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MHCP Provider Manual

Latest Manual Revisions

Revised: 12-31-2015

Updates cited below do not include minor grammatical or formatting changes that otherwise do not have bearing on the meaning of the policy contained herein. Refer to Provider Updates that may contain additional MHCP coverage policies or billing procedures. MHCP incorporates information from these updates into the Provider Manual on an ongoing basis. Sign up to get email notices of section changes.

12-31-2015
Addition(s)/Revisions

Mental Health Services

· Family Psychoeducation – MHCP now covers Family Psychoeducation services.

12-24-2015
Addition(s)/Revisions

Billing Policy
Billing the Recipient:

· Updated MinnesotaCare copays for 2016.

· Added statement that for emergency room visits for nonemergency services, a provider may not charge a recipient a copay if the provider is unable to locate a nonemergency provider for referral.

· Updated the family deductible for 2016 to $2.95.

· Added preventative services, smoking cessation treatments and prescriptions and immunizations to the copay and family deductible exclusions.

· Revised copay and family deductible limitations to extend the limit of 5 percent of gross monthly income to recipients with income over 100 percent of the federal poverty guidelines (FPG).

· Revised the policy on recipient inability to pay copay. The policy is no longer based on whether a program is state funded or federally funded. It is now based on whether the program is a Medical Assistance program or a MinnesotaCare program. See the section for exact details.

12-23-2015
Addition(s)/Revisions

Mental Health Services

· Intensive Residential Treatment Services (IRTS) – Added information for providers about billing for interpreter services.

12-14-2015
Addition(s)/Revisions

Reproductive Health/OB-GYN

· Family Planning – Changed ICD-9 diagnosis code V25.03 to ICD-10 diagnosis code Z30.012 to bill emergency contraceptives under Billing.

12-07-2015
Addition(s)/Revisions

Mental Health Services

· Telemedicine Delivery of Mental Health Services – Revised billing instructions and added information about reporting place of service.

Pharmacy Services – Changed the wording to Advance recipient notice under accepting cash payments.

12-04-2015
Addition(s)/Revisions

Provider Basics
Billing Policy (Overview)

· Minnesota-defined U Modifiers – Updated the U modifiers in this section:

· For U1: added substance abuse treatment–outpatient nonresidential codes; deleted Access Transportation Services; added code T2023 for vulnerable adult case management

· For U2: Changed Medical Supplies to Incontinence Supplies

· For U3: deleted "for sign language or any DMEPOS Medical Supply code for the code for enhanced service or item; changed "Health Care Home/Medical Home" to Medical Home Program–comprehensive care coordination and planning, initial plan; added Medical Home Program–comprehensive care coordination and planning, maintenance of plan

· For U4: deleted Health Care Home/Medical Home

· For U5: deleted Behavioral Health Home; added Medical Home Program–comprehensive care coordination and planning, initial plan, Behavioral Health Home; added Medical Home Program–comprehensive care coordination and planning, maintenance of plan, Behavioral Health Home

· For U6: added codes plus modifiers for Moving Home Minnesota; added nursing assessment or evaluation to temporary service license; added temporary service license, RN services, up to 15 minutes

· For UA: added for night supervision, per 15 minutes and per diem

· For UB: added for companion care services, 24-hour emergency service per diem

· For UD: added mental health assessment by nonphysician, follow-up or review [ARMHS]; added mental health service plan development by nonphysician, follow-up or review [ARMHS]; added typical time increments of 5 or 10 minutes for emergency department triage; added two clarifications for transitioning to community living: 1) environment intervention for management of medical conditions and 2) psychosocial rehabilitation services per 15 minutes

12-03-2015
Addition(s)/Revisions

Elderly Waiver (EW) and Alternative Care (AC) Program – Added section Billing for Waiver Services for an Individual in an Institutional Setting and Billing and Absences from a Residential Setting.

Also adding Family Memory Care to covered services.

Provider Basics
Billing Policy (Overview)

· Medicare and Other Insurance – Health Saving Accounts (HSA) are considered the recipient’s personal funds and are not to be treated as third party liability, and are secondary to MHCP. Flexible Spending Accounts (FSA) are not treated as third party liability (TPL).

12-02-2015
Addition(s)/Revisions

Transportation Services

· Special Transportation Services (STS) – Wording adjustment/clarification for Wheelchair Transports.

