Doula Enrollment Criteria and Forms

Revised: June 30, 2025

· How to Enroll Doula – Individual

· How to Enroll Doula – Organization

· Revalidation

· Reporting Changes

How to Enroll Doula – Individual

All certified doulas must enroll with Minnesota Health Care Programs (MHCP) as an individual doula to be reimbursed by MHCP or enter into a contract with a managed care organization (MCO). To enroll as an individual doula with MHCP, the individual must:

· Be registered with the Minnesota Department of Health (MDH) Doula Registry.

· Submit a copy of their Doula Registry letter from MDH.

We will return submitted enrollment applications to applicants with a request for more information letter if:

· The doula is not active on the MDH Doula Registry.

or

· The MDH Doula Registry letter was not included in the enrollment application.

Individual doulas who wish to enroll, reenroll, or revalidate with MHCP, can do so in one of the following ways:

Use the Minnesota Provider Screening and Enrollment (MPSE) portal:

· Register to access the MPSE portal.

· Complete your enrollment using the New Individual Provider Enrollers instructions.

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)

· MDH Doula Registry letter

How to Enroll Doula – Organization

Doulas should enroll as an organization if they are going to bill on behalf of more than one MHCP enrolled individual doula provider. To enroll as a doula organization with MHCP, the organization must:

· Be affiliated to an individual doula who is registered with the Minnesota Department of Health Doula Registry and enrolled with MHCP.

· Have a federal employer identification number (FEIN).

Organizations that wish to enroll, reenroll, or revalidate with MHCP, can do so in one of the following ways:

Use the Minnesota Provider Screening and Enrollment (MPSE) portal:

· Register to access the MPSE portal.

· Complete your enrollment using the New Organization Provider Enrollers instructions.

or

Complete the following documents and fax your materials to 651-431-7462.

· Organization Provider Enrollment Application (DHS-4016A) (PDF)

· Disclosure of Ownership and Control Interest of an Entity (DHS-5259) (PDF) – Organizations must disclose owners, managing employees, and authorized persons.

· 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)

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.

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

Provider Basics

New providers are encouraged to attend the Provider Basics training course. Provider Basics is held monthly and free to attend. Information about MHCP webpages, billing policy overview, and helpful resources is provided.

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 DHS.

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 before notifying MHCP, or missing or incorrect information, may result in billing suspension. Minnesota Statutes, 256B.04, subdivision 21(d).

Legal References

Minnesota Statutes, 148.995 (Definitions)
Minnesota Statutes, 148.996 (Registry)
Minnesota Statutes, 256B.0625, subdivision 28b (Doula services)