MHCP Provider Manual
2012 Manual Revisions
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.
12/28/2012 |
Immunizations & Vaccinations – Updated the Immunization and Vaccination manual section to clarify information, and update the immunizations/vaccinations available through MDH MnVFC and Adult vaccines |
12/24/2012 |
Mental Health Services – Overview |
12/20/2012 |
Mental Health Services – Overview |
12/14/2012 |
Hearing Aid Services – Added information and links to new Cochlear Implants page |
12/13/2012 |
· Home and Community Based Services (HCBS) Waiver and Alternative Care (AC) Provider Enrollment – Added instructions for using form 6638 to enroll or add services to a waiver or AC enrollment record and also instructions for submitting assurance statements as appropriate |
Physician and Professional Services – Revised billing codes listed for Genetic Counselor |
12/06/2012 |
Provider Basics |
12/05/2012 |
HCBS Waiver Services – Added Waiver and Alternative Care (AC) Programs Service Request Form (DHS-6638) under MHCP Enrollment |
12/04/2012 |
Hospital Services – Updated/removed information under Mental Health Partial Hospitalization |
12/03/2012 |
11/28/2012 |
Mental Health Services – Overview |
11/21/2012 |
11/14/2012 |
Child and Teen Checkups (C&TC) - Clarified requirements and criteria for C&TC Development Mental Health Screening |
11/13/2012 |
Health Care Homes - Effective 12/6/12, the process to notify MHCP of your Health Care Homes status has changed |
11/06/2012 |
Hearing Aid Services – Corrected hearing aid service provider definition |
11/05/2012 |
Rehabilitative Services – Removed Authorization Criteria text |
11/02/2012 |
11/01/2012 |
10/24/2012 |
Hearing Aid Services – Removed Claims with DOS 12-31-08 and earlier, use modifier RP and Claims with DOS 1-1-09 and later, use modifier RB under Repair Claims |
10/18/2012 |
10/17/2012 |
10/15/2012 |
Provider Basics |
10/11/2012 |
Mental Health Services – Overview |
Provider Basics |
10/10/2012 |
Hospital Services – Removed reference to GAMC |
Provider Basics |
10/08/2012 |
Pharmacy Services – Examples provided of proper usual and customary price submission for OTC medications |
10/04/2012 |
Mental Health Services – Overview |
09/28/2012 |
Hearing Aid Services – Clarified language related to billing aids that are unsatisfactory and removed reference to GAMC |
09/26/2012 |
Immunizations & Vaccinations – Removed reference to GAMC |
Mental Health Services – Overview |
Personal Care Assistance (PCA) Services – Removed references to GAMC |
Pharmacy Services – Removed references to GAMC |
Physician and Professional Services – Added code 98960 for 1:1 NPP education/counseling. Updated Sleep Testing section to remove the authorization requirement. Removed reference to GAMC |
Provider Basics |
Provider Basics |
Renal Dialysis Overview – Removed reference to GAMC |
Tribal and Federal Indian Health Services – Removed reference to GAMC |
09/24/2012 |
09/18/2012 |
Mental Health Services – Overview |
09/14/2012 |
09/13/2012 |
Equipment & Supplies – Updated because of the new Orthotics section · Orthotics – New subsection |
09/12/2012 |
Provider Basics |
09/11/2012 |
Elderly Waiver (EW) and Alternative Care (AC) Program – Updated link in the billing section under Payment Rate information |
09/10/2012 |
Pharmacy Services – Added link to Specialty Drug List under Specialty Pharmaceutical Reimbursement. Removed link to Drug Quantity Limits Summary Sheet. |
08/30/2012 |
08/27/2012 |
HCBS Waiver Services – Added link to Reimbursement for Overhead Expenses due to Residential Absence policy to the billing instructions for billing recipient absence |
08/24/2012 |
08/17/2012 |
Mental Health Services – Overview |
08/09/2012 |
Mental Health Services – Overview |
08/06/2012 |
08/02/2012 |
HCBS Waiver Services – Linked all covered services content to Disability Services Program policy pages. Added billing examples to the Billing section. |
Hospital Services – For elective inductions done on or after 8.1.12, physicians no longer have to submit the Non-participating Facility Births Evidence-based Childbirth Program form (DHS-6469). |