11-30-2015
Addition(s)/Revisions

Reproductive Health/OB-GYN

· ICD-9 to ICD-10 Diagnosis Conversion Table – Added ICD-9 diagnosis code V25.42 with description, and its updated ICD-10 diagnosis code, Z30.431 with description added to Conversion table.

11-24-2015
Addition(s)/Revisions

Mental Health

· Mental Health Medication Management – Clarified eligible providers refer to E/M guidelines for medication management. Updated the Additional Resources.

11-23-2015
Addition(s)/Revisions

Immunizations & Vaccinations – Updated vaccines for 2015 influenza season and deleted the 2014 ACA Enhanced Admin Rates that ended Dec. 31, 2014. Also deleted information about the Adult Vaccine Programs, which ended June 30, 2014.

Added codes 90630 and 90662 to the codes for ages 19 and older.

Provider Basics
Programs and Services

Program HH (HIV/AIDS) Covered Services – Removed NT (case management only) in the Benefit table because it is obsolete. Corrected age for sealants to "through age 20" to match policy.

Under Dental Billing corrected error from "eligible" to "denied" claims to read that providers must contact Program HH to have their denied claims reviewed for reimbursement.

Due to changes that occurred with the Affordable Care Act, COBRA premiums was removed as a insurance benefit and premiums for Qualified Health Plans obtained through MNsure and insurance obtained through the open market were added.

11-18-2015
Addition(s)/Revisions

Mental Health Services

· Children’s Mental Health Clinical Care Consultation – MHCP now covers Mental Health Clinical Care Consultation.

11-16-2015
Addition(s)/Revisions

Equipment and Supplies

· Non-Mobility Equipment Repairs – Clarified equipment eligible for maintenance service under Covered Services. Removed authorization requirement for most maintenance service.

11-05-2015
Addition(s)/Revisions

Mental Health Services – Updated manual to reflect new ICD-10-CM diagnostic code list.

· Mental Health Diagnostic Code Ranges – New section for mental health code ranges for children with emotional disturbance.

11-03-2015
Addition(s)/Revisions

Chiropractic Services – Added CPT codes 72069 and 72072 under X-ray Codes.

10-30-2015
Addition(s)/Revisions

Child and Teen Checkups (C&TC)

· Added fluoride varnish application in the primary care provider setting, including the CPT code 99188 and recommended FVA training resources

· Revised Screening for Autism Spectrum Disorder (ASD) in Toddlers section, including documentation and referrals Use the new modifier, U1, with CPT code 96110 for billing ASD specific screening

· Updates made to the Screening Exceptions section

· Updates made to resources throughout the C&TC policy

10-22-2015
Addition(s)/Revisions

Moving Home Minnesota (MHM)

· Moving Home Minnesota Supported Employment Services (MHM SES) – Added a section for Approved Moving Home Minnesota Certified Providers and linked to the certified provider list and the MHM program manual.

10-21-2015
Addition(s)/Revisions

Lab/Pathology, Radiology & Diagnostic Services

· Lab/Pathology Services – Clarified under Billing (Reference and Outside Lab Services) that providers that bill on the 837I should continue to bill as normal; providers that bill on the 837P should continue to use the 90 modifier.

Deleted confirmatory drug testing statement in the Drug Testing section.

Under Pathology Services, deleted outdated information and added to bill pathology services with the 26 modifier using 837P.

10-14-2015
Addition(s)/Revisions

Elderly Waiver (EW) and Alternative Care (AC) Program

· Waiver and AC Programs – Specialized Supplies & Equipment Authorization & Billing Responsibilities – Added email address for DSD Response Center under the Lead Agency Responsibilities.

10-09-2015
Addition(s)/Revisions

Early Intensive Developmental and Behavioral Intervention (EIDBI)

· EIDBI Billing Grid – Updated the intervention observation and direction to a maximum of 130 hours over a 6 month period. Changed to a maximum total of 65 hours over 6 months combined for family training services for Family/Caregiver Training and Counseling.

10-05-2015
Addition(s)/Revisions

Lab/Pathology, Radiology & Diagnostic Services

· Lab/Pathology Services – Removed 90 mod requirement for 837I; added information about billing by staff-model clinics for lab services performed at other sites within the same health maintenance organization (HMO) or by a reference or outside lab.

10-01-2015
Addition(s)/Revisions

Provider Basics

· Authorization – Revised to reflect new language about investigational drugs, biological products or devices and related services.

