Work with provider data

Page posted: 8/3/26

This page includes information about:

· Provider file application overview.

· How to access the provider subsystem.

· Provider enrollment.

· How to create a provider type 23 and 27 record.

· How to change certified assessor, case manager and care coordinator information.

Provider file application overview

The provider file application in MMIS (also called the provider subsystem) collects and stores comprehensive information about all enrolled providers. The provider information maintained in the subsystem supports:

· Service authorization.

· Claims processing.

· Management reporting.

· Surveillance and utilization review functions.

How to access the provider subsystem

Most MMIS users can only use inquiry mode on screens within the provider subsystem. There are several ways to access and review provider information in MMIS.

Use the F4 key

Screening document

To use F4 to navigate to the provider subsystem from a screening document:

1. Move the cursor to the numbers within the CMHP/CA NBR field on the ALT1 screen.

2. Press F4 to open the PSUM (provider summary) screen in the provider subsystem.

3. Press the transmit key to move to the PADD screen, which shows agency and contact information for the case manager, care coordinator or certified assessor.

4. Press F3 or F6 to return to the screening document.

Service agreement

To use F4 to navigate to the provider subsystem from a service agreement:

1. Move the cursor to the numbers within either of the following:

· The CM NBR field on the ASA1 screen.

· The PROV NBR field on any line item on the ASA3 screen(s).

2. Press F4 to open the PSUM screen in the provider subsystem. The PSUM screen includes that provider's specialty and categories of service (COS) information, in addition to their enrollment status.

3. Press the transmit key to move to the PADD screen, which shows:

· Contact information for the case manager or provider.

· Enrollment status and enrollment history of the case manager or provider.

4. Press the transmit key to move to the PPGM screen, which shows additional specialty codes and major program enrollment spans.

5. Press the transmit key to move to the PCOS screen, which shows additional COS history.

6. Press the transmit key to move to the PLIC screen, which shows the license and certification data associated with the provider.

7. Press F3 or F6 to return to the service agreement.

Use the F5 key

To use F5 to look up a provider from a screening document or service agreement:

1. Press F5 with your cursor anywhere in the screening document or service agreement to open a screen that allows you to search for a provider or person.

2. Enter either:

· A provider’s name at the top section of the screen to use the provider name lookup feature.

· A person’s name at the bottom section of the screen to use the recipient name lookup feature.

3. Press F4 to view either:

· A provider selection screen with any providers that match or closely match the information you entered in the provider name lookup section.

· A recipient selection screen to view any people who match or closely match the information you entered in the recipient name lookup section.

4. If there are more providers or people matching the search criteria than can be listed on one screen, you will see a +/- sign at the bottom right corner. Take the following actions:

· Press F8 to move forward through the list.

· Press F7 to move backward through the list.

· Press the tab key to move to the line containing the provider or person of interest and type X to select them.

5. Press the transmit key to open that provider’s enrollment record to the PSUM screen or the recipient summary RSUM screen.

6. Press F3 or F6 to return to the search result screen or to the screening document or service agreement. You might have to press F3 or F6 more than once.
Note: Do not press F6 too many times. If you do, you will exit without saving the screening document or service agreement and have to start over.

Use the main menu

You can enter the provider subsystem from the main menu. Session 16a in the MMIS training explains how to navigate directly to the provider subsystem from the MMIS main menu screen. This training session includes a review of several provider screens that can cause exception codes to appear on the service agreement. For training information, refer to the HCBS training section of DHS – Aging and Adult Services training and webinars.

Provider enrollment

The provider subsystem supports the processing of online provider enrollment applications and provider changes. For additional information about provider enrollment, refer to DHS – Enroll with MHCP.

Provider enrollment for home and community-based services (HCBS)

For specific enrollment instructions, refer to MHCP Provider Manual – HCBS waiver services and MHCP Provider Manual – HCBS programs provider enrollment.

For information about HCBS services, including COS, related specialty codes, available services and provider qualifications, refer to HCBS Programs Service Request, DHS-6638 (PDF).

Provider type

Each provider has a provider type classification and code in MMIS. A single provider type may be eligible and qualified to provide multiple types or categories of services. Provider types have a code in MMIS. For a list of provider types, refer to MHCP Provider Manual – Risk levels and enrollment verification requirements.

Categories of service (COS)

In addition to provider type, providers enroll to provide certain COS. All enrolled provider records include the COS codes that indicate the services they are qualified and enrolled to provide.

Provider type and COS codes control which provider and service(s) you can include on HCBS service agreements.

Exception codes (i.e., edits) 120, 125, 241, 275, 286, 410 and 412 are related to provider type or COS information in a provider's record. MMIS can post these exception codes on a service agreement if information is missing, incompatible or outdated. For information about how to resolve these exception codes, refer to MMIS LTSS Manual – Service agreement exception codes.

Provider enrollment for certified assessors, case managers and care coordinators

Every lead agency certified assessor, case manager or care coordinator who enters screening documents and service agreements or bills for case management and/or case aide services must enroll with MHCP and have a national provider number (NPI) or unique Minnesota provider identifier (UMPI). They must enroll before they can get access to MMIS or be included on services agreements for purposes of claims payment for case management or case aide services.

The NPI or UMPI identifies the certified assessor, case manager or care coordinator managing the person’s HCBS eligibility and/or support plan.

The LTC screening document shows the case manager, care coordinator or certified assessor NPI or UMPI in the CM/HP/CA number field on the ALT1 screen.

The service agreement shows the case manager NPI or UMPI in the CM NBR field on the ASA1 screen. It also shows the case manager and/or case aide NPI or UMPI on the ASA3 screens at the PROV NBR field on the line items for case management services.

