-366-5411.


    Refer to the 5010/D.0 Announcements page for information about MN–ITS functionality, technical information, scheduled downtimes and other notifications.

    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.


    Watch the 5010/D.0 page for announcements about both direct data entry (DDE) and batch transactions. We also add messages about MN–ITS availability on this page.

    Electronic health records

    Review the revised Provider Update, Minnesota Electronic Health Record Technology Requirement (MHP-14-06)


    The Protecting Access to Medicare Act of 2014 (HR 4302) delayed implementation of ICD-10 until Oct. 1, 2015. Watch this page for updated information soon.

    Durable medical equipment (DME), prosthetics and orthotics

    Capped rentals
    MHCP will reprocess and pay all capped rentals (CR) with a prior authorization (PA) and modifiers RR KJ that were overpaid due to bypass of a PA. They will be paid correctly at 75% of the actual rental rate. A mass adjustment that was scheduled to be done in October will now be done sometime in 2015. This was delayed due to systems problems with replacement claims that were not able to price correctly. We will update this message when the mass adjustment is scheduled. Refer to CMS MLNMatters for more information.

    Dually eligible recipients
    When Medicare is primary payer on Medicare paid lines, dually eligible recipients are subject to the round 2 competitive bidding single payment amount (SPA) under the Centers for Medicare and Medicaid Services (CMS) durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) competitive bidding program. MHCP will do a mass adjustment back to July 1, 2013. We will post a notice when the mass adjustment is scheduled. Refer to the CMS DMEPOS Competitive Bidding Program and Laws of Minnesota, chapter 312, article 24, sec. 40, Reimbursement for basic care services, for more information.

    FQHC and RHC

    Payment Methodology Election
    Review Provider Update, Federally Qualified Health Centers (FQHC) and Rural health Centers (RHC) Alternative Payment Methodology Election (MHP-14-07). FQHC and RHC providers must choose the appropriate payment method.

    Legislative Change
    Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) changes to implement the new 2014 Minnesota law affecting FQHC and RHC payments for MHCP services is in effect as of Jan. 1, 2015. Providers are asked to monitor MCO and MHCP remittance advice information closely. Direct MCO remit questions to the MCO. Call the Provider Call Center for questions about MHCP remit items.

    Mental Health Services

    Training Available
    The following online training is available on the Adult Mental Health Training page:

  • • MA Documentation
  • • Functional Assessment
  • • Diagnostic Assessment

  • Children’s Mental Health New Services
    The Centers for Medicare and Medicaid Services (CMS) approved intensive treatment services in foster care (ITSFC), family psychoeducation and clinical care consultation as MHCP children’s mental health services. We will provide more guidance about these covered services when benefit criteria and implementation dates have been determined.

    Adult Rehabilitative Mental Health Services (ARMHS)
    MHCP will cover functional assessments and individual treatment plans under ARMHS after the Centers for Medicare & Medicaid Services (CMS) approves the changes to the ARMHS services, MHCP will determine billing procedures for services provided on or after Jan. 1, 2015, We will communicate rate and procedure code changes through the Provider News and revisions to the MHCP Provider Manual. Also watch for information about ARMHS informational seminars using ITV locations across the state throughout 2015. (Updated 1/14/15)


    MnCHOICES is a single, comprehensive assessment and support planning web-based application for long-term services and supports in Minnesota. It replaces the following assessment tools:

  • • Developmental Disability Screening
  • • Long-Term Care Consultation
  • • Personal Care Assistance Assessment and Service Plan.

  • Rollout of MnCHOICES to counties and tribes began Nov. 4, 2013. Statewide implementation was completed in 2014 The roll-out of MnCHOICES to managed care organizations will occur in late 2015.

    Refer to the following for more information:

  • • The PCA Process Guidelines with MnCHOICES provides guidelines to counties and tribes about authorizing and documenting PCA service needs in MnCHOICES
  • • County and tribal assessors will use the MnCHOICES Community Support Plan with Coordinated Services and Supports (DHS-6791B) to develop the support plan and approve and authorize services.
  • MnCHOICES web pages

  • If you have more questions, please call the MHCP Provider Call Center.

    Nursing Facility

    Effective Jan. 1, 2015, nursing facilities will be required to submit a request for a refund of the spenddown amount withheld by DHS for clients in a managed care plan. Providers have no later than one year from the date of service or six months from the warrant date to request the refund.

    Outpatient Hospital

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

    MHCP replaced incorrectly paid claims on the Dec. 16, 2014, payment date.

    Reproductive Health

    Minnesota Family Planning Program (MFPP)
    Effective Jan. 1, 2015, Minnesota Family Planning Program (MFPP) procedure codes 87623, 876241, and 87625 will replace 87620, 87621 and 87622. Refer to Minnesota Family Planning Program (MFPP) Procedure Codes list in the Providers Manual for more information. Claims with dates of service before Jan. 1, 2015, will process with procedure codes 87620, 87621 and 87622.

    Ortho Evra Maximum quantity limit increase
    Effective immediately, MHCP increased the maximum quantity limit for CPT code J7304 to nine units. This allows providers to prescribe a three-month supply of Ortho Evra patches at a time, matching the three-month supply currently allowed for oral contraceptives.


    Access Transportation Services (ATS)
    Effective Jan. 1, 2015, the access transportation services (ATS) reimbursement rate for volunteer drivers (A0080) and the licensed foster parent reimbursement (A0090 UC) is based on the IRS business deduction mileage rate. The rate effective Jan. 1, 2015, through Dec. 31, 2015, is 57.5 cents per loaded mile unless the IRS or Minnesota Statute or Rule changes during this period.

    MHCP continues to consider no-load miles (miles driven when the client is not in the vehicle) as excluded or non-reimbursable mileage. These miles cannot be charged to the client.

    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 800-366-5411.

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

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