Manage Individual Information

Revised: January 8, 2024

Overview

On this page, you can enter your individual profile information when you are creating a new profile request or manage your existing individual profile information.

Portfolio/Profile Information

See Portfolio/Profile Information on the Recurring Items page of the Minnesota Provider Screening and Enrollment (MPSE) User Manual.

Individual Information

Under Individual Information, provide your individual profile information.

First Name

Type your first name in the First Name field. Use your full legal first name.

Middle Name

Type your full middle name in the Middle Name field. Use your full legal middle name as you report to the IRS.

Check if no Middle Name

Select the field next to Check if no Middle Name field if you do not have a middle name. This will make the Middle Name field unfillable.

Last Name

Type your last name in the Last Name field. Use your full legal last name as you report to the IRS.

Date of Birth

Enter your birthday in the format MM/DD/YYYY in the Date of Birth field.

Fiscal Year End

Type the month and day of the year that your fiscal year ends in the format of MM/DD in the Fiscal Year End field. The default fiscal year end date is 12/31 and auto populates in this field.

Email Address

Type your email address in the Email Address field.

This field is optional. You do not have to give your email address, but if you do, you must provide a valid email address. A valid email follows this format: xxx@yyy.com. For example, JohnDoe@organization.com is a valid email address. JohnDoeOrganization.com and JohnDoe@organization are not valid because the first is missing the “@ sign” and the second is missing “.com”. Other versions of .com are also acceptable such as .edu, .org, .gov., and others.

Phone Number

Type your 10-digit phone number in the format 999-999-9999 in the Phone Number field.

Fax Number

Type your 10-digit fax number in the format 999-999-9999 in the Fax Number field. Providing your fax number is optional.

Self Managed

Select the Yes option if you are personally managing your individual profile yourself. Select the No option if your organization is managing your profile on your behalf. This will allow your organization to update your profile information for you. The option defaults to No.

If you are affiliating a provider to your organization, select the No option so that the organization can continue to maintain the individual’s portfolio in the future.

Supporting Documentation

The Supporting Documentation field shows the documentation that you uploaded to support your request to change your individual information.

The Supporting Documentation field only appears once you have a profile with MHCP. Supporting documentation is used to support a change to your existing information with MHCP, so it is not necessary at the time of a new profile request.

Remove Upload

Check the Remove Upload box to remove the document that is currently uploaded. This will happen automatically if there is an existing uploaded document and you upload a new document.

Upload Supporting Documentation

Use the Upload Supporting Documentation box to upload documentation you have to support your request to change your profile identifier. Supporting documentation is not required. Click on the words Upload Supporting Documentation or click on the icon shaped like an eye to open a dialogue box on your computer which will allow you to select a document to upload. MPSE only allows the following document types for upload: PDF, JPG, and PNG.

Reason for Change Note Actions

Use Reasons for Change Note Actions to manage notes on your profile identifier.

Click Edit to add a new note or edit an existing note about your request to change your profile identifier.

Click View to review the note about changes made to your profile identifier. In View mode, you cannot make edits.

Continue

Click Continue to save your changes and go to the next page.

Cancel

Click Cancel to go back to the previous page.