Fees

Revised: September 3, 2024

· Manage Fees

· Manage Fee Information

· Payment Details

Overview

Institutional providers who enroll with Minnesota Health Care Programs (MHCP) may be required to pay an application fee. An application fee is required when institutional providers enroll for the first time, reenroll, or go through revalidation. You can find a list of providers who are considered institutional providers in the Application Fees section of the MHCP provider manual.

If your request for enrollment with MHCP is denied or terminated for any reason, and you wish to re-apply for enrollment, you will be required to pay a new enrollment application fee. You would not be able to use the previous application fee for payment.

If you have paid an application fee to Medicare or another state Medicaid program within the last five years, you can provide proof of that payment and have that payment cover your application fee with MHCP. This applies to all providers that are required to pay a fee.

If paying the application fee would cause your business a financial hardship, you may request a hardship fee exemption by completing the appropriate form and submitting supporting documentation on this page.

For more information about paying the fee and hardship exemption requests, go to the Paying the Fee page of the MHCP Provider Manual.

Use this page to view or edit the application fees you are required to pay. You can only edit the information on this page if you are in an MPSE Request.

Portfolio/Profile Information

This is a recurring section that appears on multiple MPSE pages for informational purposes only. See Portfolio/Profile Information on the Recurring Items page of the Minnesota Provider Screening and Enrollment (MPSE) User Manual.

Enrollment Record Information

This is a recurring section that appears on multiple MPSE pages for informational purposes only. See Enrollment Record Information on the Recurring Items page of the MPSE User Manual.

Manage Fees

In the Manage Fees section, you will find information related to the fees or hardship exemptions that exist for this enrollment record. If there are no existing fees on your enrollment record, this section will not have any information to display.

View/Edit
Click View/Edit to go to the Manage Fee Information page. From this page, you can view and edit your fee payment information.

Delete
Click Delete to delete your fee payment. You can only delete fee payments that have been added in the current MPSE request. The Delete option will not appear if the fee payment cannot be deleted.

View
Click View to go to the Manage Fee Information page. From this page, you can view your fee payment information but you will not be able to make any changes to the information.

Add Fee Payment Information

Click Add Fee Payment Information to go to the Manage Fee Information page.

Continue

Click Continue to go to the next page.

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Manage Fee Information

Use this page to manage your application fee payment information, request a refund, or request a hardship exemption.

Click the MHCP Provider Screening Fee Collections System link to go to the webpage where you can pay your fee.

Portfolio/Profile Information

This is a recurring section that appears on multiple MPSE pages for informational purposes only. See Portfolio/Profile Information on the Recurring Items page of the MPSE User Manual.

Enrollment Record Information

This is a recurring section that appears on multiple MPSE pages for informational purposes only. See Enrollment Record Information on the Recurring Items page of the MPSE User Manual.

Fee Information

Use this section to provide details about your fee payment, refund request, or hardship expemtion.

Fee Payment Type

Select your fee payment type from the Fee Payment Type drop-down list.

The fee payment types available to choose from are:

· Fee not required – select “Fee not required” if you are not required to pay a fee.

· Hardship exemption – select “Hardship exemption” if you need to apply for a hardship exemption. If you select this option, MHCP will forward your request for hardship exemption to the Centers for Medicare & Medicaid Services (CMS). If CMS approves your hardship exemption, MHCP will process your application. If CMS denies your hardship exemption, MHCP will send you a request for more information letter requiring you to pay the application fee before continuing to process your application.

· Medicare – select “Medicare” if you have already paid your application fee to Medicare within the past 5 years.

· State list – Select “Minnesota” if you have paid your application fee to MHCP. If you have paid your application fee to another state’s Medicaid program within the past 5 years, select the state where you paid your application fee.

To review a list of providers required to pay a fee payment, review fee payment requirements and hardship exemption information refer to the Application Fees section of the Provider Screening Requirements page of the MHCP Provider Manual.

Payment Date

Enter the date that you paid your application fee in the format of MM/DD/YYYY in the Payment Date field.

A payment date is not required if your selected fee payment type is Fee Not Required or Hardship Exemption.

Payment Confirmation Number

Only fill in this field if your fee payment type is Minnesota. The asterisk marking this field as required appears for states other than Minnesota for which this number is NOT required. If your payment type is Minnesota, type your payment confirmation number in the Payment Confirmation Number field.

Payment Confirmation Documentation

The Payment Confirmation Documentation field shows your uploaded payment confirmation document.

Remove Upload
Check the Remove Upload box to remove the Payment Confirmation Document uploaded after clicking the Continue button. The Remove Upload button only appears when the Payment Confirmation Document was uploaded during the current MPSE request.

