Minnesota Minnesota

MN–ITS User Manual

MN–ITS User Manual

Inpatient Substance Use Disorder (SUD) Services

Revised: March 1, 2024

Review MHCP Billing Policy for general billing requirements and the Substance Use Disorder Services (SUD) section in the MHCP Provider Manual when submitting SUD service claims.

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 Institutional (837I)

    • Submit an 837I Inpatient SUD claim

    To submit an 837I Inpatient SUD claim, follow the instructions in the following tables for each of the following claim screens:

    Billing Provider
    Subscriber
    Claim Information
    Coordination of Benefits (COB)
    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 Change of Enrollment Information to notify MHCP Provider Eligibility and Compliance.

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

    Field Name *
    (X12 Loop & element)

    Field Instruction

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

    The name of the Billing Provider: This could be an organization, business or the name of an individual provider identified by the NPI used to log in to MN–ITS.

    Taxonomy
    (Loop: 2000A, PRV03)

    This field only displays information when a Health care provider specialty/location code has been added to the provider file.

    If multiple taxonomy codes have been added, additional information will display. Select the radio button to identify appropriate location for this claim.

    Address 1
    (Loop: 2010AA, N301)

    The first address line reported on the provider file.

    Address 2
    (Loop: 2010AA, N302)

    The second address line reported on the provider file.

    City
    (Loop: 2010AA, N401)

    The city name for the address in address fields 1 and 2.

    State
    (Loop: 2010AA, N402)

    The state name for the address in address fields 1 and 2.

    ZIP
    (Loop: 2010AA, N403)

    The ZIP Code for the address in address fields 1 and 2.

    Telephone
    (Loop: 2010AA, PER04)

    Telephone number reported on the provider file.

    Select Locations

    When using a consolidated NPI, a table will display showing the locations and taxonomy codes information on file with MHCP.

    Select the radio button next to the location where the services were provided.

    Screen Action Button

    Select:

  • · Cancel to cancel the claim entry
  • · Continue to proceed to the next screen

    • Subscriber

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

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

    Field Name*
    (X12 loop & 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.

    Select Search to have MN–ITS find and display the subscriber associated with the subscriber ID and date of birth entered.

    The following fields auto-populate based on the information entered in the Subscriber ID and Birth Date fields:

    Subscriber First Name
    (Loop: 2010BA, NM104)

    The first name of the subscriber.

    Middle Initial
    (Loop: 2010BA, NM105)

    The middle initial of the subscriber.

    Last Name
    (Loop: 2010BA,NM103)

    The last name of the subscriber.

    Gender
    (Loop: 2010BA, DMG03)

    The gender of the subscriber.

    Select Delete to remove the subscriber information if incorrect.

    Screen Action Button

    Select:

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

    • Claim Information

    Use the Claim Information screens to report claim (header) 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 & element)

    Field Instruction

    TOB
    (Loop: 2300, CLM05)

    Enter Type of Bill:

  • 1. 11X for Hospital-based Residential.
  • 2. Enter 86X for the treatment and room and board components of non-hospital based residential treatment. This is the treatment provided by residentially licensed programs when they provide both the treatment and the room and board components to the same member.
  • 3. Numeric Values for frequency (third digit) are as follows:
  • · xx1 - admit through discharge claim
  • · xx2 - first claim in a series of continuous claims or interim billing. When submitting the first claim, the admission date field must be the same as the statement date
  • · xx3 - continuous claim or interim billing
  • · xx4 - the last claim or discharge claim
  • · xx7 - a replacement claim
  • · xx8 - a void claim

    • Payer Claim Control Number
    (Loop: 2300, REF02)

    The Payer Claim Control Number (PCN) field will display when the TOB frequency code 7 (Replacement), or 8 (Void), is entered.

    Enter the 17-digit PCN to identify the previously paid claim to be replaced or voided.

    If the claim has been retrieved from a submit response, or the request status feature, the payer claim number will display.

    Statement Date (From)
    (Loop: 2300, DTP03)

    Enter the service start date.

    Statement Date (To)
    (Loop: 2300, DTP03)

    Enter the service end date.

    *Date of discharge or transfer must be included on the final claim.

    Patient Control Number
    (Loop: 2300, CLM01)

    Enter a unique identifier assigned by you, to help identify the claim for this member. The patient control number will be reported on your remittance advice.

    Assignment/Plan Participation
    (Loop: 2300, CLM07)

    Code indicating whether the provider accepts payment from MHCP.

    Default is Assigned

    Select the correct response if different than the default.

