Minnesota Minnesota

MN–ITS User Manual

MN–ITS User Manual

Housing Stabilization Services

Revised: April 1, 2024

Review MHCP Billing Policy for general billing requirements and guidance when submitting claims. Refer to additional billing requirements in the service-specific section of the MHCP Provider Manual before you submit the claim for services.

Log in to MN–ITS

  • 1. Log in to MN–ITS
  • 2. From the left menu:
  • a. Select MN–ITS
  • b. Select Submit DDE Claims (837)
  • c. Select Professional (837P)

    • Submit the Claim

    Follow the instructions in the following tables for each of the following claim screens to submit the claim:

    Billing Provider
    Subscriber
    Claim Information
    Coordination of Benefits (COB)Services

    Billing Provider

    The billing provider screen auto-populates with the information in the enrollment profile for the NPI or UMPI used to log in to MN–ITS. If changes are needed, use the Change of Enrollment Information to notify MHCP Provider Eligibility and Compliance.

    Refer to the following table for instructions and information about each field on this screen.

    Field Name *
    (X12 Loop and element)

    Field Instruction

    Organization
    (Loop: 2010AA, NM103 (last or organization)
    NM104 (first)

    The name of the Billing Provider: This could be an organization, business or the name of an individual provider identified by the NPI or UMPI used to log in to MN–ITS.

    Taxonomy
    (Loop: 2000A, PRV03)

    This field only displays information when a health care provider specialty or location code has been added to the provider file. Refer to X12’s Provider Taxonomy Codes webpage.

    If multiple taxonomy codes have been added, additional information will display. Select the radio button to identify the appropriate location for this claim.

    Address 1
    (Loop: 2010AA, N301)

    The first address line reported on the provider file.

    Address 2
    (Loop: 2010AA, N302)

    The second address line reported on the provider file.

    City
    (Loop: 2010AA, N401)

    The city name for the address in address fields 1 and 2.

    State
    (Loop: 2010AA, N402)

    The state name for the address in address fields 1 and 2.

    Zip
    (Loop: 2010AA, N403)

    The ZIP Code for the address in address fields 1 and 2.

    Telephone
    (Loop: 2010AA, PER04)

    Telephone number reported on the provider file.

    Screen Action Buttons

    Select:

  • · Cancel to cancel the claim entry
  • · Continue to proceed to the next screen

    • Subscriber

    Use the Subscriber (member) screen to report the member who received the services reported on this claim.

    Refer to the following table for instructions and information about each field on this screen.

    Field Name*
    (X12 Loop and element)

    Field Instruction

    Subscriber ID
    (Loop: 2010BA, NM109)

    Enter the 8-digit MHCP ID for the subscriber (member) indicated on the MHCP member identification card.

    Birth Date
    (Loop: 2010BA, DMG02)

    Enter the birth date of the subscriber (MMDDCCYY).

    Select the Search action button.

    The following fields auto-populate based on the information entered in the Subscriber ID and Birth Date fields.

    Subscriber First Name
    (Loop: 2010BA, NM104)

    The first name of the subscriber.

    Middle Initial
    (Loop: 2010BA, NM105)

    The middle initial of the subscriber.

    Last Name
    (Loop: 2010BA, NM103)

    The last name of the subscriber.

    Gender
    (Loop: 2010BA, DMG03)

    The gender of the subscriber.

    Select the Delete action button in this section to remove the subscriber information if not correct.

    Screen Action Buttons

    Select:

  • · Back to go back to the previous screen
  • · Cancel to cancel the claim entry
  • · Continue to proceed to the next screen

    • Claim Information

    Use the Claim Information screens to report claim level information that will identify the type of claim and details about the services.

    Refer to the following table for instructions and information about each field on this screen.

    Field Name*
    (X12 Loop and element)

    Field Instructions

    Claim Frequency Code
    (Loop: 2300, CLM05-3)

    Specifies if the claim is an original, replacement or void.

    Default is original.

    If hand keying a claim to be replaced or voided, select the radio button in front of replacement or void.

    If the claim has been retrieved from a submit response or from the request status feature, the claim will display with the option selected.

