MHCP Enrolled Providers

Enrollment

Minnesota Health Care Programs (MHCP) Provider Enrollment responds to provider and biller needs for DHS by:

  • • Enrolling health care providers so they can receive payment for serving MHCP recipients
  • • Verifying providers’ licensure
  • • Maintaining provider agreements and other legal arrangements
  • Jump to:

  • • MHCP Provider Requirements
  • • Get a Provider Identification Number
  • • Register for MN–ITS
  • • Screen Employees and Contractors
  • • MHCP Provider/Biller Enrollment Process
  • Enrollment Applications & Agreements
  • Contact Information

  • MHCP Provider Requirements

    To participate as an MHCP provider, you must meet professional, certification and/or licensure requirements according to state and federal laws and regulations. After an individual (e.g., physical therapist) or group provider (e.g., hospital) meets these requirements and applies to be an enrolled MHCP provider, MHCP sends you a Welcome Letter to confirm your enrollment.

    Get a Provider Identification Number

    National Provider Identifiers (NPIs) are the standard unique identifiers to use in submitting and processing health care claims and other transactions. If you are a provider eligible for an NPI, you must obtain your NPI number(s) from the National Plan and Provider Enumeration System (NPPES) before you enroll with MHCP.

    Some providers do not meet the federal definition of a health care provider under HIPAA and may not be eligible to receive an NPI. These providers include:

  • • Approved day treatment centers
  • Children’s residential services
  • Clearinghouses & billing intermediaries
  • Day training and habilitation
  • • Health care case coordinators
  • Home and community based services
  • Personal care provider organizations and individual PCAs
  • Transportation (non-medical)

  • If you are not eligible for an NPI and apply for enrollment, MHCP will assign you a 10-digit Unique Minnesota Provider Identifier (UMPI) and send you a Welcome Letter to confirm your enrollment.

    Your NPI/UMPI is required on all claims submitted to MHCP, and allows you to be paid for MHCP-covered services provided to eligible MHCP recipients.

  • • Refer to Provider Requirements of the MHCP Provider Manual for a list of providers eligible to enroll
  • • Refer to the appropriate service section in MHCP Provider Manual for licensure or certification requirements for your provider type
  • • Save time and increase the accuracy of your claims submissions by using the free, Web-based, HIPAA-compliant MN–ITS
  • • MHCP-enrolled providers can assign clearinghouses or billing intermediaries as their billing agents to submit claims and other transactions electronically to MHCP

  • Contact the managed care organization with which you contract for their enrollment requirements.

    Register for MN–ITS

    Minnesota law requires all persons or entities that provide health care services or supplies within Minnesota for a fee, and are eligible for MHCP reimbursement, to submit all claims electronically by July 15, 2009. By 7/15/09, providers and their affiliated clinics or billing services must register for MN–ITS. MHCP will not process paper claims starting 7/15/09. As a registered MN–ITS user, you can:

  • • Verify active provider enrollment status
  • Verify program eligibility for one or more MHCP recipients at one time
  • Submit authorization requests for medical or dental services or medical supplies
  • • Submit service agreement (SA) requests for home care services
  • • Retrieve your authorization and service agreement letters
  • Submit claims (including claims with third party insurance or Medicare)
  • • Copy previously submitted MN–ITS claims or replace incorrectly submitted paid claims
  • • Check a claim's paid or denied status
  • • Use the MN–ITS Mailbox to access information including Remittance Advices (RAs) and Provider Updates

  • Your MHCP enrollment Welcome Letter includes a MN–ITS initial User ID, Password and registration instructions.

    Screen Employees and Contractors

    MHCP cannot enroll and pay providers that are excluded from participation in Medicare, Medicaid or other federal health care programs. The Office of Inspector General (OIG) may impose civil monetary penalties against providers who employ or enter into contracts with excluded individuals or entities to provide services or items to recipients.

    OIG makes a List of Excluded Individuals/Entities (LEIE) available to the public. As enrolling or enrolled MHCP providers, you must make sure you, your company, owners, managers, employees and contractors are not on the list. Search LEIE by the individual’s or entity’s name:

  • • Before you enroll
  • • Before you hire new employees/enter into a contract with a contractor
  • • Monthly, to see changes since your last search

  • Report any new exclusions you find in your search to MHCP Provider Enrollment at fax (651) 431-7462. Use a cover sheet.