    Benefits Assignment
    (Loop: 2300, CLM08)

    The determination of 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.

    Release of Information
    (Loop: 2300, CLM09)

    The determination of whether the provider has a signed statement by the member on file, authorizing the release of medical data to other organizations.

    Default is Yes

    Select the correct response if different than the default.

    Admission Type
    (Loop: 2300, CL101)

    From the dropdown menu options, select admission type 3.

    Admission Source
    (Loop: 2300, CL102)

    From the dropdown menu options, select admission source 8.

    Patient Status
    (Loop: 2300, CL103)

    From the dropdown menu options, select the appropriate patient status code. For example, select 30 for still inpatient or 01 for discharged to home or self care (routine discharge).

    Admission Date
    (Loop: 2300, DTP02)

    Enter the date the episode of care began or the admission date to the facility.

    Admission Time
    (Loop: 2300, DTP03)

    Enter the time the episode of care began or admission to the facility.

    Discharge Time
    (Loop: 2300, DTP03)

    Enter the appropriate discharge time.

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

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

    Principal Diagnosis Code
    (Loop: 2300, HI01-2)

    Enter the highest level of ICD or other industry-accepted codes that best describe the condition or reason the member needed the services.

    POA
    (Loop: 2300, HI01-9)

    From the dropdown menu options, select the appropriate indicator to identify whether or not the Principal Diagnosis Code was present on admission.

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

    Enter the ICD or other industry-accepted codes that best describe the condition or reason the member needed the services.

    Other Diagnosis Code
    (Loop: 2300, HI01-2)

    Enter the ICD or other industry-accepted codes that best describes the additional condition or reason the member needed the services and select Add. Repeat this process to add all other diagnosis codes.

    To delete the entered codes, select Delete.

    POA
    (Loop: 2300 HI01-1)

    From the dropdown menu options, select the appropriate indicator to identify whether or not the Other Diagnosis Code was present at time of admission.

    Situational Claim Information - Select the situational claim information accordion screen to report situational information when required.

    Principal Procedure Code
    (Loop: 2300, HI01-2)

    When appropriate, enter the Principal Procedure Ccode (ICD) identifying the procedure.

    Date
    (Loop: 2300, HI01-4)

    Enter the date the Principal Procedure was performed.

    Other Procedure Code
    (Loop: 2300, HI01-2)

    When appropriate, enter additional Other Procedure Code (ICD) identifying the other procedure.

    Date
    (Loop: 2300, HI01-3)

    Enter the date the Other Procedure Code was performed.

    Prior Authorization Number
    (Loop: 2300, REF02)

    Not applicable

    Attachment Control Number
    (Loop: 2400, PWK06)

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

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

    Attachment Type
    (Loop: 2400, PWK01)

    From the dropdown menu options, select the code indicating the type ID and description of the attachment.

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

    Situational (Continued) Claim Information

    Occurrence Code
    (Loop: 2300, HI02-2- HI12)

    When appropriate, enter the Occurrence Code defining a significant event relating to this claim.

    Date
    (Loop: 2300, HI01-4)

    Enter the date associated with the Occurrence Code.

    Select Add to add the Occurrence Code and Date. To delete entry, select Delete.

    Occurrence Span Code
    (Loop: 2300, HI01-2)

    When appropriate, enter the Occurrence Span Code that identifies an event, occurring over a span of days, that relates to this claim.

    From Date
    (Loop: 2300, HI01-3)

    Enter the beginning date associated with the Occurrence Span.

    To Date
    (Loop: 2300, HI01-4)

    Enter the end date associated with the Occurrence Span.

    Select Add to add the Occurrence Span Code and Dates. To delete entry, select Delete.

    Value Code
    (Loop: 2300, HI01-2)

    When appropriate, enter the Value Code that identifies data necessary for processing this claim.

    Enter Value Code 80 for covered inpatient days and 81 for non-covered inpatient days. This is a required field for billing the Behavioral Health Fund (BHF).

    When billing room and board services provided to MCO recipients, enter Value Code 24 and the associated five-digit rate code from the Value Code 24 MCO Room and Board Billing (PDF) list.

    When billing residential treatment services. refer to the Residential 5-digit Value Codes for Billing Direct Access and enter Value 24 and the associated five-digit rate code.

    When billing Residential treatment services for the 1115 Substance Disorder System Reform Demonstration, refer to the Residential 5-digit Value Codes titled, “ 1115 Value 24 code” and use the associated five-digit rate code from the column.