Early Intensive Developmental and Behavioral Intervention (EIDBI) – Added the MHCP Fee Schedule link to the Billing section and included information on daily individual or group intervention units.

Reproductive Health/OB-GYN

· Abortion Services – An MHCP ICD-9 to ICD-10 Abortion Diagnoses Conversion Table is now available under the Billing section.

09-30-2015
Addition(s)/Revisions

Reproductive Health/OB-GYN

· Minnesota Family Planning Program (MFPP) – An ICD-9 to ICD-10 Conversion Table is now available in the MFPP section to help providers during the conversion process. We also added a MFPP Contraceptive and Medication Supplies Table under the Contraceptive and Medication Supplies section.

09-28-2015
Addition(s)/Revisions

Individualized Education Program (IEP) Services – Home – Added links to headings under the PCA and the Billing and Authorization Requirement sections.

Individualized Education Program (IEP) Services

· IEP Personal Care Assistance (PCA) Services – Revised entire Personal Care Assistance Services section to clarify information for school-based PCA services. Added information for coverage criteria, level 1 behaviors, identifying qualified professionals (QP), documentation requirements for the QP, PCA and PCA plan of care. Added to the Legal References that are noted.

09-25-2015
Addition(s)/Revisions

Provider Basics

· Authorization – New EIDBI authorization information into the KEPRO section.

09-16-2015
Addition(s)/Revisions

Dental Services

· Authorization Requirement Tables for Children and Pregnant Women – Deleted obsolete code for Overdenture Partial (D5861) under Partial Dentures.

Mental Health Services

· Adult Rehabilitative Mental Health Services (ARMHS) – Updates section to add new policy for Functional Assessment and Individual Treatment Plan.

09-14-2015
Addition(s)/Revisions

Alcohol and Drug Abuse Services – CD 2% rate increase. Under Managed Care Recipients we removed references to the $10,000 benefit limit for MinnesotaCare because this limit ended Dec. 31, 2013.

Hospital Services

· Outpatient Hospital Services – Added a new section for Direct Admission Billing Policy. Billing outpatient observation services requires that a procedure code be reported on the 837I outpatient claim.

09-11-2015
Addition(s)/Revisions

Community Health Worker – We updated the Billing section for an increase in the maximum amount of billable units per month, per recipient to indicate the maximum units per calendar month, per recipient went from 8 units maximum per month to 24 units maximum per month.

Dental Services

· Non-Pregnant Adults – D5860 (Over denture complete) and D5861 (Over denture partial) were removed because the codes have been discontinued.

Lab/Pathology, Radiology & Diagnostic Services

· Lab/Pathology Services – Under Billing, in the Date ranges affected by this policy section, added text clarification - date ranges field on the 837P. In the Exceptions section, provider based clinic may continue to bill for laboratory services performed by a reference or outside lab and only if the lab is providing services either as part of the hospital or when operating under an arrangement that is within the scope of the hospital's certification.

09-08-2015
Addition(s)/Revisions

Provider Basics
Billing Policy (Overview)

· Billing Policy Overview – Revised policy on Free-Care services. MHCP will now pay for services even when the provider offers the same service for free to other patients.

08-27-2015
Addition(s)/Revisions

Laboratory/Pathology, Radiology & Diagnostic Services

· Laboratory/Pathology Services – Added information regarding changes for lab billing changes taking effect on October 1, 2015 for specific provider types. The MDH Infectious Disease section was removed in error and has now been reposted. Providers billing for CPT 99000 specimen handling should refer to this section for billing requirements.

08-25-2015
Addition(s)/Revisions

Medication Therapy Management Services (MTMS) – Change to Eligible Recipients now only needing to have one medication. Changed MTMS delivered via Interactive Video to allowing recipients to use in their own home.

08-17-2015
Addition(s)/Revisions

Provider Basics
Billing Policy (Overview)

· Billing the Recipient – In Noncovered Services, removed tramadol from the statement to not use the DHS-3640 for controlled substances or tramadol because tramadol is now considered a controlled substance.

Clarified the Family Deductible section and added a new section, Collecting Copays and Family Deductibles, to clarify billing rules for deductibles and copays.

Provider Basics
Provider Requirements

· Provider Screening Requirements – Added announcement about the delay in sending Revalidation Requests to some providers.

07-29-2015
Addition(s)/Revisions

Hospice Services

Updated text under:

· Eligible Recipient: Clarified the requiring dual eligibles to elect both Medicare and Medicaid Hospice.