    Also see MHCP Provider Screening Requirements.

    MHCP Provider/Biller Enrollment Process

    Providers Located in Minnesota

    Minnesota providers are approved retroactively:

  • • To the first day of the month of application
  • • For up to 90 days to the effective date of Medicare certification of the provider
  • • To the date of the recipient's established retroactive MHCP eligibility

  • Complete, sign and return to MHCP the following forms:

  • MHCP Individual Practitioner - Provider Enrollment Application (DHS-4016)
  • MHCP Organization – Provider Enrollment Application (DHS-4016A)
  • Provider Agreement (DHS-4138) (which includes a statement of terms for MHCP participation)
  • Disclosure of Ownership and Control Interest Statement for Participating Providers (DHS-5259) (not for individuals)
  • Electronic Funds Transfer

  • Providers Located Outside of Minnesota

    Out-of-state providers may apply for MHCP enrollment for the date(s) of service to an MHCP recipient. To be eligible for payment under MHCP, an out-of-state provider must:

  • • Comply with the licensing and certification requirements of the state where the provider is located, except for home and community-based waiver services providers who must meet the licensing and certification requirements of Minnesota’s federally approved waiver plan
  • • Complete, sign and return the MHCP Provider Enrollment Application and Provider Agreement to MHCP

  • Billing Organizations

    Clearinghouses and billing intermediaries sending MHCP claims and other transactions on behalf of enrolled providers must:

  • • Enroll with DHS as a billing organization
  • Submit a list (DHS-4087) of MHCP-enrolled providers for whom they bill
  • • Notify MHCP of any changes to this list
  • • Register for the Web-based MN–ITS. (Provider/biller enrollment and MN–ITS registration are two separate processes)
  • • Ensure that every provider for whom claims are submitted is also registered for MN–ITS
  • • Bill MHCP electronically via MN–ITS

  • Enrollment Applications and Agreements

    Use standard enrollment application and related documents for all providers:

  • MHCP Individual Practitioner – Provider Enrollment Application (DHS-4016)
  • MHCP Organization – Provider Enrollment Application (DHS-4016A)
  • MHCP Provider Agreement (DHS-4138)
  • Disclosure of Ownership and Control Interest Statement for Participating Providers (DHS-5259) (not for individuals)
  • Electronic Funds Transfer
  • MHCP Data Privacy Notice (DHS-6287)

  • The following providers must also complete additional forms:

  • Child & Teen Checkups (C&TC) Providers
  • Consolidated Chemical Dependency Treatment Fund Providers
  • Clearinghouses or Billing Intermediaries
  • Equipment and Supplies
  • Health Care Case Coordinators
  • Home and Community-Based Services Providers (Waiver Services)
  • IEP, Independent School Districts (ISD), Regional Cooperatives and Charter Schools
  • Individual PCA Providers
  • Intermediate Care Facility for Developmentally Disabled
  • Managed Care Organizations
  • Medication Therapy Management Services (MTMS) Providers
  • Nursing Home Providers
  • Personal Care Provider Organizations and PCA Choice Providers
  • All other provider types

  • Notify MHCP Provider enrollment in writing of any changes to your enrollment application. Use one of the following forms:

  • Individual Practitioner MHCP Provider Profile Change Form (DHS-3535)
  • Organization MHCP Provider Profile Change Form (DHS-3535A)

  • MHCP sends enrollment status letters to providers, including when changes in provider participation occur (such as when providers expand or reduce the services they provide).

    Contact Information

    Fax completed forms to: 651-431-7462

    For more information, refer to Provider Requirements of the MHCP Provider Manual or contact us.

    Legal References

  • 42 CFR 1001.1901(b) Effect of exclusion on excluded individuals and entities
  • 42 U.S.C. 1320 C-5 and 1320a-7 Review of Utilization and Quality of Health Care Services and Exclusion of certain individuals and entities from participation in Medicare and State health care programs
  • 42 CFR 1003.102(a)(2) Basis for civil money penalties and assessments
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