Provider Manual
Provider Manual
Your initial PCPO or PCA Choice application must include all items listed under Initial Application in this checklist. Owners, managing employees and qualified professionals are required to attend PCA agency training before completing the enrollment process. Any additional business sites or locations must also submit a complete application.
PCPO and PCA Choice providers must follow these steps:
**Medicare-certified home health agencies may submit the MHCP Organization – Provider Enrollment Application (DHS-4016A) (PDF) if also doing services other than PCA. If providing PCA services through the enrolled home health agency they must also follow steps 2-3 of the initial enrollment process above.
MHCP must review PCA agencies (including Medicare-certified or Class A-licensed agencies who provide PCA services) once every year for continued enrollment. MHCP will notify agencies of their annual review and its requirements. Providers have 30 days to submit required documentation. MHCP will not approve service authorizations or pay claims for services provided, if the annual review information is not submitted within 30 days of the notification.
At a minimum, MHCP will require the following at annual review:
You must also meet ongoing requirements of other state agencies for Minnesota businesses.
When a change occurs in one of the following: |
Fax the appropriate form or information from this column (below) to MHCP Provider Enrollment: | |
Name of business: |
Group, Facility or Billing Entity MHCP Provider Information Change Form (DHS-3535A) (PDF) | |
Address, phone number or fax number: | ||
Ownership (must be reported 30 days before the change occurs) |
(sale of business, add or remove owners, directors, managers, board members, other entities with control interest in the business, etc.) |
Disclosure of Ownership and Control Interest (DHS-5259) (PDF) |
Management | ||
Qualified Supervising Professional |
Qualified Professional (QP) Acknowledgement (DHS-4022C) (PDF) | |
Direct deposit/bank information |
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Billing person |
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Bonds and insurances |
Copy of new, changed or renewed bonds or insurances. Submit at the time of the change. | |
You must also meet ongoing requirements of other state agencies for Minnesota businesses.
MHCP Provider Enrollment fax: 651-431-7462
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