    Payer Claim Control Number
    (Loop: 2300, REF02)

    Identifies the previously processed claim when the claim frequency code is replacement or void.

    The payer claim control field is protected until replacement or void is selected. After selected, enter the payer claim control number to be replaced or voided.

    If the claim has been retrieved from a submit response or the request status feature, the claim number will auto-populate.

    Place of Service
    (Loop: 2300, CLM05-1)

    Select the code from the drop-down menu that identifies where the service was performed.

    Patient Control Number
    (Loop: 2300, CLM01)

    Enter a unique identifier to help identify this claim for this member. Enter numbers, letters or a combination. MHCP will report this on your remittance advice (RA).

    Assignment/Plan Participation
    (Loop: 2300, CLM07)

    Select the code indicating whether the provider accepts payment from MHCP.

    Default is Assigned. Select the correct response if different than the default.

  • · Assigned – provider has a participation agreement with MHCP
  • · Assignment Accepted – provider accepts assignment only for clinical lab services
  • · Not Assigned – neither assigned or assignment accepted apply

    • Benefits Assignment
    (Loop: 2300, CLM08)

    Select the benefit assignment to report the policy holder or person authorized to act on their behalf to give MHCP permission to pay the provider directly.

    Default is Yes. Select the correct response if different than the default.

  • · Yes – Benefits assigned to the provider
  • · No – Benefits not assigned to the provider
  • · Not Applicable – Patient refuses to assign benefits

    • Release of Information
    (Loop: 2300, CLM09)

    The determination of whether the provider has a signed statement by the member on file, authorizing the release of medical data to other organizations.

    Default is Yes. Select the correct response if different than the default.

  • · Yes – Signature collected or required
  • · Informed Consent – Signature not collected and not required

    • Provider Indicator
    (Loop: 2300, CLM06)

    Identifies whether the provider’s signature is on file, certifying services were performed by the provider.

    Default is Signature on File.

    Select the correct response if different than the default.

    Diagnosis Type Code
    (Loop: 2300, HI01-1)

    From the drop-down menu, select the diagnosis code reported on this claim using the ICD-10 classification.

    Diagnosis Code
    (Loop: 2300, HI01-2, HI02-2, HI03-2, HI04-2)

    Enter the diagnosis code (ICD) or other industry-accepted codes that best describe the condition or reason the member needed the services. Refer to the billing section of the Housing Stabilization Services Provider Manual for acceptable diagnosis codes. Select the Add button.

    Select the Delete button next to a diagnosis code to remove it from the claim.

    Situational Claim Information – This area is applicable to Housing Stabilization Services when adding an attachment.

    Prior Authorization Number
    (Loop: 2300, REF02)

    This field is not required for Housing Stabilization Services.

    Medical Record Number
    (Loop: 2300, REF02)

    This field is not required for Housing Stabilization Services.

    Claim Note
    (Loop: 2300, NTE02)

    Use only when additional information is required.
    Enter a free-form description to provide additional information about this claim.

    Attachment Control Number
    (Loop: 2300, PWK06)

    Use when submitting a claim with an attachment.

    Enter a code or number, assigned by the provider, identifying an attachment for this claim. MHCP uses only the first 30 characters when matching the attachments to the claim.

    Review the Electronic claim attachments webpage for MHCP attachment criteria and refer to the video module Sending an Attachment for a MN–ITS Claim for a demonstration.

    Type
    (Loop: 2300, PWK01)

    Use only when an attachment is required.

    Select the code from the drop-down indicating the attachment type ID and the description of the attachment.

    Select the Add action button in this section to include the attachment information on the claim.

    Contact Name
    (Loop: 2010CA, PER02)

    This field is not required for Housing Stabilization Services.

    Telephone Number
    (Loop: 2010CA, PER04)

    This field is not required for Housing Stabilization Services.

    Extension
    (Loop: 2010CA, PER06)

    This field is not required for Housing Stabilization Services.

    Related Causes
    (Loop: 2300, CLM11-1)

    This field is not required for Housing Stabilization Services.

    Date of Accident
    (Loop: 2300, DTP03)

    This field is not required for Housing Stabilization Services.

