Submit an Authorization Request for Medical Services

Posted: August 25, 2022

Some MHCP services require authorization. Do not send authorization requests for services that do not require authorization. For authorization criteria and documentation requirements refer to Authorization section of the MHCP Provider Manual.

Using MN–ITS Interactive

1. Complete all bolded and asterisked (required) fields. Field titles with an asterisk (*) indicate that the information is mandatory. Some fields are grouped together in boxes of associated information. If you complete one asterisked field within the boxed section of a screen, you must complete all asterisked field in that section.

2. Complete other nonbolded or nonasterisked fields appropriate for your request.

3. Underlined items are linked to definitions and additional information about that item, including information about completing a field, code definitions for fields, or instructional information.

Submitting an authorization request

1. Login to MN–ITS

2. Select MN–ITS from the left-hand menu

3. Select Authorization Request (278)

Completing the Authorization Tab

Authorization Category

Service Type Code: Select Medical from the drop-down menu.

Requester

1. Request ID (NPI/UMPI): The organization or last name, first name, street address, city/town, state and ZIP code will auto-populate based on the NPI or UMPI you used to login with. (The NPI/UMPI field identifies the individual party or organization that is requesting the service or item.)

2. Communication Number: Enter the telephone, fax, (including the area code) or email at which your contact can be reached. Click on the A button to add the communication type. If you need to add another communication number, click the A button.

3. Contact Name: Enter the first and last name of a contact person within your organization who can answer questions about this authorization request. If you need to add another contact name, click the A button.

Subscriber

1. Subscribers ID: Enter the subscriber’s (member’s) 8-digit number from the subscriber’s (member’s) MHCP ID card.

2. Birth Date: Enter the 2-digit month, 2-digit day, and 4-digit year (MMDDYYY) format. The birth date must match the birth date on the MHCP file.

3. Last Name: Enter the subscriber’s (member’s) last name.

4. First Name: Enter the subscriber’s (member’s) first name.

Patient Event

1. Certification Type Code: Indicates what type of request. Select the appropriate CT code.

2. Diagnosis Code: Enter the appropriate diagnosis code. Click the A button to add the diagnosis code. If you need to add another diagnosis code, click the A button.

Completing the Services Tab

Services Information

1. Begin Date: Enter the date that you would like to begin providing services using MMDDYYY date format.

2. End Date: Enter the date when you will complete these services in MMDDYYYY date format. You may leave this field blank if you are not sure of the end date.

3. Procedure Code: Enter the appropriate procedure code.

4. Modifiers: Enter modifiers in this field when necessary.

5. Quantity: Enter the number of units you are requesting.

6. Line Amount: Enter the total dollar amount (your usual and customary charge) you are billing for.

7. Service Description: Enter a description of the service to be provided in the field, if needed. Note: This field has

a 264-character limit. You will not be able to enter any more text in this field after the limit is reached.

Services Setup

1. Scroll up to this heading and click the Save button to save the line item you just entered.

2. To add additional lines, click the New button and add an additional line item and clear the fields on the screen.

3. To delete a line, select the line, then click the Delete button.

4. Repeat the steps until all line items are entered.

Submitting your Authorization Request for review

Click the Submit button. You will receive a response within seconds

If your response states:	Then:
Transaction submitted successfully This request has been received for review by DHS.	Print the response page, keep a copy for your records and one to attach to the required documentation. Write the 11-digit number assigned on each page of your documentation, and the same 11-digit number on all supporting clinical documentation pages that you will be mailing or faxing to Kepro. Mail or fax all required supporting clinical documentation together to the to assure accurate processing Kepro Attention MN Medicaid 6802 Paragon Place, Suite 440 Richmond, VA 23230 Fax: 866-889-6512
This request is incomplete or invalid. The claim status codes below will provide additional information:	Refer to the Claim Status Codes available on the X12 website
Note: If after completing the Services Tab you receive the error message: “Denied incorrect payer,” verify eligibility using the MN–ITS to confirm the subscriber (member) is not enrolled with a managed care organization (MCO):	If the subscriber (member) is enrolled in an MCO, contact the MCO. If the subscriber (member) is not enrolled in an MCO, contact the MHCP Provider Resource Center and verify the effective date of the MCO coverage. For services completed before the effective date of MCO coverage, use the actual date of service or a date before the MCO effective date.

You will receive the final Authorization Letter in your MN–ITS Mailbox Miscellaneous Received file type: PAL after your Authorization Request is approved or denied.