Provider Manual Table of Contents

Revised: March 20, 2024
Revision(s): Added Targeted Case Management. Removed CW-TCM and Relocation Service Coordination—Targeted Case Management (RSC—TCM).

Member Evidence of Coverage (EOC) Latest revisions to this Manual Coronavirus (COVID-19)
Provider Basics
Provider Requirements · Access Services · Billing Organizations/Responsibilities · Enroll with MHCP · Excluded Provider Lists · Provider Participation Requirements - Rule 101 · Provider Screening Requirements · Risk Levels and Enrollment Verification Requirements
Health Care Programs and Services · Emergency Medical Assistance (EMA) · EMA Sample Scenarios · End Stage Renal Disease (ESRD) · Kidney Transplant Services · MHCP Benefits at-a-glance
Managed Care Organizations (MCOs)
Billing Policy (Overview) · Billing the Member (Recipient) · Medicare and Other Insurance · Minnesota-defined U Modifiers · Out of State Providers · Paper Claim Submission Policies · Payment Methodology - Hospital · Payment Methodology - Non-Hospital · Supplemental Payments – Non-Hospital and Hospital
Authorization · Drug Authorizations · MHCP Pharmacy Quick Reference
Acupuncture Services
Ambulatory Surgical Services
Anesthesia Services
Behavioral Health Home Services Certified Community Behavioral Health Clinic (CCBHC)
Child and Teen Checkups (C&TC) · Abbreviations and Acronyms · C&TC Health Insurance Portability and Accountability Act (HIPAA) Referral Coding Information · Helpful Website Links
Chiropractic Services
Clinic Services · Federally Qualified Health Center and Rural Health Clinics · FQHC and RHC Global Encounters for MCO Enrollees – Examples
Community Emergency Medical Technician (CEMT) Services
Community Health Worker
Community Paramedic Services
Day Training & Habilitation (DT&H)
Dental Services · Adult Prophylaxis Criteria (PDF) · Advanced Dental Therapist (ADT) · Allied Oral Dental Health Professional (Overview) · Authorization Requirement Tables for Children and Pregnant Women · Authorization Requirement Tables for Non Pregnant Adults · Collaborative Practice Dental Hygienists (was Limited Authorization Dental Hygienists) · Critical Access Dental Payment Program · Dental Benefits for Children and Pregnant Women · Dental Benefits for Non-Pregnant Adults · Dental Therapist (DT) · Non-Dental Health Providers
Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit · Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit Billing Grid (PDF) · EIDBI) Managed Care Organization (MCO) Contact Information Grid (PDF)
Elderly Waiver and Alternative Care Program (EW and AC) · Specialized Supplies & Equipment Authorization & Billing Responsibilities
Equipment and Supplies · Airway Clearance Devices · Allergen-Reducing Products for Children · Ambulatory Assist Equipment · Apnea Monitors · Bath and Toilet Equipment · Bone Growth Stimulators · Diabetic Equipment and Supplies · Electrical Stimulation Devices · External Defibrillators · Gloves · Hospital Beds · Humanitarian Use Devices · Incontinence Products · Lower Limb Prosthetics · Mobility Devices · Nebulizers · Non-Mobility Equipment Repairs · Nutritional Products and Related Supplies	Equipment and Supplies (continued) · Orthopedic and Therapeutic Footwear · Orthotics · Oximeters · Oxygen Contract Regions and Price Schedule (PDF) · Oxygen Equipment · Patient Lifts and Seat Lift Mechanisms · Pneumatic Compression Devices · Positioning Equipment · Positive Airway Pressure for Treatment of Obstructive Sleep Apnea · Pressure Reducing Support Surfaces · Respiratory Equipment · Robotic Arms · Seasonal Affective Disorder (SAD) Lights · Specialized Wound Treatment Technology · Spirometers · Standers · Transcutaneous Electrical Nerve Stimulator (TENS) · Transfer and Mobility Device (TRAM) · Ultraviolet Light Therapy Systems · Urological and Bowel Supplies
Essential Community Supports (ECS)
HCBS Waiver Services · Billing for Waiver and Alternative Care (AC) Program · Training Requirements · Void (“Take-Back”) Waiver and Alternative Care (AC) Service Claims
Hearing Aid Services · Bone-Anchored Hearing Aids (BAHA) · Cochlear Implants · Hearing Aid Services Codes Table
Home Care Services · Home Care Nursing (HCN) Services · Home Health Aide Services · Rehabilitation Therapy Services · Skilled Nurse Visits (SNV) Services
Hospice Services
Hospital Services · Critical Access Hospital (CAH) Services · Hospital In-reach Service Coordination (IRSC) · Inpatient Hospital Authorization · Inpatient Hospitalization for Detoxification Guidelines · Inpatient Hospital Services · Outpatient Hospital Services
Housing Stabilization Services Housing Support Supplemental Services
Immunizations & Vaccinations · Immunization and Vaccine Benefits Codes for Children · Immunization and Vaccine Benefits Codes for Adults