· Content of Plan of Care: Designating a RN to coordinate the plan of care

· Hospice Services for Residents of a Long Term Care Facility: Added link to Variable Rate Adjustments, removed link to obsolete Bulletin #00-56-23

· Submitting the Hospice Transaction form: Clarified instructions for completing the Hospice Transaction Form

· Added MHCP Member Information

07-27-2015
Addition(s)/Revisions

Community Living Assistance (CLA) Services – Added the legislative increase of 1% in the submitting claims section to show the increased amount for procedure code H2015 for dates of services on or after 7/1/2015 to $4.50 per unit and H2016 to $6.06 per day.

Elderly Waiver (EW) and Alternative Care (AC) Program
Eliminated 5 daily codes for dates of service on and after 07/01/15:

· Adult Day Service S5102

· Adult Day Service (FADS) S5102 U7

· Homemaker- Assistance with personal cares S5131 TG

· Homemaker- Cleaning S5131

· Homemaker- Home Management S5131 TF

Changed references from Customized Living Tool to Residential Services Tool under Definition.

Required that lead agencies use the Residential Services tool to determine rates for foster care and residential care, beginning July 1, 2015 under Covered Services.

Revised legal citations and fixed some transposed numbers under Legal References and Resources.

Essential Community Supports
Updated the legislative information and clarification:

· Name change for CADI to Community Access for Disability Inclusion under Eligible Recipients

· Updated the monthly maximum service budget to $428 under Covered Services

· Added links to Community Living Assistance and Adult Day Services under Covered Services

· Added clarification information to the Manage Care Enrollees section that the MCO's without a lead agency delegate using MMIS will send the service agreement (SA) to DHS under Billing.

Provider Basics
Programs and Services

· MHCP Benefits at-a-glance – Updated the benefits chart to indicate transportation and interpreter services are covered under Emergency Medical Assistance (EMA). EMA has covered these services since 2012.

07-20-2015
Addition(s)/Revisions

Anesthesia Services – Clarified difference between CAH exempt and non-exempt status when billing for CRNA services.

Hospital Services

· Critical Access Hospital (CAH) Services – Added a link to the 837P under CRNA Services.

07-17-2015
Addition(s)/Revisions

Provider Basics
Programs and Services

· Health Care Programs and Services Overview – Added Hospital Presumptive Eligibility program that was part of the Affordable Care Act.

07-16-2015
Addition(s)/Revisions

Hospital Services

· Inpatient Hospital Services – Added Instructions for MHCP Eligibility Beginning After the Date of Inpatient Admission.

Individualized Education Program (IEP) Services

· IEP Providers – Changed link for the submitting information to the IEP Provider Contact List.

Pharmacy Services – Added Phentermine to Accepting Cash Payments from recipents.

07-15-2015
Addition(s)/Revisions

Ambulatory Surgical Centers – Added statement in the Billing section to refer to the Outpatient Dental Surgery Services table when billing for anesthesia used during outpatient procedures.

Immunizations & Vaccinations – Added MN Statute allows administration of influenza vaccines to patients 19 years of age and older by dentist.

07-14-2015
Addition(s)/Revisions

Laboratory/Pathology, Radiology & Diagnostic Services

· Radiology/Diagnostic Services – Change in Authorization Requirements.

07-02-2015
Addition(s)/Revisions

Early Intensive Developmental and Behavioral Intervention (EIDBI) – New EIDBI Services effective July 1, 2015

· Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment – New EIDBI Provider Enrollment Process

06-29-2015
Addition(s)/Revisions

Individualized Education Program (IEP) Services

· IEP Billing and Authorization Requirements

· Under Billing Requirements: ICD-10 codes – Added ICD Coding timeline

· Moved placement of existing text about: Seek reimbursement from other payers

· Moved placement of existing text about: Benefit Limits; Timely Billing

· Procedure Codes, Modifiers and Units: Added Clarification and Billing changes effective on July 1, 2015

06-25-2015
Addition(s)/Revisions

Provider Requirements

· MHCP Member Evidence of Coverage – Added the covered and non-covered services to the Moving Home Minnesota (MHM) section of the manual. Effective January 1, 2015, the MHCP family deductible is $2.85.

06-23-2015
Addition(s)/Revisions

Laboratory/Pathology, Radiology & Diagnostic Services

· Laboratory/Pathology Services

· Corrected the date for those providers with an exception to the reference lab services requirement. This policy change now applies effective Oct. 1, 2015, for the three listed provider types.