    Amount
    (Loop: 2300, HI101-1)

    Enter the value or amount associated with the Value Code.
    Enter the amount of days associated with Value Code 80 or 81. This is a required field for billing the Behavioral Health Fund (BHF).

    Select Add to add the Value Code and Amount. To delete entry, select Delete.

    Patient Responsibility Amt
    (Loop: 2300, AMT02)

    Enter the amount determined to be the member’s responsibility for payment.

    Other Providers (Claim Level) – Select the Other Providers accordion screen when required to report other provider information

    Rendering Provider

    NPI/UMPI
    (Loop: 2310B, NM109)

    If different than the Attending Provider:

  • · Enter the NPI of the Rendering Provider who provided the service
  • · Select Add to add the Rendering Provider NPI
  • · Select the radio button to add the Rendering Provider to the claim
  • · To delete, select Delete

    • Pay-To Provider

    NPI/UMPI
    (Loop: 2010AB, NM109)

    If different than the Billing Provider:

  • · Enter the NPI of the provider who should be paid for the item or service
  • · Select Add to add the other Pay-to Provider NPI
  • · Select the radio button to add the Pay-to Provider to the claim
  • · To delete, select Delete

    • Referring Provider

    NPI/UMPI
    (Loop: 2310A, NM109)

    If different than the Attending Provider:

  • · Enter the NPI of the provider who referred the member for the item or service
  • · Select Add to add the Referring Provider NPI
  • · Select the radio button to add the Referring Provider to the claim
  • · To delete, select Delete

    • Attending Provider

    NPI/UMPI
    (Loop: 2310A, NM101)

    Enter the NPI or UMPI of the provider who is attending the service:

  • · Select Add to add the Attending Provider NPI
  • · Select the radio button to add the Attending Provider to the claim
  • · To delete, select Delete

    • OR

    If NPI entered is Consolidated:

  • · Select Add to add the Attending Provider
  • · Select the location for the Attending Provider
  • · Select the radio button to add the Attending Provider to the claim
  • · To delete, select Delete

    • Operating Provider

    NPI/UMPI
    (Loop: 2330D, REF02)

    Enter the NPI or UMPI of the provider who did the operating for the service:

  • · Select Add to add the Operating Provider NPI
  • · Select the radio button to add the Operating Provider to the claim
  • · To delete, select Delete

    • Service Facility Location

    NPI/UMPI
    (Loop: 2310E, NM101)

    If different than the Billing Provider:

  • · Enter the NPI of the provider where the services were actually provided
  • · Select Add to add the Service Facility Location NPI
  • · Select the radio button to add Service Facility Location to the claim
  • · To delete, select Delete

    • Screen Action Buttons

    Select:

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

    • Coordination of Benefits (COB)

    Use the COB screen to report other payers, private insurance (TPL) or Medicare’s financial responsibility for all or a portion of the claim. If no other payers are involved with this claim, click the Continue button at the bottom of this screen to proceed to the next screen.

    You must verify other payers’ policy to determine the type of policy the member has when reporting other payers, third party liability (TPL) or Medicare. This supplemental guide MN–ITS Interactive Field Completion Guide (PDF) is to help you determine if the other payers’ policy EOB adjustments should be entered at the COB Tab claim (header) level, or the Services Tab (line) level.

    Medicare A/HMO Medicare Risk and TPL/Other insurance (non-Medicare) for inpatient claims should be reported on the claim (header) level for appropriate claim processing.

    To report each type of other payer information at the claim (header) level, use the following tables:

    Medicare Part A/HMO Medicare Risk

    Third Party Liability (TPL) and Private Insurance (non-Medicare)

    Medicare A/HMO Medicare Risk
    Complete the following fields to report adjustments, payments and denials from Medicare Part A.

    Field Name*
    (X12 Loop & Element)

    Field Instruction

    Other Payer Name
    (Loop: 2330B, NM103)

    Enter the name of the Medicare Part A or HMO Medicare Risk.

    Do not include symbols such as slashes, dashes, periods or plus signs.

    Other Payer Primary ID
    (Loop: 2330B, NM109)

    Enter the Payer ID listed on the Explanation of Medicare Benefits (EOMB) of the Medicare contractor or HMO Advantage or Risk health plan.

  • · For Medicare A: Refer to the CMS Provider Compliance Group Map for contractor contact information in your area.
  • · For HMO Advantage or Risk: Refer to the member’s MN–ITS Eligibility Response. The Payer ID is displayed in the Carrier ID field.

