Verify Eligibility for MHCP Members

This User Guide instructs providers to use the MN–ITS Interactive Eligibility Inquiry (270) feature to verify eligibility for a single member or up to a maximum of 50 at a time.

MHCP requires providers to verify eligibility before they render services and submit claims.

Use MN–ITS Interactive

· Bolded NPI/ UMPI and Date of Service fields auto populate

· Complete other (non-bolded, situational) fields as appropriate

· Underlined items are linked to definitions and additional information about that field, including information about completing a field, code definitions for fields or instructional information

· Some fields are grouped together in “boxes” of associated information. Field titles with an asterisk (*) indicate that the information is “situational.” If you complete one asterisked (*) field within a boxed section of a screen, you must complete all asterisked (*) fields in that section of the screen

Verifying MHCP Eligibility for a Member

1. Login into MN–ITS.

2. Select Eligibility Request (270). MN–ITS Interactive auto populates the NPI or UMPI based on your login.

3. Complete the Taxonomy Code Qualifier or asterisked (*) Taxonomy Code fields.

If you are not a consolidated provider, you do not have to complete the Taxonomy Code Qualifier or asterisked (*) Taxonomy Code fields. Proceed to step 4.

If you are a consolidated provider:

a. Click the Lookup button to lookup Provider Address. Click the radio button next to the correct address. Use the Submit button in the upper left-hand corner.

b. Once submitted, (*) Taxonomy code field will auto populate with the Taxonomy code.

For the Taxonomy Code Qualifier field, click the box and select the correct “provider’s role” related to the eligibility of benefits being verified. For example, if this inquiry is for the Rendering or Performing provider, select Performing.

4. The Date of Service field auto populates with the current date. To view a different date than the one that was auto populated, delete the From date and enter the date you want to inquire about in MM/DD/YYYY format. You can verify eligibility for up to the previous 12 months, but not for a future date. The eligibility response will only provide information for the date entered in the From field.

5. Enter a combination of two or more fields of Subscriber ID information. Click Eligibility Help at the top right of this page to see search combinations.

6. The Service Type Codes field defaults to the general inquiry 30-Health Benefit Plan Coverage. Select your code from the list in Service Type Code box.

Providers requesting eligibility information for specific Service Type Codes: use the drop-down menu to select the service type code(s) and description that best fits the service you will be providing.

7. Enter Optional Information – the following fields in the Enter Optional Information box are not required. Any information entered in this section will be included on the Eligibility Response (271).

8. Performing eligibility requests.

Single eligibility requests
If you are performing a single eligibility request, click the Submit button at the bottom of the screen to generate an Eligibility Response.

Multiple eligibility requests
You can enter up to a maximum list of 50. Remember to change the date of service for each subscriber.

If you are not a consolidated provider performing multiple eligibility requests, select Add and start at step 4.

If you are a consolidated provider performing multiple eligibility requests, select Add and start at step 3.

9. You also have the option of doing a New Query or returning to the Main Menu. If you are not sure how to read the response, scroll down to view Understanding your Eligibility Response (271).

10. Print or save the 271 Response for your records.

Understanding your Eligibility Response (271)

The Subscriber Information includes the date of service, subscriber ID number, subscriber name, birth date, age, and gender at the beginning of the page. The next line will display the last known address of the subscriber.

The next section, Provider Information, includes the provider’s NPI or UMPI (national provider identifier or unique Minnesota provider identifier) that was used for this inquiry, the provider name associated with that NPI or UMPI, the Taxonomy Code Qualifier and the Taxonomy Code, if selected, and address (consolidated only).

The eligibility information displayed will provide information pertaining to the Taxonomy Code Qualifier and Taxonomy Code reported on the Eligibility Request.

A Print button is at the top right of the page.

A Related Links list is at the top right of the page for additional eligibility request resources.