· Removed MDH Infectious Disease Reporting section. Effective Jan. 1, 2013, MHCP no longer covers this service.

· Replaced the previous section on Cytogenetic Testing with a new section including information about coverage of genetic testing.

· Revised the Drug Testing section to indicate that effective Jan. 1, 2015, confirmatory drug testing is no longer covered by MHCP.

Provider Requirements

· Provider Screening Requirements – Added Early Intensive Developmental and Behavioral Intervention (EIDBI) to the Risk Assignment table and to the list of institutional providers.

06-22-2015
Addition(s)/Revisions

Provider Basics

· Provider Requirements – Added information to the Record Keeping requirements, under Retention of Records, clarifying that records may be maintained in an electronic health record (EHR) system.

06-19-2015
Addition(s)/Revisions

Pharmacy Services

· Home Infusion Therapy – Added effective dates for using SH and SJ modifiers under Fee-for-Service (MHCP coverage only).

06-18-2015
Addition(s)/Revisions

Equipment and Supplies

· Hospital Beds – Removed Pedicraft and Sleepsafe examples from Bed Enclosure section and also removed the note regarding Posey under list of Codes.

Provider Basics
Programs and Services

· Health Care Programs and Services Overview – Added major program UN for Essential Community Supports (ECS).

06-16-2015
Addition(s)/Revisions

Individualized Education Program (IEP) Services

· IEP Providers – Added Excluded Provider List requirements for school districts under Overview.

06-15-2015
Addition(s)/Revisions

Hospice Services – Changed the % in the Bed-hold Billing section of the manual page to facility occupancy rate to 96% or greater and Bed-hold day rates are 30% of the case-mix rate.

Reproductive Health/OB-GYN

· Minnesota Family Planning Program (MFPP) Procedure Codes – Added major program FP to CPT code 87389.

06-10-2015
Addition(s)/Revisions

Equipment and Supplies

· Nutritional Products and Related Supplies

· Clarified the enteral feeding supply kits limit. With approved authorization, more than 51 units can be allowed. This is not a policy change.

· Changed the limit of 10 to 31 extension sets under Supplies Not Otherwise Classified.

· Under Noncovered Services, deleted that more than one enteral supply kit per day would not be covered, since more may be covered with authorization.

06-09-2015
Addition(s)/Revisions

Equipment and Supplies

· Mobility Devices – Changed language for Wheel Chair Options and Accessories subsections that require documentation from the recipient acknowledging that approval of these functions may affect future requests for PCA or home care services.

06-08-2015
Addition(s)/Revisions

Provider Requirements

· Provider Screening Requirements – Removed duplicate entry of Clinical Nurse Specialist from September 1, 2015, Revalidation Schedule. Clinical nurse specialists are on the schedule for May 15, 2015.

Reproductive Health/OB-GYN

· Obstetric Services and HIV Counseling

· Deleted reference to MHCP Payment Rates for Births in the Covered Services section. The document referenced has expired.

· Deleted the statement about using modifier 22 on claims for weekend classes; this is no longer required and updates the Provider Manual to conform with this change announced elsewhere previously under Maternal Health Education.

· Added in the Billing section for Obstetric Services that if all components of the panel are not performed, to bill the individual laboratory procedure codes you have CLIA approval to bill.

05-27-2015
Addition(s)/Revisions

Hospital Services

· Inpatient Hospital Services – Updated Extended Inpatient Psychiatric Services Under Contract with DHS to include additional links to Forms and Resources.

05-21-2015
Addition(s)/Revisions

Provider Basics
Provider Requirements

· Provider Screening Requirements – Added information under Revalidation, referring to the MN–ITS Mailbox user guide and the requirement for all providers to create a MN–ITS account. Clarified that revalidation letters will go to each provider record. If a provider works for an agency, both the individual provider and the agency will get a letter.

05-15-2015
Addition(s)/Revisions

Hospital Services

· Inpatient Hospital Authorization – Clarified language in the readmission prior authorization and billing process.

05-13-2015
Addition(s)/Revisions

Provider Basics

· Provider Requirements – Added the section Office of Inspector General's list in the Provider Requirements section on the requirements of providers to check the Office of Inspector General's list for employees, owners, managing employees, board member's against the list. If the person is on this list MHCP will not make payments for the services provided.

