Hearing Aid Dispenser Enrollment Criteria and Forms

Revised: October 20, 2023

Minnesota Health Care Programs (MHCP) requires providers to enroll for the services they provide to MHCP members for each location that is providing services and receiving reimbursement.

How to Enroll

Hearing aid dispenser providers wanting 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 enrollment online using the MPSE portal. Also, upload the following documents in the MPSE portal:

· Fee-for-Service (FFS) only or FFS and Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF) or MCO In-Network Provider Agreement (DHS-8355) (PDF).

· Copy of a current hearing aid dispenser license from the provider’s state of practice. MHCP allows a provider with an out-of-state license to practice in Minnesota if the provider is practicing in an Indian Health Service (IHS) tribe.

or

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

· 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 MCO In-Network Provider Agreement (DHS-8355) (PDF).

· Copy of a current hearing aid dispenser license from the provider’s state of practice. MHCP allows a provider with an out-of-state license to practice in Minnesota if the provider is practicing in an IHS tribe.

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. We will send a request for more information letter to your MN–ITS mailbox or through U.S. Postal Service explaining what you need to do to complete your enrollment if we need more information.

Revalidation

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

Refer to Revalidation in Provider Screening Requirements under Provider Basics in 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 Enrollment with MHCP under Provider Basics in the MHCP Provider Manual for details.

Additional Resources

Hearing Instrument Dispenser Certification (Minnesota Department of Health)

Legal References

Minnesota Statutes, 148.5197 (Hearing Aid Dispensing)
Minnesota Statutes, 153A.14 (Regulation)
Minnesota Statutes, 153A.15 (Prohibited Acts; Enforcement; and Penalty)