Providers who choose to participate in MHCP must meet professional, certification and licensure requirements according to applicable state and federal laws and regulations. Refer to the manual section for each type of service you want to provide to be aware of all of the MHCP requirements for that provider type.
Also contact the managed care organization with which you contract for their enrollment requirements.
Provider types marked with an asterisk (*) in the following list may not receive direct payment for the services they provide; they must bill through an agency.
The following health care provider types may be eligible for MHCP enrollment:
After an individual or group provider meets professional, certification and licensure requirements, you can apply to be an enrolled MHCP provider. Follow these steps:
1. Meet all rules and requirements
Ensure that you meet all of the requirements and certifications for the type of service you want to provide before submitting enrollment information to MHCP. Refer to the appropriate service section in MHCP Provider Manual for licensure or certification requirements for your provider type.
2. Check federal and state excluded providers lists
The federal Health and Human Services–Office of Inspector General (OIG) has the authority to exclude individuals and entities from participation in Medicare, Medicaid and other federal health care programs. MHCP also excludes individuals and entities from participation in MHCP if they are on either the federal or state excluded provider list.
MHCP cannot enroll and pay providers if they or their employees or contractors are excluded from participation in Medicare, Medicaid or other federal health care programs. The Office of Inspector General (OIG) may impose civil monetary penalties against providers who employ or enter into contracts with excluded individuals or entities to provide services or items to recipients.
OIG makes a List of Excluded Individuals/Entities (LEIE) available to the public. As enrolling or enrolled MHCP providers, you must make sure you, your company, owners, managers, employees and contractors are not on the list. Search LEIE by the individual’s or entity’s name:
Report any new exclusions you find in your search to MHCP Provider Enrollment at fax 651-431-7462. Use a cover sheet.
Also see Excluded Provider Lists and MHCP Provider Screening Requirements.
3. Get a provider identification number
National Provider Identifiers (NPIs) are the standard unique identifiers to use in submitting and processing health care claims and other transactions. If you are a provider eligible for an NPI, you must obtain your NPI number(s) from the National Plan and Provider Enumeration System (NPPES) before you enroll with MHCP.
Unique Minnesota Provider Identifier (UMPI): Providers who do not meet the federal definition of a health care provider under HIPAA may not be eligible to receive an NPI. If you are not eligible for an NPI and apply for enrollment, MHCP will assign you a 10-digit UMPI and send you a Welcome Letter to confirm your enrollment.
If you are one of the following providers, do not obtain an NPI before submitting your enrollment forms:
The following providers are not required to obtain an NPI, but may have the option of using an NPI registered to the provider:
Your NPI or UMPI is required on all claims submitted to MHCP. This number allows you to be paid for MHCP-covered services provided to eligible MHCP members.
4. Register for MN–ITS
After you are enrolled you will need to register for MN–ITS. MN–ITS is a free, web-based, HIPAA-compliant system. We will send you a Welcome Letter to confirm your enrollment. Your enrollment Welcome Letter includes a MN–ITS initial User ID, Password and registration instructions.
Minnesota law requires all persons or entities that provide health care services or supplies within Minnesota for a fee and are eligible for MHCP reimbursement to submit all claims electronically. All providers and their affiliated clinics or billing services must register for MN–ITS. MHCP does not process paper claims.
As a registered MN–ITS user, you can:
Minnesota providers are approved retroactively:
Out-of-state providers may apply for MHCP enrollment for the date(s) of service to an MHCP recipient. To be eligible for payment under MHCP, an out-of-state provider must:
Refer to additional requirements under Billing Policy and billing information for Out-of-State Providers.
Providers who choose to participate in an MHCP managed care organization’s (MCO's) network must contact the appropriate health plan for participation requirements. Refer to Prepaid Minnesota Health Care Programs for additional information about MCOs.
Notify MHCP Provider enrollment in writing of any changes to your enrollment application. Use one of the following forms:
MHCP sends enrollment status letters to providers, including when changes in provider participation occur (such as when providers expand or reduce the services they provide).
MHCP processes only complete requests within 30 days of receiving the request. Each request, including corrected and resubmitted requests is considered a new request and is subject to the same processing timelines (30 days) as an initial request.
Complete requests mean that all required fields are completed and all required documents have been received.
If a new enrollment request is incomplete, MHCP will send you a request for more information (RFMI) letter to tell you the information we still need to process your request. You have 60 days to respond and return the missing information. If we receive part of your information, but there is still missing information, we will send an additional RFMI to tell you the information that is still missing and give you an additional 30 days to return the missing information. If information is still missing or incomplete after that, we will deny the request.
If enrollment documents submitted are not complete and correct and we requested additional information or corrections, you must allow up to 30 days from the date you sent the most recent paperwork for processing.
If your enrollment record becomes inactive due to lack of claims activity and your enrollment record has been screened within the last 3 1/2 years (2 years for PCA agencies and individual Direct Support Workers), contact the MHCP Provider Call Center to request your record be reactivated.
MHCP-enrolled providers can assign clearinghouses or billing intermediaries as their billing agents to submit claims and other transactions electronically to MHCP
Clearinghouses and billing intermediaries sending MHCP claims and other transactions on behalf of enrolled providers must enroll as a billing organization.Report/Rate this page