MHCP Provider Manual - Provider Basics

Revised: March 26, 2024

This online MHCP Provider Manual is your primary information source for MHCP coverage policies, rates and billing procedures. The following linked content is for all providers and considered “provider basics.” All the following link to webpages within the MHCP Provider Manual.

Provider Requirements

· Access Services

· Billing Organizations/Responsibilities

· Excluded Provider Lists

· Provider Participation Requirements - Rule 101

· Provider Screening Requirements

· Risk Levels and Enrollment Verification Requirements

Health Care Programs and Services

· Emergency Medical Assistance (EMA)

· MHCP Benefits at-a-glance

Managed Care Organizations (MCOs)

Billing Policy Overview

· Billing the Member (Recipient)

· Medicare and Other Insurance

· Out of State Providers

· Payment Methodology - Hospital

· Payment Methodology - Non-hospital

· Supplemental Payments – Non-Hospital and Hospital

Authorization

· Drug Authorizations

· MHCP Pharmacy Quick Reference