Licensed Professional Clinical Counselor Enrollment Criteria and Forms

Revised: December 1, 2025

A Licensed Professional Clinical Counselor (LPCC) must be licensed as an LPCC by the Minnesota Board of Behavioral Health and Therapy or designated as such by a tribal entity in Minnesota to enroll as an LPCC with Minnesota Health Care Programs (MHCP). Out-of-state providers must meet the same requirements set for Minnesota LPCCs:

· Have a master’s degree in counseling

· Be licensed as a professional clinical counselor or an equivalent that satisfies Minnesota’s statutory license requirements

How to Enroll

LPCCs who want to enroll with MHCP or make enrollment requests can do so in one of the following two ways.

Online MPSE Portal

Register to access the Minnesota Provider Screening and Enrollment (MPSE) Portal and complete your enrollment online using the MPSE portal. You are required to upload the following:

· Copy of the license from the Minnesota Board of Behavioral Health and Therapy, tribal certification or verification of another state’s designation

· Completed, signed, and initialed Fee-for-Service (FFS) only or FFS and Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF) or the MCO In-Network Provider Agreement (DHS-8355) (PDF)

or

Submit Forms via Fax

Complete and fax the following enrollment forms and required documents to MHCP Provider Eligibility and Compliance at 651-431-7462.

· Copy of the license from the Minnesota Board of Behavioral Health and Therapy, tribal certification or verification of another state’s designation

· Individual – Provider Enrollment Application (DHS-4016) (PDF)

· Completed, signed, and initialed Fee-for-Service (FFS) only or FFS and Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF) or the MCO In-Network Provider Agreement (DHS-8355) (PDF)

Review and keep a copy of the MHCP Data Privacy Notice (DHS-6287) (PDF).

We process forms in order of the date received. Whether enrolling or revalidating using the MPSE portal or by fax, allow 30 days for processing. If we need more information to complete your enrollment, we will send a request for more information letter via U.S. Postal Service (or your MN–ITS mailbox, if you have an account) explaining what you need to do to complete your enrollment.

Revalidation

MHCP is required to follow the Centers for Medicare & Medicaid Services (CMS) final federal provider screening regulations.

Refer to Revalidation in the Provider Screening Requirements section of the MHCP Provider Manual for more information about how to complete your revalidation.

MHCP will notify you when you are due for revalidation. When you are notified, you must submit a revalidation request through the MPSE portal or fax all required forms and documents listed under How to Enroll to Provider Eligibility and Compliance at 651-431-7462.

We recommend using the MPSE portal and following the instructions in the Revalidation section of the MPSE user manual to revalidate your record. Log in to your MN–ITS account on the MN–ITS: Home webpage and choose the Minnesota Provider Screening and Enrollment (MPSE) portal link. If you have not registered your MN–ITS account, your login information is on your original Welcome Letter. Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 if you do not have your Welcome Letter.

Refer to Revalidation in Provider Screening Requirements under Provider Basics in the MHCP Provider Manual for important information, including timelines, the revalidation process and impacts to your enrollment. Providers who do not meet the revalidation timelines will have their enrollment terminated.

Medicare Enrollment Denials

Most LPCCs are eligible to enroll with Medicare. If Medicare denied your enrollment as a provider, submit the Medicare denial letter along with the Mental Health Professional Applicant Assurance Statement – Medicare Enrollment Denial (DHS-3864) (PDF) to MHCP Provider Eligibility and Compliance. You need to submit DHS-3864 every 18 months to verify your enrollment with Medicare was denied. Notify MHCP Provider Eligibility and Compliance immediately if Medicare approves your enrollment after you have been denied.

Reporting Changes

Report any changes made on a provider record to MHCP Provider Eligibility and Compliance. Refer to the Changes to Enrollment in the Enroll with MHCP section of the MHCP Provider Manual for details.

Legal References

Minnesota Statutes, 148B.5301 (Licensed Professional Clinical Counselor)