MHCP Provider News

October 17, 2016

  • MHCP members with Medical Assistance fee-for-service and MinnesotaCare managed care coverage: Some MHCP members may have Medical Assistance (MA) coverage through fee-for-service (FFS) and be enrolled in a MinnesotaCare managed care plan for the same date. These members are responsible for only the MA cost sharing amounts. (See Billing the Recipient in the MHCP Provider Manual.) The eligibility verification response will state the member has eligibility for Medical Assistance. However, the prepaid health plan information will state the subscriber receives MinnesotaCare through one of the managed care plans. In these situations, first bill the managed care organization (MCO). The MCO will apply MinnesotaCare benefits and copays. Then bill MHCP as the secondary payer. Report the payment and adjustments from the MCO in the coordination of benefits (COB) information, using claim filing indicator HM. Submit an attachment with the MCO explanation of benefits (EOB), following the instructions on the Claim Attachment Criteria. MHCP will process the claim and apply the MA benefits, which may change the patient responsibility amounts. Pharmacy providers: Bill your secondary claim to MHCP and report the MCO payment and adjustment information in the COB section. Your claim will deny. Then call the Provider Call Center to report the claim that needs to be reprocessed. (Added 10/20/16)
  • PERM audit: The Minnesota Department of Human Services Program Compliance and Audits section thanks you for your participation and cooperation in the PERM audit for federal fiscal year 2015, October 1, 2014, through September 30, 2015. Your accuracy collecting the specific documents the PERM review contractor A+ Government Solutions requested, and promptly submitting them to support that the sampled claim was filed for the correct service on the correct date of service, helped make the 2015 PERM review’s medical record claim error review component proceed efficiently and effectively. Refer to Payment Error Rate Measurement (PERM) on the Centers for Medicare & Medicaid Services (CMS) website for more information. If you have questions or comments about the audit, contact our medical record reviewer Eileen Dejdar at 651-431-3994 or or Laurie Grussing at 651-431-3959 or weekdays 6:30 a.m.–4:00 p.m.
  • First Annual School Mental Health Conference: Registration is open for the 2016 Minnesota School Mental Health Conference. The conference dates are November 2 through November 4, 2016. Refer to the announcement for more information and a link to the registration page.
  • Proposed rule repeal: The Department of Human Services (DHS) is proposing the repeal of a small part of its Surveillance and Integrity Review Section (SIRS) program rules about publishing notice in a general circulation newspaper. Read more information on the web page. Submit written or oral comments on possible repeal of this rule until 4:30 p.m. on October 21, 2016, by emailing, by mailing to Vanessa Vogl, Rulemaking Attorney at the Minnesota Department of Human Services, PO Box 64254, Saint Paul, MN 55164-0254, or by calling 651-431-3168. TTY users may call the Department of Human Services at 800-627-3529.
  • • See grants and requests for proposal (RFPs) for current grants available or RFPs in which you may be interested.
  • Review recent Provider Updates

  • 2016 Legislative Update (LEG-16-01)
  • Training and VideoPresence Opportunities

    Refer to the Provider Training page for information about new and ongoing training or to the list below for details on additional training sessions on special topics.


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

    Electronic Health Records (EHR)

    Response date extended for Minnesota Department of Health request for information: The Minnesota Department of Health (MDH) by legislative mandate* seeks input from the public, including health care providers, on both patient impact and costs associated with requirements** related to patient consent for release of health records for the purposes of treatment, payment and health care operations. MDH encourages individuals, health care providers, payers and related organizations to respond.

    The complete request for information (RFI) and instructions for responding are available here:
    . Responses are due October 24, 2016.

    MDH will summarize the findings from this RFI in a report to the Minnesota Legislature due in February 2017. The findings may be used for planning, policy development and decision making. They may also inform additional studies on health information exchange and future work on e-health topics related to health information privacy, security and consent.

    * See Minnesota Session Laws 2016, Regular Session, Chapter 189, Article 20, Section 5.

    ** See Minnesota Statutes, section 144.293, subdivision 2.

    Refer to the Minnesota Electronic Health Records Incentive Program (MEIP) web pages for complete information about EHR.