    Certification Condition
    (Loop: 2300: CRC02)

    This field is not required for Housing Stabilization Services.

    Condition Code
    (Loop: 2300: CRC03, CRC04. CRC05)

    This field is not required for Housing Stabilization Services.

    Situational Ambulance Information - This collapsed accordion screen is not needed for Housing Stabilization Services.

    Other Providers (Claim Level) – This collapsed accordion screen is not needed for Housing Stabilization Services.

    Screen Action Buttons

    Select:

  • · Back to go back to the previous screen
  • · Cancel to cancel the claim entry
  • · Continue to proceed to the next screen

    • Coordination of Benefits (COB)

    Use the COB screen to report other payers, third party liability (TPL) or Medicare’s financial responsibility for all or a portion of the claim. If no other payers are involved with this claim, select the Continue button at the bottom of this screen to proceed to the next screen.

    To report each type of other payer information at the claim (header) level use the following tables:

    Third Party Liability (TPL)/Other insurance (non-Medicare)

    Medicare and HMO Medicare Risk

    Third Party liability (TPL)/Other Insurance (non-Medicare)
    Complete the following fields to report adjustment, payments and denials from the private insurance (Non-Medicare) carrier.

    If reporting MB-Medicare Part B or 16-Health Maintenance Organization, HMO Medicare Risk insurance, use the instructions in the Medicare and HMO Medicare Risk table.

    Field Name*
    (X12 Loop and element)

    Field Instruction

    Other Payer Name
    (Loop: 2330B, NM103)

    Enter the full name of the insurance carrier.

    Do not use symbols such as slashes, dashes, periods or plus signs.

    Other Payer Primary ID
    (Loop: 2330B, NM109)

    Enter the identifier of the insurance carrier (this is available on the eligibility response for this member).

    Do not use symbols such as slashes, dashes, periods or plus signs.

    Claim Filing Indicator
    (Loop: 2320, SBR09)

    Select the code from the drop-down menu identifying the type of insurance. After the claim filing indicator is selected, additional fields will display for reporting TPL or private insurance.

    Payer Responsibility
    (Loop: 2320, SBR01)

    Select the code from the drop-down menu identifying the insurance carrier’s level of responsibility for payment of the claim.

    Insured ID
    (Loop: 2330A, NM109)

    Enter the policy holder’s identification number as assigned by the insurance carrier.

    For Medicare, this would be the Medicare health insurance claim number (HICN) or the Medicare beneficiary identifier (MBI) number.

    Relationship Code
    (Loop: 2320, SBR02)

    Select the relationship of the MHCP subscriber (member) to the policy holder from the drop-down menu.

    Claim Adjustment Group Code
    (Loop: 2320, CAS01)

    This field is used only when reporting TPL or private insurance at the claim (header) level rather than at the service line.

    Select the adjustment code identifying the general category of payment adjustment from the drop-down menu.

    Use the X12, on right, to find the HIPAA-compliant code that matches the adjustment response on the other payer’s EOB.

    Adj Reason Code
    (Loop: 2320, CAS02, CAS05, CAS08, CAS11, CAS14, CAS17)

    This field is used only when reporting TPL or private insurance at the claim (header) level rather than at the service line.

    Enter the code identifying the reason the other payer adjusted the payment. Refer to the other payer EOB or EOMB.

    Use the X12, on right, to find the HIPAA-compliant code that matches the adjustment response on the other payer’s EOB.

    Adj Amount  
    (Loop: 2320, CAS03, CAS06, CAS09, CAS12, CAS15 CAS18)

    This field is used only when reporting TPL or private insurance at the claim (header) level rather than at the service line.

    Enter the dollar amount of the adjustment.

    Adj Quantity
    (Loop: 2320, CAS04, CAS07, CAS10, CAS13, CAS16, CAS19)

    This field is used only when reporting TPL or private insurance at the claim (header) level rather than at the service line.

    Enter the number of units not paid when the units paid are different than the number of units submitted on the claim.

    Select the Add action button in this section to include the adjustment entries on the claim. Repeat the Claim Adjustment entries to report all adjustments as noted on the EOB from the TPL or private insurance.