Physician and Professional Services – As of 8.1.12, at hospital without a hard stop policy, physicians doing elective inductions before 39 weeks gestation on or after 8.1.12, no longer have to submit the Non-participating Facility Births Evidence-based Childbirth Program form (DHS-6469). |
07/30/2012 |
07/19/2012 |
Intermediate Care Facilities (ICF/DDs) – Added Minnesota Rules 4665.0500 Building Classification link to Legal References and removed link to Eligible Providers section for building classification |
07/17/2012 |
Hearing Aid Services – Added "wax guards" to examples of non-covered services |
07/16/2012 |
Laboratory/Pathology, Radiology & Diagnostic Services |
Mental Health Services – Overview |
07/03/2012 |
06/29/2012 |
Pharmacy Services – Updated OTC policy to reflect recent legislative changes. New policy is that pharmacies MAY repackage OTCs but must still dispense the entire package quantity in nearly all cases. Added Home Infusion Therapy to the Table of Contents under Covered Services. |
06/28/2012 |
06/26/2012 |
Hospice Services – Included reference to children's hospice benefit change, that recipients under age 21 don't have to forego curative care related to terminal illness when electing hospice benefits |
06/21/2012 |
06/20/2012 |
Nursing Facilities – Payments for leave days in a nursing facility to 30 percent not 60% in the Leave Days (SNF/NF/BCH) section |
Transportation Services (Overview) – Clarified definition for MNET and No Load Transportation |
06/14/2012 |
EMA Service Limitations – Added what happens to treatment with dates of service after June 30, 2013 |
06/11/2012 |
EMA Service Limitations – Updated to include coverage of cancer and kidney dialysis treatment as announced in EMA Announcement III |
06/08/2012 |
06/05/2012 |
Physician and Professional Services |
05/23/2012 |
05/17/2012 |
Physician and Professional Services – Removed place of service code information under Physician Services While Recipient is Inpatient Status. Removed duplicate bullets under Non-Covered Services/Treatment. Corrected information under Genetic Counselor or Geneticist, 3rd bullet. Updated information under Authorization Policy, 1st paragraph. |
05/16/2012 |
05/10/2012 |
Hearing Aid Services – Added language to clarify "trial period" and services not billable during trial period. Added "Claims for monaural dispensing must include either the LT or RT modifier" under Dispensing Fee Claims. Removed "Claims with DOS 12-31-08 and earlier, use modifier RP" and "Claims with DOS 1-1-09 and later, use modifier RB" under Repair Claims. Added "Claims with DOS prior to 90 days following dispensing date will deny" under all procedure codes under Hearing Aid Checks. |
05/03/2012 |
Laboratory/Pathology Services – Policy and editing related to blood drawns changed, modified working of INR, PAP and following of Medicare |
05/02/2012 |
Personal Care Assistance (PCA) Services – Updated table of contents. Retitled Supervision for PCA Services to Qualified Professional (QP) Supervision |
04/30/2012 |
Equipment & Supplies – Added text to clarify the Medicare guidelines for modifiers and the capped rental payment rates |
Immunizations & Vaccinations – Changed age limit IPV (90713 from 7 - 18 years to 2 months - 18 years. |
04/24/2012 |
EMA Service Limitations – Updated information about emergency medical assistance (EMA) program changes |
Mental Health Services – Overview |
04/17/2012 |
Equipment & Supplies – Updated due to new Electrical Stimulator section |
04/13/2012 |
Medication Therapy Management Services (MTMS) – Change to recipient eligibility. New criteria change for MTMS for recipients’ coverage is now allowed for recipients taking three or more prescriptions to treat or prevent one or more chronic conditions. |
Rehabilitative Services – Added language "lifting" authorization requirements retro to July 1, 2011 through December 31, 2012, per agreement btw Department and rehab professional associations (MNAPTA, MOTA, MSHA) |
04/11/2012 |
Medication Therapy Management Services (MTMS) – Changed link from DHS-4611 to DHS-4611A Provider Agreement: Individual Non Pay-To under Enrollment Applications and Agreements |
Mental Health Services – Overview |
Physician and Professional Services – Clarified criteria for billing drugs administered during an outpatient visit and coordinating of benefits for private insurance payments under Outpatient Physician Administered Drugs |