Upload Payment Confirmation Documentation

Use the Upload Payment Confirmation Documentation field to upload your proof of application fee payment. Uploaded payment confirmation documentation is only required if your Fee Payment Type is a state other than Minnesota.

Click Upload Payment Confirmation 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 to be uploaded: PDF, JPG, and PNG.

Request Refund

Select the Yes option if you are requesting a refund of your fee payment. Select the No option if you are not requesting a fee payment refund. The option button defaults to No and a refund may only be requested when your Fee Payment Type is Minnesota.

Request Refund Reason

If you have selected the option Yes for Request Refund, you are required to select a request refund reason.

Select your reason for requesting a refund from the Request Refund Reason drop-down list.

The available selections for your request refund reason are:

· CMS approved Hardship Request – select CMS approved hardship request if your hardship exemption was approved after you paid your application fee.

· Duplicate application fee payment – select duplicate application fee payment if you paid a fee to MHCP after you made a payment to Medicare or another state’s Medicaid program.

· Entered incorrect Business Address – select entered incorrect business address if your fee payment was applied to the wrong location.

· Entered incorrect FEIN/SSN – select entered incorrect Federal Employer Identification Number (FEIN)/Social Security Number (SSN) if your fee payment was applied to the wrong FEIN/SSN.

· Exempt from application fee payment – select exempt from application fee payment if you have paid the application fee but are exempt from the application fee payment.

· Withdrawing enrollment application – select withdrawing enrollment application if you have decided you no longer wish to enroll with MHCP and have already paid your application fee.

Refund Issue Date

This field is for office use only. Once MHCP has reviewed and processed your refund request, the Refund Issue Date field will show the date your refund was issued.

Refund Confirmation Number

This field is for office use only. Once MHCP has reviewed and processed your refund request, MHCP will enter a refund confirmation number for your refund in the Refund Confirmation Number field.

Hardship Exemption Documentation

The Hardship Exemption Documentation field shows your uploaded hardship exemption document.

Remove Upload
Check the Remove Upload box to remove the Hardship Exemption Documentation uploaded after clicking the Continue button. The Remove Upload button only appears when the Hardship Exemption Documentation was uploaded during the current MPSE request.

Upload Hardship Exemption Documentation

Use the Upload Hardship Exemption Documentation field to upload your documentation in support of your hardship exemption. Uploaded hardship exemption documentation is required if your selected Fee Payment Type is Hardship Exemption.

Review the Hardship Exemption section of the Provider Screening Requirements page of the MHCP Provider Manual for examples of appropriate documentation to support your request.

Click Upload Hardship Exemption 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 to be uploaded: PDF, JPG, and PNG.

CMS Hardship Referral Status

This field is for office use only. The CMS Hardship Referral Status field is updated by MHCP when the referral has been sent to CMS and will be updated once a decision has been made on your hardship request.

Your CMS hardship referral status will be one of the following:

· Approved – when CMS has approved your hardship exemption.

· Denied – when CMS denies your hardship exemption.

· Initial Referral To CMS – when MHCP sends your first referral to CMS.

· Pending CMS Review – when your referral has been sent to CMS and is pending CMS review.

· Re-referral To CMS – when a referral has been sent to CMS that is not your first referral for hardship exemption.

CMS Hardship Referral Date

This field is for office use only. MHCP enters the date in the CMS Hardship Referral Date field and it shows the date your hardship exemption request was referred to CMS for review.

Fee Information History

In the Fee Information History section, historical information related to the fee payment you are reviewing is displayed. If there is no historical data to display, this section will not display any information.

The fee information history is shown in order with the most recent information at the top of the list and the oldest at the bottom. You can review all changes that are made to your fee payment and review the detailed information about your fee payment before and after changes were made. For example: You enter your initial fee payment information and later you make an edit to that payment information by changing your payment confirmation number. The history is captured in this section and allows you to view your fee information as it was both before and after the edit. To view this information, click View under the View All Fields column.

View
Click View to go to the Fee Payment Details page. From this page, you can view the original information that was entered for that fee payment at the time it was submitted.

Continue

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

Cancel

Click Cancel to go back to the previous page.

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Fee Payment Details

Overview

In this section of MPSE, you can view the details of your payment, refund or hardship exemption. You can not make changes to any of the information in this section. The information displayed on this page is the information that was entered on the Manage Fee Information page.

Payment Details

In the Payment Details section, you will find your fee payment details. You will be able to review this information but will not be able to make any changes.

Continue

Click Continue to go back to the Manage Fee Information page.

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