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MN–ITS User Manual

MN–ITS User Manual

Submit an Authorization Request (278) for CT and MRI Imaging Services

Revised: June 22, 2022

MN–ITS Authorization Request (278) will give providers an immediate approved authorization response for certain imaging services. This function is limited to providers when the ordering or referring provider is affiliated with MHCP–enrolled organizations that utilize a clinical decision support tool or identify when the age, diagnosis and medical history coverage criteria are met.

Providers will be prompted to answer specific coverage criteria questions when the ordering or referring provider is not affiliated or did not use the clinical decision support tool and may receive an immediate approved authorization response if criteria for the procedure are met.

Using MN–ITS Authorization (278) allows a more timely and cost-efficient process for scheduling procedures which may produce better health outcomes for the member. Refer to the Authorization Requirements in the Radiology/Diagnostic Services manual page for authorization criteria and documentation requirements.

Using MN–ITS Interactive

  • · Complete all bolded and asterisked (required) fields
  • · Complete other (nonbolded, situational) fields appropriate for your request
  • · 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
  • · 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 a boxed section of a screen, you must complete all asterisked fields in that section of the screen

    • Submitting an Authorization Request

  • 1. Log in to MN–ITS
  • 2. Select MN–ITS from the left-hand menu.
  • 3. Select Authorization Request (278). The MN–ITS Authorization Request contains two tabs:

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    Completing the Authorization Tab

    Authorization Category

    Select the appropriate Service Type Code from the drop-down menu.

    Requester

    The provider’s name, street address, city/town, state and ZIP code will auto-populate based on the NPI used to log in. To indicate a different NPI, enter a new NPI in the Requester ID NPI/UMPI field and the system will auto-populate with the new provider’s information. You must enter a Contact Name and Communication Number to be able to submit an authorization request.

    If the requester information does not auto-populate, complete the following steps.

  • 1. Enter the NPI/UMPI of the rendering provider in the Request ID NPI/UMPI field.
  • 2. Enter the last name of the rendering provider in the Organization or Last field.
  • 3. Enter the street address where your facility is located in the Address field.
  • 4. Enter the city/town where your facility is located in the City field.
  • 5. Enter the state where the facility is located in the State field.
  • 6. Enter your facility’s ZIP code in the ZIP code field.
  • 7. Enter the first and last name of a contact within your organization who can answer questions about this request in the Contact Name field.
  • 8. Enter the area code and phone number at which your contact can be reached at in the Communication Number field.
  • 9. Select the Communication Type from the drop down field.
  • 10. Select the A button to add the communication number.

    • Subscriber

  • 1. Enter the member’s last name in the Last Name field.
  • 2. Enter the 8-digit member number from the subscriber’s (member’s) MHCP member ID card in the Subscriber ID field.
  • 3. Enter the subscriber’s (member’s) first name in the First Name field.
  • 4. Enter the subscriber’s (member’s) birth date in the Birth Date field in 2-digit month, 2-digit day, and 4-digit year (MMDDYYYY) format. The birth date must match the birth date on the MHCP file.

    • Patient Event

  • 1. The Certification Type Code field identifies the type of request. The default response is I for initial request that indicates this is an original request. The user can select a different identifier by clicking the arrow at the end of the field.
  • 2. Enter the primary ICD-CM-10 diagnosis code in the Diagnosis Code field.
  • 3. Select the A button to add the diagnosis code.

    • Completing the Services Tab

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    Service Information

  • 1. Enter the date that you would like to begin providing services in the Begin Date field in MMDDYYYY format.
  • 2. Enter the date that you will complete these services in the End Date field in MMDDYYYY format.
  • 3. Enter the appropriate code in the Procedure Code field.
  • 4. Enter modifiers when necessary in the Modifiers field.
  • 5. Enter the number of units you are requesting in the Quantity field.
  • 6. Enter the total dollar amount you are billing for the line item in the Line Amount field. Multiply your usual and customary charge by the number of units in the quantity field to get the total dollar amount.
  • 7. Enter a description of the service to be provided in the Service Description field.
  • (Note: 25 line limit in service description field)
  • 8. Scroll up to the Service Setup heading and click the Save button to save the line item information that was entered. Saved line information is visible next to the blue dot.
  • · To add additional lines, select the New button to add an additional line and clear the fields on the screen
  • · To delete a line, select the Delete button to delete the line item

  • 9. Repeat Steps 1 – 8 until all line items are entered.
  • · Note: if after completing the Services Tab you receive the error message: “Denied incorrect payer”, verify eligibility using MN–ITS to confirm the subscriber (member) is not enrolled with a managed care organization (MCO):
  • a. If the subscriber (member) is enrolled in an MCO, contact the MCO
  • b. If the subscriber (member) is not enrolled in an MCO, contact the MHCP Provider Resource Center and verify the effective date of MCO coverage. For services completed before effective date of MCO coverage, use the actual date of service or a date before the MCO effective date

    • Submitting your Imaging Service Authorization Request for review

    Click the Submit button. You will receive a response within seconds. Review the Authorization Request Responses table for steps to take after you receive a response.

    Authorization Request Responses

    If your response states:

    Then:

    Transaction submitted successfully.

    This request has been received for review by DHS. image

    Print the response, keep a copy for your records and attach all required documentation and mail or fax to the medical review agent for review.

    Write the 11-digit number assigned on each page of your documentation and use fax cover sheet.

    Submit via mail or fax to:
    Kepro, Inc.,
    Att’n Minnesota Healthcare Programs or use the portal at     mhcp.kepro.com.

    Your authorization request was not submitted due to the following conditions:

    Refer to the Claim Status Codes available on the X12 website.

    Note: All information provided on the authorization request must be documented in the patient’s medical record. Post payment review will be done on authorization requests approved with a prior authorization number.

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

    Call the MHCP Provider Resource Center at 651-431- 2700 or 1-800-366-5411 if you have questions related to this request.

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