Clinical Nurse Specialist Enrollment Criteria and Forms

Revised: December 5, 2023

To enroll as a clinical nurse specialist (CNS) with Minnesota Health Care Programs (MHCP), a CNS must:

· Be licensed as a CNS by state of practice.

· Have CNS certification from American Nurses Credentialing Center or other accepted national board

If the provider is licensed and resides in one state but practices in another, MHCP will accept the license only if both states participate in the Nurse Licensure Compact (NLC). Minnesota does not participate in the Nurse Licensure Compact, so, if the provider practices in Minnesota, the nurse must have a Minnesota registered nurse license. For example, provider resides and is licensed in South Dakota but practices in North Dakota. Both states participate in Nurse Licensure Compact so the provider can enroll with MHCP. Providers must be licensed in their state of permanent residency.

Enrollment Criteria

Providers who wish to enroll with MHCP or make enrollment requests can do so in one of the following ways.

· Register to access the Minnesota Provider Screening and Enrollment (MPSE) portal and complete your enrollment online using the MPSE portal. Also, upload the following in the MPSE portal:

· Copy of current CNS license

· Copy of current CNS national certification

· 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)

Note: Clinical nurse specialists are currently labeled as certified nurse specialist in the MPSE portal. Until the MPSE portal has been updated, providers enrolling as a clinical nurse specialist must select the certified nurse specialist as their enrollment record type.

or

· Complete the following documents required to enroll as a CNS and fax your materials to MHCP Provider Eligibility and Compliance at 651-431-7462.

· Enrollment forms:

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

· 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)

· Copy of current CNS license

· Copy of current CNS national certification

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

We process forms in order of date received. Whether enrolling 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 notice or letter telling you what we need or 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.

Reporting Changes

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

Additional Resources

Minnesota Statutes, 148.171 (Nurses; Definitions; Title)
Minnesota Statutes, 6305.0300, subpart 1 (Authorization to Practice Nursing; Required authorization)
Code of Federal Regulations, title 42, section 440.60 (Medical or other remedial care provided by licensed practitioners)