05-19-2015
Addition(s)/Revisions

Intermediate Care Facilities (ICF/DDs) – Added the ICF/DD Portal link under billing and removed an old link for Long Term Care E3 changes update that did not exist anymore. Included new information when billing for weekly units.

05-15-2015
Addition(s)/Revisions

Hospital Services

· Inpatient Hospital Authorization – Clarified language in the readmission prior authorization and billing process.

Reproductive Health/OB-GYN

· Doula Services – Corrected number of visits to seven from six under Covered Services.

· Family Planning Codes with Increased Rates – When billing for levongestrel IUD insertions use J7307 as J7306 is no longer billable.

· Minnesota Family Planning Program (MFPP) Procedure Codes – Bill J7307, Implanon implant system, when billing contraceptive services as it has replaced J7306.

05-14-2015
Addition(s)/Revisions

Dental Services

· Non-Dental Health Providers – Clarified text and added billing information for FVA with CPT code.

05-13-2015
Addition(s)/Revisions

Dental Services

· Non-Pregnant Adults – Updated PA requirement for partial dentures.

Provider Basics
Provider Requirements

· Provider Screening Requirements

· Moved the screening actions table to the end of the risk levels section

· Clarified which provider types MHCP assigns risk levels to

· Elaborated on the revalidation process

· Added a 2015 revalidation schedule for provider types

· Added information that CMS may request more information before making a final determination about hardship requests

05-12-2015
Addition(s)/Revisions

Child and Teen Checkups (C&TC)

· Added Primary Care Provider Requirements in Dental Service section.

· Revised the Developmental and Mental Health Screenings section and renamed it Developmental and Social-Emotional or Mental Health Screenings. Revisions in this section include the following:

· Clarified language regarding screening instruments and billing

· Updated resources

· Added the new CPT code 96127 for billing for a social-emotional or mental health screening with a standardized instrument

· Updated information about documentation. CPT code 96127 for a social-emotional or mental health screening has been added.

· Revised first paragraph of Screening for Autism in Toddlers and updated information about documentation.

05-06-2015
Addition(s)/Revisions

Hospital Services

· Inpatient Hospital Services – Updated policy on Anesthesia Services to reflect the Legislative Update that went into effect on November 1, 2014 for CRNAs. Hospitals must exclude charges for certified nurse anesthetists from inpatient rates.

· Outpatient Hospital Services – Removed initial codes for the contract information code on the following: Hydration, Infusion, Drug Injections, and Chemotherapy Administration.

05-01-2015
Addition(s)/Revisions

Dental Services (Overview) – Added a section about Temporomandibular Joint Disorder (TMD).

Rehabilitative Services – Under Documentation Requirements, we removed the statement that the ordering or prescribing physician must sign the plan of care. In the Billing section, we corrected information about billing timed therapy codes and added clarifying information to not follow Medicare’s rounding rules for speech, occupational, and physical therapy services.

04-28-2015
Addition(s)/Revisions

Transportation

· Special Transportation Services (STS) – Added the MN Statute 256B.04, Subd. 14a Level of need determination to the bottom of the STS manual page in the Legal References section.

04-21-2015
Addition(s)/Revisions

Provider Basics

· Authorization – Updated phone and fax numbers for Telligen.

Programs and Services

· Emergency Medical Assistance (EMA) – Updated phone and fax numbers for Telligen.

04-16-2015
Addition(s)/Revisions

Alcohol and Drug Abuse Services

· Continuum of Care Pilot – New sub-section has been added under the Alcohol and Drug Abuse Services section for chemical health providers participating in the Continuum of Care Pilot.

04-10-2015
Addition(s)/Revisions

Individualized Education Program (IEP) Services

· Individualized Education Program (IEP) Services home – Added link to Health Recordkeeping and Documentation under Speech Language Pathology

· Speech and Language Pathology and Audiology Services – Added the standard text and link to the Recordkeeping and Documentation section of the IEP manual.

04-09-2015
Addition(s)/Revisions

Reproductive Health/OB-GYN

· Sterilization – Added "From date" to the information about premature births and the sterilization form requirements to clarify the information.

04-02-2015
Addition(s)/Revisions

Individualized Education Program (IEP) Services

· Occupational Therapy Services – Added Treatment Plan and goals under Authorization section to clarify.

· Physical Therapy Services – Added Treatment Plan and goals under Authorization section to clarify.

· Speech and Language Pathology and Audiology Services – Added Treatment Plan and goals under Authorization Requirements section to clarify.

