Skip To: Main content|Subnavigation|
Minnesota Department of Human Services MN–ITS User Manual
Advanced Search|  

Billing for IEP Services

Revised: 10-27-2015

Review the billing requirements in the IEP Technical Assistance Guide or the IEP section of the MHCP Provider Manual before you submit the claim.

Log in to MN–ITS

  • 1. Log in to MN–ITS
  • 2. From the left menu:
  • a) Select MN–ITS
  • b) Select Claim Transactions
  • c) Select Professional (837P)
  • Submit the Claim

    To submit the claim, follow the instructions in the tables below for each of the following claim screens:

    Billing Provider
    Subscriber

    Claim Information

    Coordination of Benefits (COB)

    Services

    Billing Provider

    The billing provider screen will auto- populate the information on file for the NPI/UMPI used to log into MN–ITS. If changes are needed, review the Change of Enrollment Information in the MHCP Provider manual to notify MHCP Provider Enrollment.

    Refer to the table below for instruction and information about each field on this screen.

    Field Name
    (X12: Loop & element)

    Field Instruction

    Organization
    (X12: Loop 2010AA, NM103 (last name or organization) NM104 (first)

    Name and school district number

    Taxonomy
    (X12: Loop 2000A, PRV03)

    Not Required for IEP Service - No action needed

    Address 1
    (X12: Loop 2010AA, N301)

    First line of the address reported on the provider file

    Address 2
    (X12: Loop 2010AA, N302)

    Second line of the address reported on the provider file

    City
    (X12: Loop 2010AA, N401)

    City name for the address in address fields 1 and 2

    State
    (X12: Loop 2010AA, N402)

    State name for the address in address fields 1 and 2

    Zip
    (X12: Loop 2010AA, N403)

    Zip code for the address in address fields 1 and 2

    Telephone
    (X12: Loop 2010AA, PER04)

    Telephone number reported on the provider file

    Screen Action Button

    Select:

  • Cancel to cancel the claim entry
  • Continue to proceed to the next screen
  • Subscriber

    Use the Subscriber screen to report the recipient who received the service(s) reported on this claim.

    Refer to the table below for instruction and information about each field on this screen.

    Field Name
    (X12: Loop & element)

    Field Instruction

    Subscriber ID
    (X12: Loop 2010BA, NM109)

    Enter the 8-digit MHCP ID number of the child.

    Birth Date
    (X12: Loop 2010BA, DMG02)

    Enter date of the birth for child in the DDMMCCYY format.

    Select the Search
    button

    The following fields auto-populate based on the information entered in the Subscriber ID and Birth Date fields.

    Subscriber First Name
    (X12: Loop 2010BA, NM105)

    First name of the child

    Middle Initial
    (X12: Loop 2010BA, NM105

    Middle initial of the child

    Last Name
    (X12: Loop 2010BA, NM104)

    Last name of the child

    Gender
    (X12: Loop 2010BA, DMG03)

    Gender of the child

    Select the Delete action button in this section to remove the subscriber information if not correct.

    Screen Action Buttons

    Select:

  • Back to go back to the previous screen
  • Cancel to cancel the claim entry
  • Continue to proceed to the next screen
  • Claim Information

    Use the Claim Information screen(s) to report claim level information that will identify the type of claim and details about the service(s).

    Refer to the table below for instruction and information about each field on this screen.

    Field Name
    (X12: Loop & element)

    Field Instruction

    Claim Frequency Code
    (X12: Loop 2300, CLM05 - 3)

    Specifies if the claim is an original, replacement or void.

    The default is Original. If hand keying a claim to be replaced or voided, select the radio button in front of replacement or void.

    If the claim has been retrieved from the request status feature, the claim will display with the option selected.

    Payer Claim Control Number
    (X12: Loop 2300, REF02)

    Identifies the previously processed claim when the claim frequency code is replacement or void.

    The payer claim control field is protected until the replacement or void radio button is selected. Once selected, enter the payer claim control number to be replaced or voided.

    If the claim has been retrieved from a submit response or the request status feature, the payer claim number will display.

    Place of Service
    (X12: Loop 2300 CLM05-1)

    Select from the drop down, the place of service
    IEP allows for place of service 03-school and 12-home

    Patient Control Number
    (X12: Loop 2300, CLM01)

    Enter a unique identifier assigned by the school district.

    Assignment/Plan Participation
    (X12: Loop 2300, CLM07)

    The default response is Assigned – This is the most commonly used response

    Assigned indicates the school district is enrolled with MHCP and can bill MHCP for IEP services.

