Medicare Certified Hospital Based Clinics Information
Revised: January 18, 2024
Medicare Certified Hospital Based Clinic Information
Overview
Use this page to manage your enrollment record’s hospital based clinic information. You can only edit the information on this page if you are in an MPSE Request.
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.
Medicare Certified Hospital Based Clinics Information
The Manage Hospital Based Clinics Information section displays information related to your existing hospital based clinics in your enrollment record. If you have not added any hospital based clinic information, this section will not have any information to display. If you have existing information in this section, you can select the following options from the User Actions column.
View/Edit
Click View/Edit to go to the Medicare Certified Hospital based Clinic page. From this page, you can view and edit your hospital based clinics information. To have the View/Edit option, you must be in an MPSE Request.
View
Click View to go to the Medicare Certified Hospital based Clinic page. From this page, you can view your hospital based clinics information. You will not be able to make any edits while in view mode.
Delete
Click Delete to delete Medicare certified hospital based clinic information. You will not be able to delete hospital based clinic information Minnesota Health Care Programs (MHCP) has approved.
Add Hospital based Clinic Information
Click Add Hospital based Clinic Information to go to the next page.
Continue
Click Continue to save your changes and go to the next page.
Cancel
Click Cancel to go back to the previous page.
Medicare Certified Hospital Based Clinic Information
Portfolio/Profile Information
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.
Medicare Certified Hospital based Clinic
In the Medicare Certified Hospital based Clinic section, you can add new hospital based clinic information or edit existing hospital based clinic information.
Name
Type the name of your hospital based clinic name in the Name field. The name field only allows 50 characters or less. If your clinic name is longer than 50 characters, type the whole name without abbreviations until you hit the character max and then stop.
NPI/UMPI
Type your hospital based clinic’s National Provider Identifier (NPI) or Unique Minnesota Provider Identifier (UMPI) in the NPI/UMPI field.
Taxonomy Code
Type your hospital based clinic’s taxonomy code in the Taxonomy Code field, if applicable. Taxonomy codes are only required if you have multiple hospital based clinics that share a zip code.
Street Address 1
Type your hospital based clinic’s street address in the Street Address 1 box.
Street Address 2 Type
Select your hospital based clinic’s address type from the Street Address 2 Type drop-down list. Street address type is required if you have typed information into the Street Address 2 Data field. If you have not typed data in the Street Address 2 Data field, do not select a Street Address Type 2.
The options you can select are:
Street Address 2 Data
Type your street address data into the Street Address 2 Data field. For example, if you select “Apt” as your street address 2 type, type your apartment number into the Street Address 2 data field.
Only enter information into this box if you select a street address type. If you have not typed data in the Street Address 2 Data field, do not select a Street Address Type 2.
City
Type the name of the city of your hospital based clinic in the City box.
State
Select the state of your hospital based clinic from the State drop-down list.
ZIP Code
Type the 5-digit zip code of your hospital based clinic in the ZIP Code box.
Begin Date
Enter the begin date of your hospital based clinic in the Begin Date box.
End Date
Enter the end date of your hospital based clinic in the End Date box, if applicable.
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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