Minnesota Minnesota

MN–ITS User Manual

MN–ITS User Manual

Community First Services and Supports (CFSS)

Posted: January 17, 2025

Review MHCP Billing Policy for general billing requirements and guidance when submitting claims.
Refer to additional billing requirements in the CFSS section of the MHCP Provider Manual before you submit the claim for services.

Log in to MN–ITS

  • 1. Log in to MN–ITS
  • 2. From the left menu:
  • a. Select “MN–ITS”
  • b. Select “Submit DDE Claims (837)”
  • c. Select “Professional (837P)”

    • Submit the Claim

    Use the instructions in the following tables for each of the following claim screens to submit the claim:

    Billing Provider
    Subscriber
    Claim Information
    Coordination of Benefits (COB) (complete only when the subscriber (recipient/member/participant) has other/private insurance)
    Services

    Billing Provider

    The billing provider screen auto-populates with the information in the enrollment profile for the NPI or UMPI used to log in to MN–ITS. If changes are needed, use the Changes to Enrollment Information to notify MHCP Provider Enrollment.

    Refer to the following table for instructions and information about each field on this screen.

    Field Name *
    (X12 Loop and element)

    Field Instruction

    Organization
    (Loop: 2010AA, NM103 (last or organization)
    NM104 (first)

    The field auto-populates with the name of the CFSS agency.

    Taxonomy
    (Loop: 2000A, PRV03)

    This field only displays information when a Provider Taxonomy Code has been added to the provider file.

    Address 1
    (Loop: 2010AA, N301)

    This field auto-populates with the first line of your address in your provider file.

    Address 2
    (Loop: 2010AA, N302)

    This field auto-populates with the second line of your address in your provider file.

    City
    (Loop: 2010AA, N401)

    This field auto-populates with the city listed in the address of your provider file.

    State
    (Loop: 2010AA, N402)

    This field auto-populates with the state listed in the address of your provider file.

    Zip
    (Loop: 2010AA, N403)

    This field auto-populates with the ZIP Code listed in the address of your provider file.

    Telephone
    (Loop: 2010AA, PER04)

    This field auto-populates with the telephone number reported on the provider file.

    Action Button

    Select Continue to proceed to the next screen.

    Subscriber

    Use the Subscriber (member) screen to report the subscriber (member) who received the services reported on this claim.

    Refer to the following table for instructions and information about fields to complete on this screen when entering CFSS claims.

    Field Name*
    (X12 Loop and element)

    Field Instruction

    Subscriber ID
    (Loop: 2010BA, NM109)

    Enter the 8-digit MHCP ID for the subscriber (member) indicated on the MHCP member identification card.

    Birth Date
    (Loop: 2010BA, DMG02)

    Enter the birth date of the subscriber (member).

    Select the Search action button in this section to have MN–ITS find and display the subscriber associated with the subscriber (member) ID and date of birth entered.

    The following fields auto-populate based on the information entered in the Subscriber (member) ID and Birth Date fields.

    Subscriber First Name
    (Loop: 2010BA, NM104)

    The first name of the subscriber (member).

    Middle Initial
    (Loop: 2010BA, NM105)

    The middle initial of the subscriber (member).

    Last Name
    (Loop: 2010BA, NM103)

    The last name of the subscriber (member).

    Gender
    (Loop: 2010BA, DMG03)

    The gender of the subscriber (member).

    Select Delete to remove the subscriber (member) information if the not correct.

    Screen Action Buttons

    Select one of the following screen action buttons:

  • · Continue to proceed to the next screen.
  • · Back to go back to the previous screen
  • · Cancel to cancel the claim entry

    • Claim Information

    Use the Claim Information screens to report header (claim) level information that will identify the type of claim and details about the services. Information entered on the claim information screen will apply to all lines of the claim.

    Refer to the following table for instructions and information about each field on this screen.

    Field Name*
    (X12 Loop and element)

    Field Instruction

    Claim Frequency Code
    (Loop: 2300, CLM05-3)

    Leave Original if not submitting a Replacement or Void claim. The default is Original.

    Select Replacement if you are replacing a claim that MHCP previously paid for this subscriber (member).

    Select Void if you are voiding a claim that MHCP previously paid for this subscriber (member).

    Payer Claim Control Number
    (Loop: 2300, REF02)

    This field only displays if you selected the replacement or void claim frequency code.

    Enter the claim you want to replace or void.

    Place of Service
    (Loop: 2300 CLM05-1)

    Select appropriate place of service from the drop-down menu

    Patient Control Number
    (Loop: 2300, CLM01)

    Enter a unique identifier to help identify this claim for the subscriber (member) to be reported on the remittance advice (RA). You cannot enter the following symbols in this field: * ~

    MHCP will report this back to you on the RA.