    • Claim Filing Indicator
    (Loop: 2320, SBR09)

    From the dropdown menu options, select the code identifying the type of Medicare.

    For HMO Advantage or Risk: Refer to the Medicare Replacement (Advantage or Risk Plans) section.

    After the claim filing indicator is selected, additional fields will display for reporting Medicare information.

    Payer Responsibility
    (Loop: 2320, SBR01)

    From the dropdown menu options, select the code identifying the payer’s level of responsibility for payment of a claim.

    Insured ID
    (Loop: 2330A, NM109)

    Enter the policy holder’s identification number as assigned by the payer.

    For Medicare, this would be the Medicare health insurance claim number (HIC) or the Medicare beneficiary identifier (MBI) number.

    Relationship Code
    (Loop: 2320, SBR02)

    From the dropdown menu options, select the relationship of the MHCP subscriber (member) to the policy holder.

    Claim Adjustment Group Code
    (Loop: 2320, CAS01)

    From the dropdown menu options, select the code identifying the general category of the payment adjustment for this line.

    Adj Reason Code
    (Loop: 2320, CAS03)

    Enter the code identifying the reason the adjustment was made.

    Adj Amount
    (Loop: 2320, CAS03)

    Enter the total adjusted dollar amount for this line.

    Payer Paid Amount
    (Loop: 2320, AMT02)

    Enter the prior payer paid amount.

    Non-Covered Charge Amount
    (Loop: 2320, AMT02)

    Enter the noncovered charge amount.

    Other Payers Claim Control Number
    (Loop: 2330B, REF02)

    Enter the claim number reported on the Medicare EOMB.

    Benefits Assignment
    (Loop: 2320, O103)

    The determination of the policy holder or person authorized to act on their behalf, to give the other payer permission to pay the provider directly.

    Default is Yes. Select the correct response if different than the default.

    Release of Information
    (Loop: 2320, O106)

    The determination of whether the provider has a signed statement by the member authorizing the release of medical data to other organizations on file.

    Default is Yes. Select the correct response if different than the default.

    Inpatient Adjudication Information (MIA)

    Remark Code
    (Loop: 2320, MIA20-MIA23)

    Enter the Medicare remark codes from the Medicare EOMB.

    Select Add to add the code to the claim.

    Section Action buttons

    Select:

  • · Delete to remove the Medicare information from the claim level
  • · Save to save the entered Medicare information
  • · Add to add additional prior payer on this claim

    • Screen Action Buttons

    Select:

  • · Back to return to the previous screen
  • · Cancel to the entire claim entry
  • · Continue to proceed to the next screen

    • TPL and Private Insurance
    Complete the following fields to report adjustments, payments and denials from the private insurance (Non-Medicare) carrier.

    Field Name*
    (X12 Loop & Element)

    Field Instruction

    Other Payer Name
    (Loop: 2330B, NM103)

    Enter the name of the TPL insurance payer.

    Do not include symbols such as slashes, dashes, periods or plus signs.

    Other Payer Primary ID
    (Loop: 2330B, NM109)

    Enter the Identifier of the insurance carrier. (This is available on the member’s eligibility response.)

    Do not use symbols such as slashes, dashes, periods or plus signs.

    Claim Filing Indicator
    (Loop: 2320, SBR09)

    From the dropdown menu options, select the code identifying type of insurance. After the claim filing indicator is selected, additional fields will display for reporting TPL or private insurance.

    Payer Responsibility
    (Loop: 2320, SBR01)

    From the dropdown menu options, select the code identifying the insurance carrier’s level of responsibility for payment.

    Insured ID
    (Loop: 2330A, NM109)

    Enter the policy holder’s identification number as assigned by the payer.

    Relationship Code
    (Loop: 2320, SBR02)

    From the dropdown menu options, select the relationship of the MHCP subscriber (member) to the policy holder.

    If reporting adjustments at the claim (header) level for TPL, complete the remaining Claim Level Adjustments.

    If reporting adjustments at the line level, select the Save action button in this section. Then scroll down to the Other Insurance Information section of this screen.

    Claim Adjustment Group Code
    (Loop: 2320, CAS01)

    From the dropdown menu options, select the code identifying the general category of the payment adjustment.

    Refer to the other payer EOB.

    Adj Reason Code
    (Loop: 2320, CAS03)

    Enter the code identifying the reason the other payer adjusted the payment. Refer to the other payer EOB.

    Adj Amount
    (Loop: 2320, CAS03)

    Enter the dollar amount of the adjustment.