    Day Training and Habilitation (DT&H)

    Free webinar about employment for people with disabilities: DT&H and prevocational services providers are encouraged to register and join a free webinar session about advancing employment for people with intellectual and developmental disabilities, Organizational Transformation: From Workshops to Community Employment, on October 20, 2016, at 2:00 p.m.

    Federally Qualified Health Centers

    Supplemental payment settlement deadline: The deadline for federally qualified health centers (FQHC) and rural health clinics (RHC) supplemental payment settlement is December 31, 2016. Submit your detailed requests and supporting claims data immediately for all dates of service through December 31, 2014. We must have your detailed request and supporting claims data by the deadline or we will consider all supplemental payments settled. (Minnesota Session Laws 2014, Chap 312, Art. 24, Sec. 35(i))

    For questions about the deadline and submitting information, please contact: Jo Ann Sharkshnas, 651-431-2537, and Patricia Kimmes, 651-431-2539,

    Group Residential Housing Supplemental Services (GRHSS)

    MHCP enrollment: Most providers of group residential housing (GRH) need to enroll as an MHCP provider to receive supplemental services payments from MHCP. MHCP Provider Enrollment must receive all paperwork for your enrollment by October 31, 2016, to ensure we can process your enrollment by the December 31, 2016, deadline.

    If you are a GRH provider and are not sure if you need to enroll, here is how you can tell: Add the amount that a resident pays you each month for room and board to the amount you receive from the state for GRH for that resident. If those two amounts together are $891 or less, you are only receiving GRH base-rate room and board payments. If you are receiving only GRH base-rate room and board payments for all GRH residents in your setting, you are not receiving GRH supplemental service rate payments and do not need to enroll.

    If your total GRH payment is more than $891 per month for one or more of your residents, you need to enroll with MHCP to continue receiving supplemental service payments. GRH supplemental service rate payments are any payments MHCP makes to GRH providers in excess of the maximum room and board rate of $891.Beginning January 1, 2017, you will bill GRH supplemental services through MHCP.

    Before you enroll, you must watch the recorded webinar available through the link on the GRH Supplemental Services training web page. After watching the recorded webinar, complete the Group Residential Housing (GRH) Supplemental Services – Provider Enrollment Application (DHS-5924) (PDF) and fax all required forms to MHCP Provider Enrollment. If you have any questions about GRH supplemental services, call the MHCP Provider Call Center at 651-431-2700 or 800-627-3529.

    Enrollment Assistance: To help GRH supplemental services providers meet the December 31, 2016, enrollment deadline, MHCP is offering in-person or online help. For help completing your enrollment application, we invite you to attend a provider enrollment assistance session. Check the web page for available sessions and registration information.


    Inpatient hospital claims suspended: Inpatient hospital claims with discharge dates on or after October 1, 2016, are currently suspending and will not be processed in time for the October 18, 2016, payment date. The claims are suspending because of a problem with our APR-DRG grouper software. We are working to resolve this issue and expect to process the suspended claims by the November 1 payment date. Do not submit duplicate claims until we have processed the suspended claims.

    Lab, Pathology, Radiology and Diagnostic Services

    Drug screening: MHCP does not cover drug screening required for employment related issues or when court ordered when it is not medically necessary. Drug testing costs are not included in the Consolidated Chemical Dependency Treatment Fund (CCDTF) rate for services other than medication-assisted therapy.

    When drug screening is considered medically necessary as described in the Centers for Medicare & Medicaid Services (CMS) Local Coverage Determination (LCD) (L36037), report drug screening using HCPCS codes G0477–G0483 for encounters with dates of service on and after November 1, 2016. Presumptive drug tests (codes G0477–G0479) cannot be billed with confirmatory drug tests (codes G0480–G0483). Bill confirmatory drug tests after presumptive drug tests only if the presumptive drug test comes back as positive.

    Effective November 1, 2016, MHCP will no longer cover CPT codes 80300–80377.