    All other responses cannot bill MHCP.

    Benefits Assignment
    (X12: Loop 2300, CLM08)

    The policy holder or person authorized to act on their behalf, has given MHCP permission to pay the school district directly.

    The default response is Yes - If this response is not correct and benefits are not assigned, you cannot bill MHCP.

    Release of Information
    (X12: Loop 2300, CLM09)

    The default response is Yes – Indicating the school district has a signed statement on file to authorize the release of medical data to other organizations.

    IEP services require a signature of parental consent.

    Provider Indicator
    (X12: Loop 2300, CLM06)

    The default response is Yes – Indicating the providers signature is on file.

    Signature is required for IEP services.

    Diagnosis Type Code
    (Loop: 2300, HI01-1)

    From the drop down menu, select whether the diagnosis code reported on this claim is in the ICD-9 or ICD-10 classification.

    Diagnosis Code
    (X12: Loop 2300, HI01-2, HI02-2, HI03-2, HI04-2)

    Enter the appropriate ICD-10-CM code that best describes the sign, symptom or condition that is causing the need for IEP services.
    Select Add to add the diagnosis code to the claim.

    Once a diagnosis code is added a delete action button will display next to that entry in the display field below.

    Select Delete to remove an entry if incorrect.

    Situational Claim Information
    This accordion screen is used by IEP services only when reporting an Attachment Control number and Type.

    Prior Authorization Number
    (X12: Loop 2300, REF02)

    Not Required for IEP Service - No action needed

    Medical Record Number
    (X12: Loop 2300, REF02)

    Not Required for IEP Service - No action needed

    Claim Note
    (X12: Loop 2300 NTE02)

    Not Required for IEP Service - No action needed

    Attachment Control Number
    (X12: Loop 2300, PWK06)

    Enter a number created by the school district, identifying a claim attachment for either:

  • • Assistive Technology pricing/documentation
  • • Reporting 3 unsuccessful attempts to get a response from a private insurance carrier (TPL)
  • MHCP uses only the first 30 characters when matching the attachments to the claim.

    Type
    (X12: Loop 2300, PWK01)

    Select from the drop down, OZ-Support Data for Claim. This field is required when reporting an Attachment Control Number.

    Select Add to add this information to the claim.

    Contact Name
    (X12: Loop 2010CA, PER02)

    Not Required for IEP Service - No action needed

    Telephone Number
    (X12: Loop 2010CA, PER04)

    Not Required for IEP Service - No action needed

    Extension
    (X12: Loop 2010CA, PER06)

    Not Required for IEP Service - No action needed

    Related Causes
    (X12: Loop 2300, CLM11 -1)

    Not Required for IEP Service - No action needed

    Date of Accident
    (X12: Loop 2300, DTP03)

    Not Required for IEP Service - No action needed

    Certification Condition
    (X12: Loop 2300, CRC02)

    Not Required for IEP Service - No action needed

    Condition Code
    (X12: Loop 2300, CRC03, CRC04, CRC05)

    Not Required for IEP Service - No action needed

    Situational Ambulance Information- Select the situational claim information accordion panel to report situational information for ambulance when required.

    Certification Condition
    (Loop: 2300, CRC02)

    Not Required for IEP Service - No action needed

    Condition Code
    (Loop: 2300, CRC03, CRC04, CRC05, CRC06, CRC07)

    Not Required for IEP Service - No action needed

    Patient Weight
    (Loop: 2300, CR102)

    Not Required for IEP Service - No action needed

    Transport Distance
    (X12: Loop 2300, CR106)

    Not Required for IEP Service - No action needed

    Transport Reason Code
    (Loop:2300 CR104)

    Not Required for IEP Service - No action needed

    Round Trip Purpose Description
    (Loop: 2300, CR109)

    Not Required for IEP Service - No action needed

    Stretcher Purpose Description
    (Loop: 2300, CR110)

    Not Required for IEP Service - No action needed

    Pickup Address
    (X12: Loop 2310E, N301)

    Not Required for IEP Service - No action needed

    Address {contd}
    (X12: Loop 2310E, N302)

    Not Required for IEP Service - No action needed

    City
    (X12: Loop 2310E, N401)

    Not Required for IEP Service - No action needed

    State
    (X12: Loop 2310E, N402)

    Not Required for IEP Service - No action needed

    Zip Code
    (X12: Loop 2310E, N403)

    Not Required for IEP Service - No action needed

    Dropoff Address
    (X12: Loop 2310F, N301)

    Not Required for IEP Service - No action needed

    Address {contd}
    (X12: Loop 2310F, N302)

    Not Required for IEP Service - No action needed

    City
    (X12: Loop 2310F, N401)

    Not Required for IEP Service - No action needed

    State
    (X12: Loop 2310F, N402)

    Not Required for IEP Service - No action needed

    Zip Code
    (X12: Loop 2310F, N403)

    Not Required for IEP Service - No action needed

    Other Providers (Claim Level)
    This collapsed accordion screen is not used for IEP Services.