04/04/2012 |
Immunizations & Vaccinations – Corrected age limit for MnVFC Meningococcal conjugate (90734) from 2 years and older to 2-18 years |
03/27/2012 |
Anesthesia Services – New MHCP anesthesia rates for 2012 |
03/26/2012 |
Laboratory/Pathology Services – Clarified text, added coverage indication |
Pharmacy Services – Clarification of DAW text to reflect e-prescribing and clarification of reimbursement methodology |
03/23/2012 |
03/21/2012 |
Equipment & Supplies – Added link to Hearing Aid section, removed information about Cranial Electrical Stimulators · Oximeters – Clarified policy on intermittent oximeter |
03/14/2012 |
Immunizations & Vaccinations – Updated the Immunization (vaccines/toxoids) list to reflect the changes that became effective January 1, 2012 for adult vaccines and clarified age requirements for other codes |
03/13/2012 |
Acupuncture Services – Added clarifying test for limits on service under Covered Services |
03/12/2012 |
Elderly Waiver (EW) and Alternative Care (AC) Program – Added link to HCBS Contract Template |
03/09/2012 |
03/08/2012 |
Equipment & Supplies – Updated due to new subsections · Oximeters – New subsection |
03/07/2012 |
03/01/2012 |
Tribal and Federal Indian Health Services – Clarified language to state that drugs given as part of an outpatient or inpatient visit are included in the encounter rate. Facilities can not have a mail order pharmacy bill MHCP and then give the drug during the visit. |
02/28/2012 |
02/27/2012 |
Rehabilitative Services – Updated to reflect the 3/1/12 legislative change ending the rehab service thresholds |
02/24/2012 |
Mental Health Services – Added a link to the Adult Mental Health Targeted Case Management (AMH-TCM) section |
02/22/2012 |
Immunizations & Vaccinations – Removed eligibility type FP from the Eligible Recipient section |
02/21/2012 |
02/15/2012 |
Immunizations & Vaccinations – Updated rates for the administration of immunizations and vaccines |
Mental Health Services – Redesigned section |
02/13/2012 |
Equipment & Supplies – Added links to new sections Orthopedic and Therapeutic Footwear and Ultraviolet Light Therapy Systems and removed existing content from section |
02/10/2012 |
02/09/2012 |
Dental Services (Overview) – New providers dental therapist and advanced dental therapist and new multiple surgery modifier requirements |
Mental Health Services – Overview |
02/08/2012 |
Mental Health Services – Overview |
02/07/2012 |
Mental Health Services – Overview |
02/02/2012 |
Mental Health Services – Overview |
02/01/2012 |
01/31/2012 |
01/27/2012 |
Pharmacy Services – Removed out of date NCPDP payer sheets and added link to the D.0 payer sheets |
01/25/2012 |
EMA Service Limitations – Updated information about emergency medical assistance (EMA) program changes |
Billing Policy Overview – Updated with 2011 legislative changes |
Provider BasicsPrograms and Services – Updated program changes |
01/24/2012 |
01/23/2012 |
· Compound Drugs – Updated references to administration routes and changed NCPDP version from 5.1 to D.0 |
01/19/2012 |
Hospital Services – Clarified Observation Billing Policy for code 762 under Outpatient Observation Services |
01/17/2012 |
Physician and Professional Services – Added Evidence-based Childbirth Program Policy information |
01/13/2012 |
Acupuncture Services – New section |
Chiropractic Services – Added link to new Acupuncture Services section |
Physician and Professional Services – Removed acupuncture information and added link in Table of Contents to the new Acupuncture Services section |
01/12/2012 |
Elderly Waiver & Alt Care – Clarified qualifications to provide adult day services |
Immunizations & Vaccinations – Made change to Major program type under eligible recipients - deleted EH from eligible recipients list |
01/11/2012 |
Elderly Waiver & Alt Care – Added Specialized Supplies & Equipment Authorization & Billing Responsibilities to the drop down section in the table of contents. Changed link title under Billing to Authorization and Billing Responsibilities vs. Responsibilities |
01/06/2012 |
01/05/2012 |
Immunizations & Vaccinations – Clarified age related coverage for 90649, 90650 and the Q codes |
01/04/2012 |
Previous Revisions
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