    Medical Supply

    Enteral nutrition: DHS previously instructed providers about the reprocessing of enteral nutrition (HCPCS codes B4149 through B4155) claims. Please disregard those instructions. We will issue updated claims replacement and reprocessing information soon.

    Rate changes for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS): We have reprocessed DMEPOS claims for dates of service from July 1, 2015, through October 12, 2016, to apply the following increases:

  • • 9.5 percent increase to durable medical equipment codes that were subject to the competitive bidding Medicare rate reduction in 2009
  • • 2.94 percent increase to all DMEPOS

  • You will see the increase for reprocessed claims on your November 1, 2016, remittance advice. By-report codes do not receive the 9.5 percent or 2.94 percent increases.

    For DMEPOS provided on or after January 1, 2016, the MHCP fee schedule base rate reflects the 2016 Medicare rates for non-competitive bidding codes. (Revised 10/20/16)


    Follow-up To previous request for information (RFI): DHS has received useful input in response to Request for Information, Changes to Outpatient Pharmacy Reimbursement Methodology. We are scheduling three webinar meetings for additional input on specific topics from stakeholders, including enrolled health care providers, managed care organizations, trade groups, experts in pharmacy reimbursement policy, and members of the public potentially affected or otherwise concerned with pharmacy reimbursement policy. We invite any member of the public to participate in the webinars. See Changes to Outpatient Pharmacy Reimbursement for Ingredients and Dispensing for information about the webinars.

    Home Infusion Therapy (HIT) services—home infusion pharmacies serving dual eligible recipients: Do not bill MHCP using per diem HIT codes if the recipient has Medicare eligibility. You must research the Medicare plans or contact Medicare about the Part B or Part D plan to determine which Medicare plan will pay for the home infusion therapy components. (Refer to the Home Infusion Therapy section of the MHCP Provider Manual.)

    Some home infusion pharmacies have been billing MHCP using a mechanism that is not consistent with what is in the MHCP Provider Manual. These providers changed the codes on home infusion crossover claims to the home infusion therapy per diem S codes to obtain reimbursement in excess of the Medicare coinsurance. On October 19, 2016, MHCP will start denying crossover claims submitted with a bundled S code. We will take back incorrectly billed claims going back to January 1, 2016.

    Rural Health Centers

    Supplemental payment settlement deadline: The deadline for federally qualified health centers (FQHC) and rural health clinics (RHC) supplemental payment settlement is December 31, 2016. Submit your detailed requests and supporting claims data immediately for all dates of service through December 31, 2014. We must have your detailed request and supporting claims data by the deadline or we will consider all supplemental payments settled. (Minnesota Session Laws 2014, Chap 312, Art. 24, Sec. 35(i))

    For questions about the deadline and submitting information, please contact: Jo Ann Sharkshnas, 651-431-2537, and Patricia Kimmes, 651-431-2539,

    Waiver and Alternative Care (AC) Programs

    HCBS revised transition plan public comments sought by 4 p.m. Thursday, November 3, 2016: DHS plans to submit a revised statewide transition plan (STP) to the Centers for Medicare & Medicaid Services (CMS) after a 30-day public comment period. The STP describes how Minnesota will meet the new federal rule for home and community-based services (HCBS) settings. Review the notice Public comments period for HCBS transition plan changes for more information.

    Waiver plan changes public comment period: DHS is working with the Centers for Medicare & Medicaid Services (CMS) on approval of a package of amendments for the following home and community-based services waivers:

  • • Brain Injury (BI)
  • • Community Alternative Care (CAC)
  • • Community Access for Disability Inclusion (CADI)
  • • Developmental Disabilities (DD)
  • In February, DHS sent a notice for a 30-day public comment period for updated federal waiver plan amendments. This is a new 30-day comment period for the waiver plan changes that ends at 4 p.m. Wednesday, November 2, 2016. Review Public comment period for waiver plan changes for information and how to submit comments. If you commented during the previous period, you do not need to resubmit your comments.

    Training and VideoPresence Opportunities

    Information about most new and ongoing training is on the Provider Training page. Any information listed in this section is for additional training sessions on special topics.

    Grants and RFPs

    See the Grants and requests for proposals web page for more information.

    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.

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