    Screen Action Buttons

    Select:

    Back to go back to the previous screen

    Cancel to cancel the claim entry

    Continue to proceed to the next screen

    Coordination of Benefits (COB)

    Use the COB screen to report other payers, private insurance (TPL). If there are no other payers, select Continue Screen Action Button at the bottom on the screen to advance.

    Refer to the table below for instruction and information about each field on this screen.

    Field Name*
    (X12: Loop & element)

    Field Instruction

    Other Payer Name
    (Loop: 2330B, NM103)

    Other Payer:
    Enter the full name of the insurance carrier.

    Do not use symbols such as slashes, dashes, periods or plus signs.

    Other Payer Primary ID
    (X12: Loop 2330B, NM109)

    Enter the Other Payer Primary ID (Carrier ID) of the private insurance.

    This information is displayed on the MN–ITS eligibility response for the child

    Claim Filing Indicator
    (X12: Loop 2320, SBR09)

    Select from the drop down, the appropriate code to identify the type of insurance

    If undetermined, select CI-commercial insurance.

    Once the claim filing indicator is selected, new field will display

    Payer Responsibility
    (X12: Loop 2320, SBR01)

    Other Payer Subscriber:
    Select from the drop down, the private insurance carrier’s level of responsibility for the claim.

    Insured ID
    (X12: Loop 2330A, NM109)

    Enter the policyholder’s identification number as assigned by the private insurance carrier.

    Relationship Code
    (X12: Loop 2320, SBR02)

    Select from the drop down, 19-Child to identify the relationship of the child to the policy holder.

    Claim Adjustment Group Code
    (X12: Loop 2320, CAS01)

    Claim Level Adjustments:
    Select from the drop down, OA-Other Adjustment, once it has been identified that the private insurance carrier will not cover services in the school.
    OR

    If the private insurance carrier paid for any part of the services on this claim, refer to the explanation of benefits (EOB) from the private insurance for the correct code(s) to report. Must report on service line level.

    Adj Reason Code
    (X12: Loop 2320, CAS02, CAS05, CAS08, CAS11, CAS14,CAS17)

    Enter the adjustment reason code B1 to report the service is not covered, once it has been identified that the private insurance carrier will not cover services in the school.
    OR

    If the private insurance carrier paid any part of the services on this claim, refer to the explanation of benefits (EOB) from the private insurance for the correct code(s) to report. Must report on service line level.

    Adj Amount
    (X12: Loop 2320, CAS03, CAS06, CAS09, CAS12, CAS15 CAS18)

    Enter the total charges for the claim when the IEP services are not coved by the private insurance carrier.
    OR

    If the private insurance carrier paid any part of the services on this claim, refer to the explanation of benefits (EOB) from the private insurance to report the dollar amount adjusted from your submitted charge. Must report on service line level.

    Adj Quantity
    (X12: Loop 2320, CAS04, CAS07, CAS10, CAS13, CAS16, CAS19)

    Not Required for IEP Service

    Select Add to add the Claim Level Adjustment information.

    Payer Paid Amount
    (X12: Loop 2320, AMT02)

    Other Payer Amounts:
    Enter the total dollar amount paid by the private insurance carrier. If the private insurance paid nothing, enter 0.00.

    Non-Covered Charge Amount
    (X12: Loop 2320, AMT02)

    Enter the total dollar amount the private insurance carrier did not pay.

    Benefits Assignment
    (X12: Loop 2320, O103)

    Other Insurance Information:
    Select the appropriate radio button.
    The default response is Yes – Indicating benefits from the private insurance carrier were assigned to the school.

    Release of Information
    (X12: Loop 2320, O106)

    Select the appropriate radio button.

    The default response is Yes – Parental consent is required for IEP services.

    Section Action Button

    Select the Delete action button at the bottom of this section to remove the payer that is displayed on the screen

    Section Action Button

    Select the Save action button at the bottom of this section to save this payer information on the claim

    Screen Action Button

    Once the Other Payer Information is saved an ADD button will display below this section.