    Select the Delete action button next to an adjustment to remove it from the claim.

    Payer Paid Amount
    (Loop: 2320, AMT02)

    This field is used only when reporting TPL or private insurance at the claim (header) level rather than at the service line.

    Enter the total dollar amount paid by the other payer.

    Non-Covered Charge Amount
    (Loop: 2320, AMT02)

    Not used by MHCP.

    Benefits Assignment
    (Loop: 2320, O103)

    The determination of the policy holder, or person authorized to act on their behalf, to give the other payer permission to pay the provider directly.

    Default is Yes.

    Select the correct response if different than the default.

    Release of Information
    (Loop: 2320, O106)

    The determination of whether the provider has a signed statement by the member on file, authorizing the release of medical data to other organizations.

    Default is Yes.

    Select the correct response if different than the default.

    Section Action Buttons

    Select:

  • · Delete in this section to remove this payer from the claim level and at the line level
  • · Save in this section to include the TPL or private insurance information on the claim

    • Section Action Button

    Select the ADD action button in this section to enter additional payers. Repeat the COB entry process to report all payers for the claim.

    Screen Action Buttons

    Select:

  • · Back to go back to the previous screen
  • · Cancel to cancel the claim entry
  • · Continue to proceed to the next screen

    • Medicare and HMO Medicare Risk
    Complete the following fields to report adjustment, payments and denials from Medicare or an HMO Medicare Risk plan.

    Field Name*
    (X12 Loop and element)

    Field Instruction

    Other Payer Name
    (Loop: 2330B, NM103)

    Enter the full name of the insurance carrier.

    Do not use symbols such as slashes, dashes, periods or plus signs.

    Other Payer Primary ID
    (Loop: 2330B, NM109)

    Enter the Payer ID of the Medicare contractor or Medicare Risk (Advantage) health plan.

  • · For Medicare: Refer to the CMS Provider Compliance Group Map for contractor contact information in your area
  • · For HMO/Medicare Risk/Advantage (Coverage Type: 07): Refer to the member’s MN–ITS Eligibility Response. The Payer ID is displayed in the Carrier ID field.

    • Claim Filing Indicator
    (Loop: 2320, SBR09)

    Select the code identifying the type of insurance from the drop-down menu. Additional fields will display for reporting Medicare payments after the claim filing indicator is selected.

    Payer Responsibility
    (Loop: 2320, SBR01)

    Select the code identifying the insurance carrier’s level of responsibility for payment of the claim from the drop-down menu.

    Insured ID
    (Loop: 2330A, NM109)

    Enter the policy holder’s identification number as assigned by the insurance carrier.

    Relationship Code
    (Loop: 2320, SBR02)

    Select the relationship of the MHCP subscriber (member) to the policy holder from the drop-down menu.

    Other Payers Claim Control Number
    (Loop: 2330B, REF02)

    Enter the claim number reported on the Medicare EOMB.

    Payment Remark Code
    (Loop: 2320, MOA03-MOA07)

    Enter the remittance advice remark codes reported on the Medicare EOMB. Report only if on the Medicare EOMB.

    Select the Add action button in this section to include the remark code on the claim. Repeat the remark code entries to report all remark codes as noted on the Medicare EOMB.

    Select the Delete action button next to a remark code to remove it from the claim.

    Payer Paid Amount
    (Loop: 2320, AMT02)

    This field is not used when reporting Medicare or HMO Medicare risk insurance COB. This information should be reported at the service line.

    Non-Covered Charge Amount
    (Loop: 2320, AMT02)

    Not used by MHCP.

    Benefits Assignment
    (Loop: 2320, O103)

    The determination of the policy holder, or person authorized to act on their behalf, to give the other payer permission to pay the provider directly.

    Default is Yes.

    Select the correct response if different than the default.

    Release of Information
    (Loop: 2320, O106)

    The determination of whether the provider has a signed statement by the member on file, authorizing the release of medical data to other organizations.

    Default is Yes.

    Select the correct response if different than the default.