Individualized Education Program (IEP) Services
Intermediate Care Facilities (ICF/DDs)
Lab/Pathology, Radiology & Diagnostic Services · Authorization Criteria: Cardiac Magnetic Resonance Imaging of the Coronary Arteries · Coverage Criteria: Computed Tomography Colonography · Laboratory/Pathology Services · Laboratory Authorization Code List · Radiology/Diagnostic Services
Medication Management Therapy Services
Mental Health Services · Adult and Children's Crisis Response Services · Adult Day Treatment · Adult Mental Health Targeted Case Management (AMH-TCM) and Children’s Mental Health Targeted Case Management (CMH-TCM) · Adult Rehabilitative Mental Health Services (ARMHS) · Adult Residential Crisis Stabilization Services (RCS) · Assertive Community Treatment (ACT) · Certified Family Peer Specialist · Certified Peer Specialist Services · Children’s Mental Health Clinical Care Consultation · Children’s Mental Health Residential Treatment · Children’s Therapeutic Services and Supports (CTSS) · Clinical Supervision of Outpatient Mental Health Services · CTSS Children's Day Treatment · Diagnostic Assessment · Dialectical Behavior Therapy Intensive Outpatient Program (DBT IOP) · Explanation of Findings · Family Psychoeducation · Functional Assessments · General MHCP Non-Enrollable Mental Health Provider Requirements · Health Behavior Assessment/Intervention · Inpatient Visits · Intensive Residential Treatment Services (IRTS) · Children's Intensive Behavioral Health Services · Level of Care Assessment · Mental Health Diagnostic Code Ranges · Mental Health Provider Travel Time · MHCP Professional Certification & Enrollment Requirements · Neuropsychological Services · Partial Hospitalization Program · Physician Consultation, Evaluation and Management · Psychiatric Consultations to Primary Care Providers · Psychiatric Residential Treatment Facility (PRTF) · Psychological Testing · Psychotherapy · Psychotherapy for Crisis · Telehealth Delivery of Mental Health Services · Youth Assertive Community Treatment (Youth ACT)/Intensive Rehabilitative Mental Health Services (IRMHS)
Moving Home Minnesota · Moving Home Minnesota Demonstration and Supplemental Services Table (PDF) · Moving Home Minnesota Supported Employment Services (MHM SES)
Nursing Facilities Officer-Involved Community-Based Care Coordination Services Optical Services
PCA Services · Individual PCA Enrollment Criteria
Pharmacy Services · 340B Drug Pricing Program · Compound Drugs · Drug Categories with Limited Coverage · Home Infusion Therapy · Long Term Care (LTC) · Medicare · Minnesota Covered Active Pharmaceutical Ingredient (API) and Excipient List · NCPDP Payer Sheets Guidelines · Pharmacy Early-Refill Overrides · Point of Sale Diabetic Testing Supply Program · Pro-DUR Conflict Codes · Quantity Dispensing Limits Table
Physician and Professional Services · Gender-Affirming Surgery · Transplant Authorization Code List · Health Care Homes (HCH)
Program HH (HIV/AIDS) Services · Program HH Dental Authorization Requirement Chart
Rehabilitation Services · Audiology Services Procedure Codes · Augmentative Communication Devices · Casting & Strapping Services/Supplies · Orthotic Procedures · Rehabilitative and Therapeutic Services Authorization Criteria · Rehabilitative Services Procedure Codes
Renal Dialysis · Renal Dialysis Billing
Reproductive Health/OB-GYN · Abortion Services · Breast and Cervical Cancer (BRCA) Genetic Testing and Presumptive Eligibility Services · Doula Services · Family Planning · Family Planning Codes with Increased Rates · Free-Standing Birth Center Services · Hysterectomy · ICD-9 to ICD-10 Diagnosis Conversion Table · Minnesota Family Planning Program (MFPP) · Minnesota Family Planning Program (MFPP) Procedure Codes · Obstetrics Services and HIV Counseling · Sterilization
School-Based Community Services (SBCS)
Screening, Brief Intervention, and Referral to Treatment (SBIRT)
Substance Use Disorder Services (SUD) · Substance Use Disorder (SUD) Withdrawal Management Services · Telehealth Delivery of Substance Use Disorder Services
Targeted Case Management
Transportation Services · Nonemergency Medical Transportation (NEMT) Services (Overview) · Access Services Ancillary to Transportation · Ambulance Transportation Services · Ancillary Services Claim and Rate Information for Counties and Tribes · Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Transportation Services · Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information · Protected Transportation Services · State-Administered NEMT · State-Administered Transportation Procedure Codes, Modifiers and Payment Rates
Tribal and Federal Indian Health Services