If a case manager contracts with several lead agencies, they will have an NPI or UMPI and provider record for each lead agency.

Information for county/Tribal Nation staff

County/Tribal Nation staff with the appropriate MMIS security access can enter information on the PADD screen of the provider subsystem to enroll a case manager/case aide and obtain a new case manager nine-digit NPI or UMPI under provider type 23. The county/Tribal Nation staff must change the status from "pend" to "active - no pay" before the case manager/case aide can be included on the screening document or service agreement. The effective date entered in the enrollment record should be the date the case manager/case aide is approved to provide case management or other activities.

Information for managed care organization (MCO) staff

Staff contracted with or employed by MCOs to provide case management, care coordination or certified assessor activities recorded in MMIS enroll using provider type 27. They have one provider number 27, even if they contract with more than one MCO. If a county/Tribal Nation worker is also an MCO delegate for assessment, case management or care coordination, they must also enroll as provider type 27, in addition to their provider number type 23 enrollment as a county/Tribal Nation certified assessor/case manager.

How to create a provider type 23 and 27 record

To create a provider type 23 or 27 record:

1. Select PROVIDER FILE APPLICATION from the MMIS main menu.

2. Enter A in the ACTION CODE field on the PKEY (provider key panel) screen.

3. Enter the following information on the PADD screen:

· PROV TY is the provider type, which is either 23 or 27.

· SSN is the Social Security Number, which is a required field. This is a federal requirement. The SSN field is not viewable by anyone except DHS Provider Enrollment staff, as needed. It is used for numerical comparison only.

· NAME is the case manager's first name, middle initial and last name.

· PRAC ADDRESS is the business name (e.g., Minnesota Co Human Services).

· CORR DATE RECD is the request date, if required.

· PRAC ADDRESS (1) is the street address. This must be the physical address and cannot be a P.O. box.

· TEL is the case manager's business phone number with area code but no dashes between the numbers.
Note: It is important to keep this field updated. MMIS will add this phone number to the recipient and provider service agreement letters and any other documents as needed.

· CNTY is the county code number preceded by a zero (i.e., three digits total). It is the county where the PRAC ADDRESS is located.

· TYPE PRAC is the type of practice field. Enter 01 for individual.

· FAX is the fax number that is accessible and used by the case manager/care coordinator/certified assessor.

· APP DT is today's date.

· SORT NAME is the case manager's name, entered with the last name first (phone-book style), with no punctuation.

4. Activate the provider number:

· Provider type 23: Note the pending status. Change the provider type 23 number to status 3 to activate the NPI or UMPI number. You also can email dhs_mhcp_provider_enrollment@state.mn.us to request activation. Include the provider number, full name, agency name and provider type.

· Provider type 27: You can email dhs_mhcp_provider_enrollment@state.mn.us to request activation. Include the provider number, full name, agency name and provider type. Alternatively, you can wait for DHS Provider Enrollment to receive a daily report showing new provider entries. They will activate the record. Until the number is active, you cannot use the care coordinator number type 27 on the screening document or for receiving reports in their MN–ITS mailboxes.

5. Press F3 to save your entry. If you are adding a duplicate person to the same agency who already has a provider type 23 or 27 number, you will see the following message when you press F3: “Duplicate SSN found on Provider File. Provider = XXXXXXX 00.” Check the number to verify that it is not a duplicate.

Tip: When completing enrollment, you will see the following message: “Date of birth is required.” It is not required for these provider types. Press F3 to advance past the message.

You can also request a new provider number for provider type 27 by completing Health Care Case Coordinator – Provider Enrollment Application, DHS-4474 (PDF) and faxing it to 651-431-7462.

If a case manager (provider type 23) works for more than one lead agency, they can have more than one provider number.

How to change certified assessor, case manager or care coordinator information

It is important to keep the case manager information current. The service agreement letters to the person and provider(s) contain the name and phone number of the case manager listed on the PADD screen.

Changes to provider type 23

If a certified assessor or case manager/case aide leaves the agency, you can terminate their provider number at ENROLLMENT STATUS on the PADD screen by adding a new span for one of the following statuses with the effective date:

· H: Deceased.

· J: Voluntary.

You also can email dhs_mhcp_provider_enrollment@state.mn.us to request this termination type and date to the provider type 23 record. Include the NPI or UMPI number, full name, agency name, termination date and provider type.

If a certified assessor or case manager/case aide (provider type 23) changes agencies, they must obtain a different number for the new agency. The old agency terminates the old number. If the certified assessor/case manager/case aide leaves one agency, then later returns to the same agency, the old agency can reactivate their original provider number by updating the enrollment record and changing the status. For more information, ask your MMIS security liaison.

If a certified assessor/case manager/case aide changes their name, you must change the name and sort fields.

Changes to provider type 27

If you need to change a provider type 27 record, you can:

· Call the MHCP Provider Resource Center at 1-800-366-5411.

· Email dhs_mhcp_provider_enrollment@state.mn.us and include the NPI or UMPI number, full name, agency name, termination date and provider type.

Additional resources

DHS – Aging and Adult Services training and webinars
DHS – Enroll with MHCP
HCBS Programs Service Request, DHS-6638 (PDF)
Health Care Case Coordinator – Provider Enrollment Application, DHS-4474 (PDF)
MHCP Provider Manual – HCBS programs provider enrollment
MHCP Provider Manual – HCBS waiver services
MHCP Provider Manual – Risk levels and enrollment verification requirements
MMIS LTSS Manual – Service agreement exception codes