MHCP Provider News

May 31, 2016

  • EFT date change due to Memorial Day holiday: The correct electronic funds transfer (EFT) date for this week is Wednesday, June 1, 2016. The MHCP Payment and Claim Cut-off Calendar incorrectly lists EFT on Tuesday, May 31. Funds will not be transferred until June 1.
  • Professional and outpatient claims reprocessing: MHCP corrected a system error that incorrectly denied professional and institutional outpatient claims processed between March 9, 2016, and April 27, 2016. These claims were reported on your remittance advice with remark code N265, indicating a missing, incomplete or invalid ordering provider name. We have identified claims that were denied in error and will begin replacing them for the May 3, 2016, payment date.
  • • See grants and requests for proposal (RFPs) for current grants available or RFPs in which you may be interested.
  • Review recent Provider Updates

    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

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


    CMS has corrected the 2016 Minnesota conversion factor amount from $21.50 to $21.13. MHCP identified and reprocessed claims for dates of service between January 1 and March 15, 2016. The reprocessed claims were on your May 3, 2016, remittance advice.

    Child and Teen Checkups

    The updated Child and Teen Checkups (C&TC) Schedule of Age-Related Screening Standards (DHS-3379) (PDF) is now available to order on the DHS bulk order site.

    Dental providers

    General dentist license: Dentists with a limited general dentist license may enroll with MHCP. The applicant and the supervising provider must complete and sign the MHCP Individual Practitioner – Provider Enrollment Application (DHS-4016) (PDF), the Provider Agreement (DHS-4138) (PDF), and the Limited General Dentist Assurance Statement (DHS-3932) (PDF). Submit both forms with supporting documents to MHCP.

    House calls for removable prosthesis: Effective July 1, 2016, MHCP will cover up to five house calls (D9410) each calendar year for fitting removable prosthesis. Bill both CPT codes D9410 and D5992; D9410 will pay at the current rate and D5992 will pay at zero.

    Individualized Education Program (IEP)

    MHCP will reprocess IEP claims that were denied in error for age requirements for ICD-10 code F94.9. You will see the reprocessed claims on your May 17, 2016, remittance advice.

    Laboratory Services

    Outpatient hospital laboratory services: MHCP identified several outpatient laboratory services that were incorrectly priced from Jan. 1 through Apr. 29, 2016. These have been reprocessed and will be on the June 1, 2016, remittance advice.

    This group of laboratory claims does not include the outpatient laboratory services assigned a status indicator Q4. We will reprocess the laboratory services claims with a Q4 indicator separately after the systems work is completed.

    Mental Health

    Provider Travel Time: Follow these requirements to bill MHCP for mental health provider travel time:

  • • Document start and stop time of travel times to the minute for each service in each progress note
  • • Bill for the most direct route
  • • Enter the exact number of minutes of travel time in the units field on the claim
  • • Use the appropriate place of service code on the claim
  • • Bill travel time for only one member if the services are being delivered in a group format
  • • Document unusual travel conditions that may cause a need to bill for additional time
  • • Do not bill for detours for lunch breaks, nonmember service activities, or time for vehicle breakdowns

  • Members must have an individual treatment plan (ITP) specifying why the provider must travel to the member’s home, place of work, or other setting to provide services. Provider travel time covers only the time the provider is in transit to and from the member. Review the Mental Health Provider Travel Time section of the MHCP Provider Manual for more information.

    Rate Increase to Mobile Crisis Services: Effective July 1, 2015, the Centers for Medicare & Medicaid Services (CMS) approved the rate increases for mobile crisis response services. MHCP will replace claims for mobile crisis services with dates of service on or after July 1, 2015. We will post a message when we know the date the replacement claims will be on the remittance advice.

    Crisis providers who have billed at the published fee-for-service rate will not see an increase to adjusted claims. Claims billed for more than the allowable amount will receive the increased rate. MHCP pays claims at the lesser of the provider’s submitted charge or the MHCP allowable payment rate. Continue to bill the usual and customary charge that applies on the date you provide the service, according to Minnesota Rules 9505.0450.

    Diagnostic assessment rate correction: MHCP has updated its system to reflect a rate change effective January 1, 2016. We will replace claims with procedure code 90791 or 90792 and modifier TS or TG to pay at the correct reimbursement rate for dates of service starting January 1, 2016. The adjusted claims are on the May 17, 2016, remittance advice.

    We will update the system and adjust claims at a later date for procedure 90791 and 90792 with modifier 52. These adjusted claims will be on your May 31, 2016, remittance advice. Refer to the Diagnostic Assessment section of the MHCP Provider Manual for CPT codes and information.

    Waiver and Alternative Care Program Providers

    Restriction on adding or changing service agreements: The Minnesota Legislature authorized the following rate and limit changes for services provided on or after July 1, 2016:

  • • 0.2 percent rate increase for Consumer Directed Community Supports (CDCS), Consumer Support Grant (CSG) and personal care assistance services (PCA)
  • • 21.3 percent increase to Elderly Waiver (EW) and Alternative Care (AC) individual case-mix budget caps, Elderly Waiver customized living and 24-hour customized living service limits, and CDCS monthly case-mix limits in EW and AC
  • • Transition to daily rate for EW customized living services and adult foster care

  • DHS will run an MMIS automation process on June 13, 2016, for rate changes on Service Agreements (SAs). Lead agency (county and tribal) staff will be unable to add or make changes to some SAs from June 9 to June 14, 2015, while we update the system for this change. This does not affect ADAD and homecare SAs. DHS will notify lead agencies when they are again able to update SAs.

    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.

    Refer to the following for home and community-based services grants and RFPs:

  • Grants available to provide innovative home and community-based services (HCBS). Disability Services Division (DSD) seeks proposals from qualified responders to provide innovative home and community-based services to improve outcomes in community integration, competitive employment and integrated housing for people with disabilities 
  • RFP available for qualified responders to provide financial management services for people who use CSG and CDCS. The DHS Disability Services and Aging and Adult Services divisions seek proposals from qualified responders to provide vendor fiscal or employer agent financial management services (VF/EA FMS) for Consumer Support Grant (CSG) and Consumer Directed Community Supports (CDCS).
  • 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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