    Assignment/Plan Participation
    (Loop: 2300, CLM07)

    Select the code indicating whether the provider accepts payment from MHCP. The default is Assigned. Select the correct response if different than the default.

  • · Assigned - provider has a participation authorization with MHCP
  • · Assignment Accepted - provider accepts assignment only for clinical lab services
  • · Not Assigned - neither assigned nor assignment accepted apply

    • Benefits Assignment
    (Loop: 2300, CLM08)

    Select the benefit assignment to report the policy holder or person authorized to act on their behalf to give MHCP permission to pay the provider directly. Default is Yes. Select the correct response if different than the default.

  • · Yes - Benefits assigned to the provider
  • · No - Benefits not assigned to the provider
  • · Not Applicable - Patient refuses to assign benefits

    • Release of Information
    (Loop: 2300, CLM09)

    Report the determination of whether the provider has a signed statement by the subscriber (member) on file authorizing the release of medical data to other organizations. Default is Yes. Select the correct response if different than the default.

  • · Yes - Signature collected or required
  • · Informed Consent - Signature not collected and not required

    • Provider Indicator
    (Loop: 2300, CLM06)

    Identifies whether the provider’s signature is on file, certifying services were performed by the provider. The default is Signature on File. Select the correct response if different than the default.

    Diagnosis Type Code
    (Loop: 2300, HI01-1)

    From the drop-down menu, select whether the diagnosis code reported on this claim is in the ICD-9 or ICD-10 classification.

    Diagnosis Code
    (Loop: 2300, HI01-2, HI02-2, HI03-2, HI04-2)

    Enter the diagnosis code (ICD) that is listed on your service authorization (SA) or assessment and service plan document that coordinates with the dates of service for this claim.

    Select the Add action button in this section to include the diagnosis code on the claim.

    Select the Delete button next to a diagnosis code to remove it from the claim.

    Situational Claim Information - Select this accordion panel to report service authorization or authorization number.

    Prior Authorization Number
    (Loop: 2300, REF02)

    Enter the service authorization number from your service authorization (SA) letter.

    Attachment Control Number
    (Loop: 2400, PWK06)

    Use only when submitting a claim with attachment.

    Enter a code or number assigned by the provider, identifying an attachment for this claim.

    Review the Electronic Claim Attachments page for MHCP Attachment Criteria and additional information.

    Attachment Type
    (Loop: 2400, PWK01)

    Use only when submitting a claim with an attachment.

    Select the code from the drop-down indicating the attachment type ID and the description of the attachment.

    Select Add to add the attachment Control Number and Type ID to the entire claim. Select Delete to delete the entry.

    Other Providers (Claim Level) – Select this accordion panel to report other providers when required

    Rendering Provider

    NPI/UMPI
    (Loop: 2310B, NM109)

  • · When billing for T1019, enter the rendering provider’s (individual CFSS worker’s) UMPI or NPI on the service line for each date of service.
  • · Select Add to add the individual CFSS worker’s information.
  • · Select the radio button to select this individual CFSS worker for all lines on the claim; otherwise leave blank.
  • · When billing for codes T5999, S5116, T1023, and T2040, you do not need to enter the rendering provider.

    • Screen Action Button

  • · Select Continue to proceed to the next screen.
  • · Back to go back to the previous screen
  • · Cancel to cancel the claim entry

    • Coordination of Benefits (COB)

    Use the COB screen to report other payers, third party liability (TPL) or Medicare’s financial responsibility for all or a portion of the claim. For CFSS services, there are no other payers involved because MHCP is the primary payer for CFSS services. Select the Continue button at the bottom of this screen to proceed to the next screen.

    Services

    Use the Services screen to enter each date of service you provided CFSS services for the subscriber (member or recipient). Information reported on a service line will override information reported at the header (claim) level for that line.

    Refer to the following table for instructions and information about each field on this screen.

    Field Name*
    (X12 Loop and element)

    Field Instruction

    Date of Service (From)
    (Loop: 2400, DTP03)

    Enter the date the service was provided (MMDDCCYY).

    Date of Service (To)
    (Loop: 2400, DTP03* RD8* required in DTP02 when TO date is reported)

    The date of service (to) will auto populate with the date of service (from). For CFSS services each date of service should be billed on a separate line. Bill only for services provided within the same calendar month.

    Place of Service
    (Loop: 2300 CLM05-1)

    Select the appropriate place of service from the drop-down menu

    Procedure Code
    (Loop: 2400, SV101-2)

    Enter the HCPCS code identifying the service from your service authorization letter.

