Manage Agreements and Addendums
Revised: April 10, 2024
Overview
Use this page to view or edit the agreements and addendums associated with the enrollment record. You can only edit the information on this page if you are in an MPSE Request.
All providers enrolling with Minnesota Health Care Programs (MHCP) are required to complete a provider agreement. The provider agreement that you are required to complete depends on whether you selected Fee-for-Service and In-Network Managed Care or In-Network Managed Care Only for the Encounter Indicator field on the Enrollment Record Information page. You may also be required to complete additional provider agreements or addendums depending on the services you have selected.
All provider agreements and addendums for individual providers must be signed and dated by the enrolling provider. Agreements and addendums for organization providers must be signed and dated by a person listed on the Owner or Authorized Person Master List that displays in the MPSE portal.
Portfolio/Profile Information
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.
Required But Missing Agreements/Addendums
The Required But Missing Agreements/Addendums section shows a list of all of the agreements or addendums that you are required to complete for your enrollment record type and services.
Once you have added an agreement or addendum on your required but missing agreements or addendums list, it will no longer appear in the list. Once you have completed all of your required agreements and addendums, the Required But Missing Agreements/Addendums section will disappear from this page.
Agreements/Addendums
The Agreements/Addendums section shows information related to your existing provider agreements and addendums. If you have not yet added any agreements or addendums to your enrollment record, this section will not have any information to display.
To view details of a specific agreement or addendum in this section, click the View or View/Edit button in the User Actions column.
View/Edit
Click View/Edit to go to the Manage Agreement/Addendum page. From this page, you can review and edit the information for that agreement or addendum as needed.
Delete
Click Delete to delete your provider agreement or addendum. This option only appears when the agreement or addendum was added in the current request.
View
Click View to go to the Manage Agreement/Addendum page. From this page, you can view the information for that agreement or addendum. You will not be able to make any changes while in View mode.
Add Agreement/Addendum
Click Add Agreement/Addendum to go to the Manage Agreement/Addendum page.
Continue
Click Continue to save your changes and go to the next page.
Cancel
Click Cancel to go back to the previous page.
Manage Agreement/Addendum
Overview
On this page, you can view an existing agreement or addendum, make changes to an existing provider agreement or addendum, or add a new provider agreement or addendum.
Portfolio/Profile Information
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.
Agreement/Addendum
Under Agreement/Addendum, view, edit, or complete the information for the agreement or addendum you selected.
Agreement/Addendum
Click the field to select an agreement or addendum from the Agreement/Addendum drop-down list. Once you have selected an agreement or addendum to complete, a link to that form appears.
The options you have to select from are the agreements and addendums that are available for the enrollment record type and services you have selected.
DHS-####
Once you select an agreement or addendum, a link to that form appears. The link appears as the form number for that form. For example, if you have selected the MHCP Provider Agreement, the link will appear as DHS-4138, which is the form number for the Fee-for-Service (FFS) only or FFS and Managed Care Organization In-Network Provider Agreement.
Click the link to go to the agreement or addendum and complete the form either electronically or print out the form and sign and date it. All provider agreements and addendums for individual provider types are required to be signed and dated by the individual that is the enrolling provider. Agreements and addendums for organization provider types must be signed and dated by a person listed on the Owners and Authorized Persons master list who has a role type of Owner Managing Interest or Authorized Agent.
Agreement/Addendum Documentation
The Agreement/Addendum Documentation box shows your agreement or addendum after it has been uploaded.
Remove Upload
Check the Remove Upload field to remove the agreement or addendum that is currently uploaded. This will happen automatically if there is an existing document, and you upload a new document.
Upload Agreement/Addendum Documentation
Use the Upload Agreement/Addendum Documentation box to upload your completed agreement or addendum.
Digital Signature
Type the full name of the person uploading the agreement or addendum in the Digital Signature box.
Signers Title
Type the professional title of the person uploading the agreement or addendum in the Signers Title box.
Signature Date
Enter the date you are uploading the agreement or addendum in the Signature Date box.
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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