Manage Service Provider to Trading Partner Affiliations
Revised: November 18, 2024
Overview
Service provider to trading partner affiliations are required when a service provider enrolled in Minnesota Health Care Programs (MHCP) has a professional relationship with a trading partner. Trading partners can be intermediary billing entities, electronic data interchange or clearinghouses. Trading partners complete billing on behalf of providers they are in an agreement with. Review the Billing Organization/Responsibilities page of the MHCP provider manual for more information on trading partners.
Use this page to view, add, or edit a trading partner affiliation. 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. Refer to the 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. Refer to the Enrollment Record Information on the Recurring Items page of the MPSE User Manual.
Modified Service Provider to Trading Partner Affiliation
The Modified Service Provider to Trading Partner Affiliation section displays information on your current affiliation request. If you do not have a current request, this section will not appear.
View/Edit
Click View/Edit to go to the Manage Service Provider to Trading Partner Affiliation page.
Delete
Click Delete to delete the affiliation. This option only appears when the affiliation has not been approved by MHCP. If you wish to end an affiliation already approved by MHCP click View/Edit and add an End Date on the Manage Service Provider to Trading Partner Affiliation page.
All Service Provider to Trading Partner Affiliations
The All Service Provider to Trading Partner Affiliations section displays information related to your existing service provider to trading partner affiliations. If you do not have any service provider to trading partner affiliations, this section will not have any information to display.
View
Click View to go to the Manage Service Provider to Trading Partner Affiliation page. You cannot modify an affiliation when in view mode.
View/Edit
Click View/Edit to go to the Manage Service Provider to Trading Partner Affiliation page. This option only appears when you are in an MPSE Request.
Create New Affiliation
Click Create New Affiliation to go to the Service Provider to Trading Partner Affiliation Search page.
Continue
Click Continue to go to the next page.
Service Provider to Trading Partner Affiliation Search
Use this page to search for trading partners currently enrolled and active with MHCP.
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. Refer to Enrollment Record Information on the Recurring Items page of the MPSE User Manual.
Search Information
Search by entering the national provider identifier (NPI) or unique Minnesota provider identifier (UMPI) of the trading partner you would like to affiliate with.
If search results appear, that trading partner is actively enrolled with MHCP and you can select to affiliate with them. Click Select in the user actions column to go to the Manage Service Provider to Trading Partner Affiliation page.
If your search does not display any results, the message, “No enrollment records were found that match the search information” will appear. You will not be able to complete your affiliation request until that trading partner enrolls with MHCP.
Manage Service Provider to Trading Partner Affiliation
Use this page to view, add, or modify details about the service provider to trading partner affiliation.
Portfolio/Profile Information
This is a recurring section that appears on multiple MPSE pages for informational purposes only. Refer to the 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. Refer to Enrollment Record Information on the Recurring Items page of the MPSE User Manual.
Provider Information
This section displays the name and UMPI number for the trading partner that the affiliation is for and is for informational purposes only.
Affiliation Information
Complete all required fields in this section. Required fields are marked with an asterisk (*).
Start Date
Enter the start date of the affiliation in MM/DD/YYYY format.
End Date
Enter the end date of the affiliation in MM/DD/YYYY format. This field is optional, only enter an end date if you wish to end the affiliation.
Remittance Advice Statement
Select the appropriate option for the requested affiliation using the drop-down list. Your options are:
Review the Billing Organization/Responsibilities page of the MHCP provider manual for more information on these options.
Digital Signature
Type the full name of the person uploading the Electronic Remittance Advice (RA) Request (DHS-4087) (PDF) in the Digital Signature field. Go to the Digital Signature section on the Recurring Items page of the MPSE User Manual for more information.
Signers Title
Type the professional title of the person uploading the Electronic Remittance Advice (RA) Request (DHS-4087) (PDF) in the Signers Title field. Go to the Digital Signature section on the Recurring Items page of the MPSE User Manual for more information.
Signature Date
Type the date you are uploading the Electronic Remittance Advice (RA) Request (DHS-4087) (PDF) in the Signature Date field. Go to the Digital Signature section on the Recurring Items page of the MPSE User Manual for more information.
Upload
At least one document is required to be uploaded with your affiliation request. Upload the Electronic Remittance Advice (RA) Request (DHS-4087) (PDF) by clicking on the words Add File. This opens 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. You can upload multiple files by continuing to click Add File.
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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