Paper Claim Submission Policies

Revised: December 26, 2018

MHCP accepts paper claims in limited circumstances from non-MHCP enrolled out-of-state providers. The provider must be currently enrolled with Medicare or another state Medicaid agency, and may only bill MHCP once prior to requiring screening and enrollment with MHCP. If MHCP screening and enrollment is required, the out-of-state provider must bill electronically through MN–ITS using either MN–ITS direct data entry User Guides or following x12 and Minnesota’s Uniform Companion Guides.

Refer to the following additional resources:

· MN–ITS User Guide

· Remittance Advice webpage to read the RA

All paper claims must be typed or computer printed. Use the following guidelines to complete paper claim forms:

· Use original claim forms (ADA; CMS-1500; UB-04). MHCP does not accept faxed, copied, or screen
printed invoices

· Use appropriate authorization request forms, as needed, completing all required information

· Do not write or mark outside the boxes

· Use only black ribbon or print

· Do not use bold, compressed, cubic, enlarged, italic, mixed or script typestyles or fonts. Capitalize all alpha characters

· Do not use symbols (#, $, &, @, !, %)

· Do not fold or staple paper claims

Claim Attachments

Review MHCP Attachment Criteria to determine if you need to submit an attachment with the claim. MHCP will deny claims with attachments that are unnecessary.

· Use clean 8 ½ x 11-inch paper

· Paperclip all pages together with the claim; do not use staples.

Address

Mail paper claims, including attachment, as appropriate, to:

Minnesota Department of Human Services
MHCP Claims Processing
PO Box 64993
St Paul, MN 55164-0993