    Payer Paid Amount
    (Loop: 2320, AMT02)

    When reporting TPL adjustments at the claim (header level), enter the prior payer paid amount.

    Non-Covered Charge Amount
    (Loop: 2320, AMT02)

    When reporting TPL at the claim (header level), enter the noncovered charge amount.

    Benefits Assignment
    (Loop: 2320, O103)

    Other Insurance Information: The determination of the policy holder or person authorized to act on their behalf, to give the other payer permission to pay the provider directly.

    Default is Yes. Select the correct response if different than the default

    Release of Information
    (Loop 2320, O106)

    The determination of whether the provider has a signed statement by the member on file, authorizing the release of medical data to other organizations.

    Default is Yes. Select the correct response if different than the default.

    Section Action Buttons

    Select:

  • · Delete to remove this payer from the claim level
  • · Save to include this TPL or private insurance information on the claim
  • · Add to add additional prior payer on this claim

    • Screen Action Buttons

    Select:

  • · Back to return to the previous screen
  • · Cancel to cancel the entire claim entry
  • · Continue to proceed to the next screen

    • Services

    Use the Services screen to describe details for each service being billed. Information reported on a service line will override information reported at the claim (header) 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

    Revenue Code
    (Loop: 2400, SV201)

    Enter the appropriate revenue code used to specify the service line item detail for a health care institution.

    Refer to the Revenue and Procedure Codes table of the Substance Use Disorder (SUD) Services section of the MHCP Provider Manual for appropriate codes.

    Line Item Charge Amount
    (Loop: 2400, SV102)

    Enter your usual and customary charge for this service.

    Unit Code
    (Loop: 2400, SV204)

    Enter the units or manner in which a measurement has been taken.

    Service Unit Count
    (Loop: 2400, SV104)

    Enter the quantity of units, time, days, visits, services or treatments for the service.

    Other Payer – Medicare A and TPL for inpatient claims should be reported on the claim (header) level for appropriate processing. Do not complete this section.

    Other Providers – Select the Other Providers accordion panel when required to report other provider information on the service line, if different than what was reported at the claim level.

    Referring Provider
    (Loop: 2420 D, NM109)

    Any provider listed here will override at header level.

  • · From the Other Providers accordion, select Referring Provider
  • · Enter NPI of the provider who is not already reported at claim level as the Attending Provider or the Referring provider

    • When reporting the NPI, use the recipient for the service associated with that line.

  • · Select the Add action button in this section to add the provider information
  • · Select the radio button to add the provider to the claim

    • NPI/UMPI
    (Loop: 2420D, NM109)

    Any provider listed here will override the information entered at the claim (header) level.

  • · Enter the NPI or UMPI of the provider who is not already reported at claim (header) level as the Attending Provider or the Referring Provider
  • · Select the Add action button in this section to add the provider information.
  • · Select the radio button to add the provider to the claim

    • Screen Action Button (under the display of Other Providers)

    Select:

  • · Save/View Lines to save and view all entered lines in the service line table
  • · Copy to save and copy the entire line information to an additional service line
  • · Delete to remove the entered service line information

    • Screen Action Buttons

    After saved, a summary table will display the following information for each line on the claim:

  • · Line number
  • · From and to date
  • · Revenue code
  • · Procedure code
  • · Modifier
  • · Units
  • · Charges

    • Select:

  • · Edit, next to a line, to change the information for that service line
  • · Add to create a new line that is blank. Repeat the service line entry steps to add all lines to the claim

    • Screen Action Buttons

    Select:

  • · Back to return to the previous screen
  • · Cancel to cancel the entire claim entry
  • · Validate to determine if the claim has met the HIPAA-compliant and certain basic requirements at both the claim and service line level information. Use the X12 health care codes to identify the claim status category and claim status codes displayed on the validate response.
  • · Submit to identify if the claim will be paid, denied, or suspended for review at the claim and service line level of the claim. Use the X12 health care codes lists to identify the claim status category and claim status codes displayed on the submit claim response.

    • Copy, Replace or Void (take back) the Claim

    After submitting the claim and receiving a claim response, the Copy, Replace or Void action buttons will appear at the bottom of the claim response screen. Use each of these features to do the following:

    Copy – To correct an error of this denied claim or to copy information from this previously submitted claim. Copy this exact claim.

    Replace - To replace the previously paid claim if the claim paid, but paid incorrectly (including zero pay). The user may access the claim, correct the information and resubmit. The original paid claim will be taken back and replaced with the new claim submission

    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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