Enrollment Record Request

Revised: August 30, 2023

Overview

Within your portfolio, you can have many different enrollment records. Your enrollment records are specific to practice locations and the types of services you provide at that location. Your enrollment records may each have a different National Provider Identifier (NPI), but all your enrollment records within one portfolio share the same Social Security number (SSN) or Federal Employer Identification Number (FEIN).

Examples

Organizations: If you have five different practice locations and use the same FEIN for each location, you will have five enrollment records within your portfolio.

If you have five different provider types, you will have five different enrollment records.

If you have any enrollment records that use a different FEIN or SSN, you will need to register a separate organization in MPSE.

Individuals: If you have the credentials to be both a dentist and a physician and want to enroll with Minnesota Health Care Programs (MHCP) as both, you will have two enrollment records, one for each of the types of services you provide.

An enrollment record in the MPSE portal consists of the information in the enrollment record list on this page. You can modify the information in your enrollment records or add new enrollment records by submitting an enrollment record request.

Steps to Create an Enrollment Record Request

1. Click on the Create a New Request button on the Manage Portfolio page of the MPSE portal.

2. Select Enrollment Record Request.

3. Enter a Request Effective Date. The Request Effective Date is the date you want Minnesota Health Care Programs to consider your request effective. Note that not all dates entered in the Request Effective Date field can be accommodated. Some service effective dates have specific requirements.

4. Click Continue.

5. You will be brought to the Manage Enrollment Record page. On this page, you have three options:

· If you need to add a new enrollment record, click Add a New Enrollment Record at the bottom of the page. Then, follow the steps to Add a New Enrollment Record.

· If you need to end an enrollment record, follow the steps on the Enrollment Record Information page.

· If you need to update an enrollment record, select the enrollment record that needs updating by clicking Edit in the appropriate row. Then, use the following links to update specific pages when making an enrollment record request.

· Enrollment Record Information – General information about the enrollment record including phone number, electronic fund transfer information, remittance advice settings, and tribal affiliations. Providers can also request voluntary termination of an enrollment record here.

· Addresses – Addresses for credentialing, physical location, and mailing

· Provider Identifier – NPI or Unique Minnesota Provider Identifier (UMPI) number

· Services – Services provided at this location

· Credentials – Licensure, MHCP forms, and other credentials

· Fees – Fee payment information for initial enrollment, revalidation, and reinstatement

· Site Visits – Site visits performed by State of Minnesota, another State, or Medicare

· Agreements and Addendums – Provider agreements

Notes on Making Enrollment Record Requests:

· Only one enrollment record request per location with a request status of Draft or Pending Review can be made at a time.

· Use the Help link in the top-right corner of the MPSE portal page for help with defining specific fields and requirements for the MPSE portal page you are in.

Screenshot of MPSE Help link