    Section Action Buttons

    Select:

  • · Delete in this section to remove this payer from the claim level and at the line level
  • · Save in this section to include the TPL or private insurance information on the claim

    • Section Action Button

    Select the ADD action button in this section to enter additional payers. Repeat the COB entry process to report all payers for the claim.

    Screen Action Buttons

    Select:

  • · Back to go back to the previous screen
  • · Cancel to cancel the claim entry
  • · Continue to proceed to the next screen

    • Services

    Use the Services screen to describe details for each service being billed. Information reported on a service line will override information reported at the header (claim) level for that line.

    Refer to the following table for instructions and information about each field on this screen.

    Field Name*
    (X12 Loop and element)

    Field Instruction

    Date of Service (From)
    (Loop: 2400, DTP03)

    Enter the start date the service was provided (MMDDCCYY).

    Date of Service (To)
    (Loop: 2400, DTP03 * RD8* required in DTP02 when TO date is reported)

    Enter the end date the service was provided (MMDDCCYY). Bill only one day at a time for services provided within the same calendar month.

    Place of Service
    (Loop: 2400, SV105)

    This will default to what was entered on the claim information screen

    Procedure Code
    (Loop: 2400, SV101-2)

    Enter appropriate procedure code for Housing Stabilization Services. Refer to the billing section of the Housing Stabilization Services Provider Manual for appropriate codes.

    Procedure Code Modifier(s)
    (Loop: 2400, SV101-3, SV101-4, SV101-5, SV101-6)

    Enter appropriate modifiers for Housing Stabilization Services. Refer to the billing section of the Housing Stabilization Services Provider Manual for appropriate modifiers.

    Diagnosis Pointer
    (Loop: 2400, SV107-1, SV107-2, SV107-3, SV107-4)

    This will default from the diagnosis code entered on the claim information screen

    Line Item Charge Amount
    (Loop: 2400, SV102)

    Enter your usual and customary charge for this service. Receipts for Moving Expenses must equal the line item charge.

    Service Unit Count
    (Loop: 2400, SV104)

    Enter the number of units for the service.

  • · Consultation is one unit only.
  • · Housing Transition and Sustaining are 15-minute units.
  • · Housing Stabilization – Transition Moving Expenses is one unit only.

    • Other Payer – This collapsed accordion screen is not needed for Housing Stabilization Services.

    Section Action Buttons

    Select:

  • · Save/View Line(s) to save the service line and view a summary table, displaying information for each line on the claim
  • · Copy to save and copy the information to a duplicate service line. The information populated in the new service line is identical to what was entered on the copied line. Edit the information in each section of the new service line, as needed
  • · Delete to remove the service line from the claim

    • Section Action Buttons

    A summary table will display the following information for each line on the claim after saved:

  • · Line number
  • · From and to date
  • · Procedure code
  • · Modifier
  • · Charge
  • · Place of service


    • Select:

  • · Edit, next to a line, to change the information for that service line.
  • · Add to create a new service line that is blank. Repeat the service line entry steps to add all lines to the claim.

    • Screen Action Buttons

    Select:

  • · Back to go back to the previous screen.
  • · Cancel to cancel the claim entry.
  • · Validate to determine if the claim has met the HIPAA-compliant and certain basic requirements at both the claim and line level information. Use X12’s External Code Lists health care codes to identify the claim status category and claim status codes displayed on the validate response.
  • · Submit to identify if the claim will be paid, denied or suspended for review at the claim level and the line level of the claim. Use X12’s External Code Lists health care codes lists to identify the claim status category and claim status codes displayed on the claim response.

    • Copy, Replace or Void (take back) the Claim

    After submitting the claim and receiving a claim response, an option to Copy, Replace or Void the claim is available.

    Use each of these features to do the following:

    Copy – To correct an error of a denied claim or to copy information from other similar claims previously submitted.

    Replace – If the claim paid, but paid incorrectly or a line item was denied. The user may access the claim, correct the information and resubmit. The original paid amount will be taken back and replaced with the correct information on the replacement claim.

    Void (take back) - If the claim was submitted in error. This reverses the claim and takes the payment back.

    Review the Copy, Replace, Void (take back), or Reverse a Claim User Guide for step-by-step instructions when completing these transactions.

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