Laboratory/Pathology, Radiology & Diagnostic Services

· Laboratory/Pathology Services – Under Billing, we removed the statement that indicated providers cannot bill for reference lab services on the 837I for dates of service before January 1, 2015.

04-01-2015
Addition(s)/Revisions

Hospital Services

· Inpatient Hospital Authorization – The Appropriateness Evaluation Protocal is being replaced with Interqual that policy is still currently working on.

03-27-2015
Addition(s)/Revisions

Provider Basics
Billing Policy (Overview)

· Billing the Recipient – Under Copays and Family Deductible, we revised copay information to remove reference to copays on inpatient services and remove the annual limit of $10,000 for MinnesotaCare.

03-18-2015
Addition(s)/Revisions

Hospital Services

· Inpatient Hospital Authorization – Under Criteria to Determine Medical Necessity, we deleted Appropriateness Evaluation Protocol (AEP) as the evidence-based clinical support tool. We revised the text to reflect the current standard and practices.

03-17-2015
Addition(s)/Revisions

HCBS Waiver Services

· Home and Community Based Services (HCBS) Programs Provider Enrollment – Changed the title and information on the page to include enrollment for ECS programs as well as waiver and AC. Added information and additional instructions when checking the OIG Exclusions list, enrolling each service location and revalidation for HCBS providers.

03-13-2015
Addition(s)/Revisions

Personal Care Assistance (PCA) Services – Under Supervision for PCA Services, we removed the Qualified Professional (QP) Activities & Timelines (PDF) because some of the information was not up to date.

03-11-2015
Addition(s)/Revisions

Hospital Services

· Inpatient Hospital Services – Added information to MinnesotaCare section. Effective for dates of service on or after January 1, 2015, inpatient hospital services for MinnesotaCare Basic Plus One (major program BB) enrollees are covered by the MCO.

03-10-2015
Addition(s)/Revisions

HCBS Waiver Services

· HCBS Waiver Services – Clarified text for Billing Recipient Absences.

03-06-2015
Addition(s)/Revisions

Laboratory/Pathology, Radiology & Diagnostic Services

· Laboratory/Pathology Services – In the Billing section for Reference and Outside Lab Services, we added information that the policy change is effective July 1, 2015, for services billed by the following provider types:

· Outpatient hospitals

· Provider-based clinics

· Independent laboratories

Pharmacy Services

· Home Infusion Therapy – In the section Fee-for-Service ( MHCP coverage only) - the fifth bullet point - added " Use of SH and SJ modifiers reduce line item payable to 50% of current allowable charge".

03-05-2015
Addition(s)/Revisions

Hearing Aid Services

· Cochlear Implants – Revised criteria for cochlear implants for both adults and children.

03-02-2015
Addition(s)/Revisions

Day Training and Habilitation (DT&H) – Under Special Needs Rate Exception for ICF/DD Resident added code X7020 and updated code X7025 to X5628.

Provider Basics

· Provider Requirements – Added information about the requirement of providers to report suspected maltreatment of a child or vulnerable adult.

02-26-2015
Addition(s)/Revisions

Community Living Assistance (CLA) Services – Added Community Living Assistance (CLA) Services as a new section to the MHCP Provider Manual.

02-25-2015
Addition(s)/Revisions

Day Training and Habilitation (DT&H) – Revised DT&H Manual page to include following sections: Overview; Eligible Providers; Eligible Recipients; Covered Services; Noncovered Services; Authorization; Billing and Rates. Added DWRS information and link. Removed Pilot Rates since this no longer applies. Clarified text for Services for Recipients Age Twenty One and Under section. Clarified text for Submitting Claims section.

02-24-2015
Addition(s)/Revisions

Essential Community Supports – Added Essential Community Supports as a new service to the MHCP Provider Manual.

02-17-2015
Addition(s)/Revisions

Provider Basics

· Managed Care Organizations (MCOs) and Prepaid Health Plans (PPHPs) – Added information to Covered Services and Carve-Out Services sections. Effective for dates of service on or after January 1, 2015, inpatient hospital services for MinnesotaCare Basic Plus One (major program BB) enrollees are covered by the MCO.

02-13-2015
Addition(s)/Revisions

Provider Basics
Provider Requirements

· Health Care Programs and Services Overview – Added a sentence in the Incarcerated Recipients section.

Rehabilitative Services – Added clarifying text for MHCP enrollment, rehab billing entities and timed codes.

