Certified Professional Midwife Enrollment Criteria and Forms

Posted: November 30, 2023

To enroll as a certified professional midwife (CPM) with Minnesota Health Care Programs (MHCP), a CPM must be:

· Licensed with a traditional midwife license with the Minnesota Board of Medical Practice.

How to Enroll

Providers who wish to enroll or reenroll, or providers required to revalidate with MHCP, can do so in one of the following two ways:

· Use the Online Minnesota Provider Screening and Enrollment (MPSE) portal.

· Register to access the MPSE portal by using the instructions under the Registration and Access section in the MPSE Enrollment Manual

· Complete your enrollment online using the MPSE portal. If enrolling through the MPSE portal, you will be required to upload a:

· Copy of current midwife license from Minnesota Board of Medical Practice

· Completed, signed and initialed copy of the 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)

or

· Complete the following documents and fax your materials to 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 midwife license from the Minnesota Board of Medical Practice

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

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

Incomplete information will delay processing. Resubmission of corrections or missing information restarts the 30-day processing timeline.

Revalidation

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

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 to the Minnesota Department of Human Services.

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

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.

Changes that occur prior to notifying MHCP or missing or incorrect information may result in billing suspension. Minnesota Statutes, 256B.04, subdivision 21(d).

Legal References

Minnesota Statutes, 147D.03 (Midwifery)