    Select the ADD action button to enter additional payers.

    Repeat the same Other Payer and Claim Adjustments step for additional payers. Once all payers are reported select the appropriate Screen Action Button displayed at the bottom of the screen.

    Screen Action Button

    Select:

  • Back to go back to the previous screen
  • Cancel to cancel the claim entry
  • Continue to proceed to the next screen
  • Services

    Use the Services screen to describe details of the service line(s) being billed.(Information entered on the claim information screen will apply to all lines of the claim). Change the information being reported at the service line level if it is different from what was reported at the claim level.

    Refer to the table below for instruction and information about each field on this screen.

    Field Name*
    (X12: Loop & element)

    Field Information

    Date of Service (From)
    (X12: Loop 2400, DTP03)

    Enter the date, or the begin date of a consecutive date range for the service provided in the MMDDCCYY format.

    Date of Service (To)
    (X12: Loop 2400, DTP03 * RD8* required in DTP02 when TO date is reported)

    Enter the date, or the last date of a consecutive date range for the service provided in MDDCCYY.

    Place of Service
    (X12: Loop 2400, SV105)

    Select from the drop down, the place the service, if different than the place of service reported on the claim information screen.

    Procedure Code
    (X12: Loop 2400, SV101-2)

    Enter the CPT code identifying the product or service for this service line.

    Refer to the Billing section under IEP Procedure Codes, Modifiers and Units.

    Procedure Code Modifier(s)
    (X12: Loop 2400, SV101-3, SV101-4, SV101-5, SV101-6)

    Enter the Procedure Code Modifier(s) that identifies the product or service.

    Refer to the Billing section under IEP Procedure Codes, Modifiers and Units.

    Diagnosis Pointer
    (X12: Loop 2400, SV107-1, SV107-2, SV107-3, and SV107-4)

    Displays the diagnosis code that was reported on the Claim Information screen.

    Verify that the diagnosis code is displayed.

    Line Item Charge Amount
    (X12: Loop 2400, SV102)

    Enter the total charge for the service line.

    Service Unit Count
    (X12: Loop 2400, SV104)

    Enter the number of units provided for this service line.

    Other Payer
    This collapsed accordion screen is not needed for IEP Service.

    Situational Services
    This collapsed accordion screen is not needed for IEP Services unless primary insurance makes payment

    Situational Ambulance Information
    This collapsed accordion screen is not needed for IEP Service.

    Other Providers
    This collapsed accordion screen is not needed for IEP Services.

    Section Action Button

    Select one of the following:

  • Save/ View Line(s): to save the line item if only one line item is entered or if not using the Copy or Add action button for the next line.
  • Copy: to save and copy the service line information that was just entered so that you can make changes to the copied service line.
  • Delete: to remove the service line information that is displayed.
  • Add: to add a new service line to the claim. A new service line will display for you to enter new information for your next service line.
  • Section Action Button

    Select Save once all entries are complete.

    Each time you select save/view line, a summary table will display providing a summary for each line, showing:

  • • Line number
  • • From and to Date
  • • Procedure Code
  • • Modifier
  • • Charge
  • • Units
  • Select the Edit button next to the line item if changes are needed to that service line.

    Select Add below the service line summary table to add additional service line(s).

    Screen Action Button

    Select:

    Back to go back to the previous screen

    Cancel to cancel the claim entry

    Validate to determine if the claim has met the HIPAA-compliant and certain basic requirements at both the claim and line level information.

    Submit to submit the claim for adjudication. The submit response will identify if the claim will be paid, denied or suspended for review at the claim level and the line level of the claim.

    Use the Washington Publishing Company (WPC) health care codes lists to identify the claim status category and claim status codes displayed on the claim response

    Copy, Replace or Void the Claim

    After submitting the claim and receiving a claim response, an option to Copy, Replace, or Void the claim is available. Use each of these features to do the following:
    Copy
    - To correct an error of a denied claim or to copy information from other similar claims previously submitted
    Replace
    - If the claim paid, but paid incorrectly or a line item was denied. The user may access the claim, correct the information and resubmit. The original paid amount will be taken back and replaced with the correct information on the replacement claim
    Void
    - If the claim was submitted in error. This deletes the claim and takes the payment back

    Review the Copy, Replace or Void User Guide for step-by-step instructions when completing these transactions.

    Rate/Report this pageReport/Rate this page

    © 2017 Minnesota Department of Human Services Updated: 10/27/15 2:51 PM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 10/27/15 2:51 PM