MCO Provider Reinstatement

Posted: December 2, 2021

Overview

Use this page to reinstate the enrollment information for inactive individual or organization providers. Managed Care Organizations (MCOs) are required to verify the providers listed on encounter claims are in one of the following active enrollment statuses:

1 – Active

2 – Active, Reinstated

3 – Active, Do-Not-Pay

4 – Active, MCO Network Provider Only – not active for fee-for-service (FFS) – not enrolled in Minnesota Health Care Programs (MHCP)

Once Provider Eligibility and Compliance reviews and approves the MCO provider reinstatement request, you will be able to view the provider’s account through your MN–ITS account. We may request more information, clarification, or corrections prior to reinstating the MCO organization or individual as an MHCP Provider.

· Steps to reinstate an organization provider

· Steps to reinstate an individual provider

Steps to reinstate an organization provider:

Step 1 Log in to MN-ITS with your MCO username.

Step 2 Click the link for the Minnesota Provider Screening and Enrollment (MPSE) portal in the left-side navigation. (If you do not see the link, contact your MN-ITS administrator.) This brings you to the MCO Home page.

Step 3 Click Search for MHCP Provider.

Step 4 On the MHCP Provider Search page, type your search criteria in the Search Criteria section. The organization provider’s National Provider Identifier (NPI), Unique Minnesota Provider Identifier (UMPI), Social Security Number (SSN) or Legal Name are required to complete a search for an organization.

Step 5 Click Search and follow the steps related to your situation in the next steps.

Step 6 If MPSE shows no results for your search and you only need to register the new provider, follow the steps for MCO Provider Registration.

Step 7 If MPSE shows results for your search and you need to reinstate the organization provider’s enrollment information, click Reinstate.

Step 8 Complete the Request Information section on this Provider Enrollment Request Information page. Some sections will display a default response due to the information you used to search for the provider.

8.1 Type the Legal Name.

8.2 The Federal Employer Identification Number (FEIN) is defaulted.

8.3 The Enrollment Record Type is defaulted.

8.4 Update and complete the address for the organization.

8.4.1 Type the Street Address 1.

8.4.2 Type the Street Address 2 Type / Data.

8.4.3 Type the City.

8.4.4 Select the State.

8.4.5 Type the Zip Code.

8.4.6 Select the County or Tribe.

8.5 The NPI/UMPI is set as the default.

8.6 Update and type the 10-digit phone number in the Phone Number box.

8.7 Type the provider’s 10-digit fax number in the format 999-999-9999 in the Fax Number box. Providing a fax number is optional.

8.8 Type the effective date of the MCO reinstatement request in the Request Effective Date box.

8.9 Click Submit.

8.10 Click Continue on the Submission Approval Page.

Steps to reinstate an individual provider:

Step 1 Log in to MN-ITS with your MCO username.

Step 2 Click the link for the Minnesota Provider Screening and Enrollment (MPSE) portal in the left-side navigation. (If you do not see the link, contact your MN-ITS administrator.) This brings you to the MCO Home page.

Step 3 Click Search for MHCP Provider.

Step 4 On the MHCP Provider Search page, type your search criteria in the Search Criteria section. The individual provider’s National Provider Identifier (NPI), Unique Minnesota Provider Identifier (UMPI), Social Security Number (SSN) or individual provider Name are required to complete a search for an individual.

Step 5 Click Search and follow the steps related to your situation in the next steps.

Step 6 If MPSE shows no results for your search and you only need to register the new provider, follow the steps for MCO Provider Registration.

Step 7 If MPSE shows results for your search and you need to reinstate the individual provider’s enrollment information, click Reinstate.

Step 8 Complete the Request Information section on this Provider Enrollment Request Information page. Some sections will display a default response due to the information you used to search for the provider.

8.1 Type the First Name, Middle Name (if no middle name please select the indicator box) and Last Name.

8.2 The Date of Birth is defaulted.

8.3 The Social Security Number (SSN) is defaulted.

8.4 The Enrollment Record Type is defaulted.

8.5 Update and complete the address for the individual.

8.5.1 Type the Street Address 1.

8.5.2 Type the Street Address 2 Type / Data.

8.5.3 Type the City.

8.5.4 Select the State.

8.5.5 Type the Zip Code.

8.5.6 Select the County or Tribe.

8.6 The NPI/UMPI is defaulted.

8.7 Update and type the 10-digit phone number in the Phone Number box.

8.8 Type the provider’s 10-digit fax number in the format 999-999-9999 in the Fax Number box. Providing a fax number is optional.

8.9 Type the effective date of the MCO reinstatement request in the Request Effective Date box.

8.10 Click Submit.

8.11 Click Continue on the Submission Approval Page.