    Procedure Code Modifier(s)
    (Loop: 2400, SV101-3, SV101-4, SV101-5, SV101-6)

    If applicable, enter the modifier from your service authorization letter that clarifies or further identifies the service indicated in the procedure code field.

    Some modifiers are claim-only and are not required to be on a service authorization but does need to be reported on the claim by the provider. Those modifiers are: UN, UP, UD, TS, U2.

    Refer to the Community First Services and Supports codes table for when to use these modifiers.

    Diagnosis Pointer
    (Loop: 2400, SV107-1, SV107-2, SV107-3, SV107-4)

    Enter the diagnosis code from your service authorization letter.

    Review to ensure the diagnosis code is displaying in the first field.

    If the code is not visible, use the drop-down menu to select the correct diagnosis code for this line of the claim.

    Line-Item Charge
    (Loop: 2400, SV102)

    Enter your total charge for all units on this line.

    T1019 (Agency Model): To determine the total line-item charge, multiply the number of units for this line by your usual and customary charge for this service.

    T1019 (Budget Model): To determine the total line-item charge, calculate the total payroll cost (all wages, payroll related-taxes, PTO, and worker’s compensation).

    T1023: The total line-item charge is your usual and customary charge for this service.

    T5999: The total line-item charge is the total amount approved from your service authorization letter for line T5999.

    S5116: The total line-item charge is the total cost for the training or class (agency or formal training).

    T2040: The total line-item charge is the total cost for the failed background study fee or the financial management services fee.

    Service Unit Count
    (Loop: 2400, SV104)

    Enter the number of units for this service line.

    T1019: 1 unit = 15 minutes

    T1023: 1 unit = per session

    T5999: 1 unit = total purchased goods and services from the service authorization letter

    S5116: 1 unit = per training session or class

    T2040: 1 unit = the failed background study fee or the financial management services fee

    Other Payer – Use this section only if reporting other payer (TPL) COB payments or denials at the service (line) level. For CFSS services, there are no other payers involved because MHCP is the primary payer for CFSS services. Select the Continue button at the bottom of this screen to proceed to the next screen.

    Other Providers – For T1019, use this accordion section to report the individual CFSS worker who provided the service on each service line.

    Rendering Provider

    NPI/UMPI
    (Loop: 2420A, NM109)

    If different than the provider reported on the claim information screen:

  • · Enter the NPI of the provider who provided the service.
  • · Select the action button in this section to add the other provider information.
  • · Select the radio button to add the other provider to the claim

    • Section Action Button

    Select one of the following:

  • · Save/View Line(s): to save the line item if only one line item is entered or if not using the Copy or Add action button for the next line; and to view a summary table displaying information for each line on the claim.
  • · Copy: to save and copy the service line information that was just entered so that you can make changes to the copied service line.
  • · Delete: to remove the service line information that is displayed.
  • · Add: to add a new service line to the claim. A new service line will display for you to enter new information for your next service line.


    • Select Save/View Line(s) after all entries are complete.

    Service Line Recap Table

    Each time you select save/view line, a summary table will display providing a summary for each line, showing:

  • · Line number
  • · From and to Date
  • · Procedure Code
  • · Modifier
  • · Charge
  • · Units


    • Select:

  • · Edit, next to the line item, to change information for that service line.
  • · Add, under the service line summary table, to add additional service line(s).

    • Finish the Claim

    Select one of the following action buttons to finish the claim:

  • · Back to go back to the previous screen
  • · Cancel to cancel the claim entry
  • · Validate to determine if the claim has met the HIPAA-compliant and certain basic requirements at both the claim and line level information.
  • · Submit to submit the claim. The submit response will identify if the claim will be paid, denied or suspended for review at the claim level and the line level of the claim.


    • Use the X12 External Code Lists to identify the claim status category and claim status codes displayed on the claim response.

    Copy, Replace or Void (take back) the Claim

    After submitting the claim and receiving a claim response, an option to Copy, Replace, or Void the claim is available.

    Use each of these features to do the following:

    Copy - To correct an error of a denied claim or to copy information from other similar claims previously submitted

    Replace - If the claim paid, but paid incorrectly or a line item was denied. The user may access the claim, correct the information and resubmit. The original paid amount will be taken back and replaced with the correct information on the replacement claim

    Void (take back) - If the claim was submitted in error. This reverses the claim and takes the payment back

    Review the Copy, Replace, Void (take back), or Reverse a Claim User Guide for step-by-step instructions when completing these transactions.

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