Reproductive Services

· Free-Standing Birth Center Services – We clarified that physicians are eligible for reimbursement of services provided in Free-Standing Birth Centers, for those facilities that employ a physician. We also clarified to use CPT code 59400 to bill globally on the 837P and 837I under the Billing section.

Transportation Services (Overview) – Clarified all text in document.

02-11-2015
Addition(s)/Revisions

Hospital Services

· Inpatient Hospital Services – Added language explaining under Eligible Recipients that a person incarcerated in a state or local correctional facility may qualify for MA payment for inpatient hospital services.

02-09-2015
Addition(s)/Revisions

Provider Basics
Provider Requirements

· Provider Screening Requirements – Under Application Fees we updated the screening fee requirements amount to reflect the new fee of $533.00, which became effective January 1, 2015.

Transportation Services

· Special Transportation Services (STS) – Formatting and overall text clarification.

02-06-2015
Addition(s)/Revisions

Anesthesia Services – The 2015 anesthesia rates are now available.

Medication Therapy Management Services (MTMS) – Under Billing added clarification that drug combination products are counted as one medication.

MHCP Member Evidence of Coverage – Effective January 1, 2015, the MHCP family deductible is $2.85.

01-28-2015
Addition(s)/Revisions

Provider Basics
Provider Requirements

· Access Services – Added the description of the modifiers for serving multiple patients to the table.

01-27-2015
Addition(s)/Revisions

HCBS Waiver Services

· Void (“Take-Back”) Waiver and Alternative Care (AC) Service Claims for Fee-for-Service – Added text: Voids for MCOs should refer back to health plan.

Provider Basics
Provider Requirements

· PCA Provider Agency Enrollment – Added that the name and address for the liability insurance needs to be "MHCP PE" and include the appropriate address.

01-23-2015
Addition(s)/Revisions

Home Care Services – Changed PDN to HCN

01-21-2015
Addition(s)/Revisions

HCBS Waiver Services – Clarified billing for hospital stay.

01-20-2015
Addition(s)/Revisions

Reproductive Health/OB-GYN

· Minnesota Family Planning Program (MFPP) – Changed the text and link under Referrals to Other Providers that directed recipients to the DHS-3417 doc to now direct them to the MNsure website.

01-16-2015
Addition(s)/Revisions

Reproductive Health/OB-GYN

· Minnesota Family Planning Program (MFPP) Procedure Codes – As of Jan. 1, 2015, lab codes 87620, 87621 and 87622 are replaced with 87623, 87624 and 87625. MHCP will process any claims with codes 87620, 87621 and 87622 for dates of service before Jan. 1, 2015.

01-15-2015
Addition(s)/Revisions

Moving Home Minnesota (MHM) – Updated the MHM Eligible Providers information section and information about providers of other MHM services. Also updated the MHM Covered Services section and removed the original Demonstration and Supplement table in the manual and created a link to the table as a separate page and added provider qualifications and waiver interactions to the table.

01-13-2015
Addition(s)/Revisions

Physician and Professional Services – Added a sentence to the Preventative Medicine Services section to clarify that MHCP also covers Grade A and B preventive services recommended by the U.S. Preventive Services Task Force.

Reproductive Health/OB-GYN

· Obstetric Services and HIV Counseling – Deleted under Noncovered Services that doula services are not covered because MHCP now covers doula services.

01-12-2015
Addition(s)/Revisions

Chiropractic Services – Clarified use of modifier 25 when billing for E/M: An evaluation and management (E/M) service is allowed on the same date of service as a spinal manipulation only if the E/M service is significant and separately identifiable from the procedure that is performed.

01-09-2015
Addition(s)/Revisions

Provider Basics
Billing Policy

· Billing the Recipient – Effective January 1, 2015, the MHCP family deductible is $2.85.

01-07-2015
Addition(s)/Revisions

Reproductive Health/OB-GYN

· Free-Standing Birth Center Services – Clarified that CPT code 59400 should be used for care before birth (antepartum), labor and delivery, and postpartum.

01-02-2015
Addition(s)/Revisions

Moving Home Minnesota (MHM)

· Moving Home Minnesota Demonstration and Supplemental Services Table (PDF) – Extending the Moving Home Minnesota Demonstration and Supplemental Services and adding Provider Qualifications and Waiver Interactions to the table.

Previous Revisions

2014 Manual Revisions

2013 Manual Revisions

2012 Manual Revisions

2011 Manual Revisions

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