Minnesota Minnesota

MN–ITS User Manual

MN–ITS User Manual

Submit an Authorization Request for Dental Services

Revised: July 28, 2022

Some Minnesota Health Care Programs (MHCP) services require authorization. Do not send authorization requests for services that do not require authorization. For authorization criteria and documentation requirements, refer to either the Authorization Requirement Tables for Children and Pregnant Women or Authorization Requirement Tables for Non-Pregnant Adults section of the MHCP Provider Manual.

Using MN–ITS Interactive

  • · Complete all bolded and asterisked (required) fields. Field titles with an asterisk (*) indicate that the information is mandatory.
  • · Complete other nonbolded or nonasterisked fields appropriate for your request
  • · Underlined items are linked to help and include additional information about that item, including information about completing a field, code definitions for fields, or instructional information.

    • Submitting an Authorization Request

  • 1. Log in to MN–ITS
  • 2. Select MN–ITS from the left-hand menu
  • 3. Select Authorization Request (278)

    • Completing the Authorization Tab

    Authorization Category

    Service Type Code: Select Dental Care from the drop-down menu.

    Requester

  • 1. Request ID (NPI/UMPI): The Organization or last name, first name, street address, city/town, state and ZIP code will auto-populate based on the NPI you used to log in. (The NPI/UMPI field identifies the individual party or organization that is requesting the service or item.)
  • 2. Communication Number: Enter the telephone, fax number (including area code) or email at which your contact can be reached. Click the A button to add the communication type. If you need to add another communication number, click the A button.
  • 3. Contact Name: Enter the first and last name of a contact person within your organization who can answer questions about this authorization request.

    • Subscriber

  • 1. Subscriber ID: Enter the subscriber’s (member’s) 8-digit number from the subscriber’s (member’s) MHCP ID card.
  • 2. Birth Date: Enter 2-digit month, 2-digit day, and 4-digit year (MMDDYYYY) format. The birth date must match the birth date on the MHCP ID card.
  • 3. Last Name: Enter the subscriber’s (member’s) last name.
  • 4. First Name: Enter the subscriber’s (member’s) first name.

    • Patient Event

  • 1. Certification Type Code: Indicates what type of request. The default response is (Initial). Select the appropriate CT code.
  • 2. Diagnosis Code: Diagnosis codes are not required for dental care.

    • Completing the Services Tab

    Service Information

  • 1. Begin Date: Enter the date when you would like to begin providing services in MMDDYYYY format in this field.
  • 2. End Date: Enter the date when you will complete these services in MMDDYYYY format in this field. You may leave this field blank if you are not sure of the end date.
  • 3. Procedure Code: Enter the appropriate procedure code.
  • 4. Modifiers: Enter modifiers in this field when necessary.
  • 5. Quantity: Enter the number of units you are requesting.
  • 6. Line Amount: Enter the total dollar amount (your usual and customary charge) you are billing for.
  • 7. Service Description: Enter a description of the service to be provided in the field, if needed. Note: This field has a 264-character limit. You will not be able to enter any more text in this field after the limit is reached.

    • Dental Information

    Tooth Number, Oral Cavity Designation and Prosthesis: These fields should only be used when the service you are requesting requires it.

    Service Setup

  • 1. Scroll up to this heading and click the Save button to save the line item you just entered.
  • 2. To add additional lines, click the New button to add an additional line item and clear the fields on the screen.
  • 3. To delete a line, select the line, then click the Delete button.
  • 4. Repeat the steps until all line items are entered.

    • Submitting your Authorization Request for review

    Click the Submit button. You will receive a response within seconds.

    Authorization Request Responses

    If your response states:

    Then:

    Transaction submitted successfully

    This request has been received for review by DHS.

    Print the response page, keep a copy for your records and one to attach to the required documentation.

    Write the 11-digit number assigned on each page of your documentation, and the same 11-digit number on all supporting clinical documentation pages that you will be mailing or faxing to Kepro.

    Refer to or for information on what supporting documentation needs to submitted for each specific PA request.

    Mail or fax all required supporting clinical documentation together to the     to assure accurate processing.

    Kepro
    Attention MN Medicaid
    6802 Paragon Place, Suite 440
    Richmond, VA 23230

    Fax: 866-889-6512

    This request is incomplete or invalid. The claim status codes below will provide additional information:

    Refer to the Claim Status Codes available on the X12 website.

    Note: if after completing the Services Tab you receive the error message: “Denied incorrect payer,” verify eligibility using MN–ITS to confirm the subscriber (member) is not enrolled with a managed care organization (MCO):

  • · If the subscriber (member) is enrolled in an MCO, contact the MCO.
  • · If the subscriber (member) is not enrolled in an MCO, contact the MHCP Provider Resource Center and verify the effective date of MCO coverage. For services completed before effective date of MCO coverage, use the actual date of service or a date before the MCO effective date

    • You will receive the final Authorization Letter in your MN–ITS Mailbox Miscellaneous Received file type: PAL after your Authorization Request is approved or denied.imageimageimage

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