Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Enrollment
Review the EIDBI provider manual, EIDBI policy manual or take the EIDBI 101 training for providers for more information about the EIDBI benefit.
Enrollment for EIDBI Providers
The Minnesota Provider Screening and Enrollment (MPSE) portal is the web-based system providers will use to submit and manage their enrollment records and requests for Minnesota Health Care Programs (MHCP). Register to access the Minnesota Provider Screening and Enrollment (MPSE) portal and complete your enrollment online. The MPSE Home webpage is intended to instruct providers in navigating and completing processes within the MPSE portal. Continue to check back for the latest updates.
CMDE Providers
Follow these steps to enroll as an EIDBI comprehensive multi-disciplinary evaluation (CMDE) provider. Complete and submit the following to DHS through the MPSE portal or fax to 651-431-7462:
MHCP providers adding CMDE services
To add CMDE services to your current enrollment record, complete and submit the following to Minnesota Department of Human Services (DHS) through the MPSE portal or by fax:
Clinical supervisor and clinical trainee
Providers enrolling as a qualified mental health professional supervisor
Enrolled licensed mental health professionals are eligible to provide qualified supervisor services. The clinical trainee may complete the CMDE under the supervision of an enrolled mental health professional supervisor.
Providers enrolling a mental health practitioner clinical trainee
To add mental health practitioner clinical trainee services to your existing Level I or II provider record, complete the EIDBI Comprehensive Multi-Disciplinary Evaluation (CMDE) Provider Assurance Statement (DHS-7120A) (PDF).
For additional information, refer to the Clinical Supervision requirements and MHCP Mental Health Practitioner Clinical Trainee requirements.
EIDBI Provider Agencies
Follow these steps to enroll as an EIDBI provider agency. Complete and submit the following to DHS through the MPSE portal or by fax at 651-431-7462:
Qualified Supervising Professional (QSP) and Level I, II and III Providers
Do not enroll as a Level I, II or III provider until your affiliated agency is actively enrolled with MHCP to provide EIDBI services. Level I, II and III providers and QSPs must be affiliated with an actively enrolled EIDBI agency.
Providers do not need to enroll at multiple levels (for example, QSP and Level I). If you would like to move up to a higher provider enrollment level, submit the required assurance statement and all required documentation. After MHCP approves your request, your existing enrollment will be updated to reflect your new level.
National Provider Identifier (NPI) and Unique Minnesota Provider Identifier (UMPI) numbers
QSP, Level I and II providers require an NPI number, if they are eligible to receive one. You can obtain an NPI number from the National Plan and Provider Enumeration System (NPPES) website. If you do not qualify for an NPI number, you will be assigned an UMPI number. The provider’s NPI or UMPI number is required on the claim to bill for services. For more information on billing, see the EIDBI billing grid.
Complete and submit the information indicated for each provider type to DHS through the MPSE portal or by fax at 651-431-7462.
QSP providers
To enroll as an EIDBI qualified supervising professional (QSP) provider, complete and submit the following to DHS through the MPSE portal or by fax:
To add QSP services to your current enrollment record, complete and submit the following to DHS through the MPSE portal or by fax:
Level I providers
To enroll as an EIDBI Level I provider, complete and submit the following to DHS through the MPSE portal or by fax:
To add Level I provider services to your current enrollment record, complete and submit the following to DHS through the MPSE portal or by fax:
Level II provider
To enroll as an EIDBI Level II provider, complete and submit the following to DHS through the MPSE portal or by fax:
To add Level II provider services to your current enrollment record, complete and submit the following to DHS through the MPSE portal or by fax:
Level III providers
To enroll as an EIDBI Level III provider, complete and submit the following to DHS through the MPSE portal or by fax:
To add Level III provider services to your current enrollment record, complete and submit the following to DHS through the MPSE portal or by fax:
Telehealth services
All enrolled EIDBI individual providers that qualify and plan to deliver telehealth services must self-attest that they meet all conditions of the MHCP telehealth policy. Review the telehealth criteria on the EIDBI telehealth services webpage.
Individual providers should complete and submit the Provider Assurance Statement for Telehealth (DHS-6806) (PDF) to DHS through the MPSE portal or by fax to add telehealth services to your current enrollment record.
Processing Timelines
MHCP processes enrollment requests in the order received. MHCP will process the request and provide a response within 30 days. Responses include the following: pending for more information, approval and denial. You will not be able to submit claims for services you provide until MHCP notifies you that your enrollment request is complete and approved.
MHCP will also conduct a site visit as part of the enrollment process. Please allow SIRS up to an additional 60 days screening time. For more information, refer to the Provider Screening Requirements webpage.
If MHCP approves your initial enrollment request, you will receive a Welcome Letter, including information about registering for MN–ITS. You must register for and use MN–ITS to receive mail from and submit electronic transactions to MHCP.
Minnesota Health Care Programs (MHCP) Provider and Minnesotahelp.info directories
Fee-for-service members, lead agencies and other provider types use the Minnesota Health Care Programs (MHCP) Provider Directory and the Minnesotahelp.info directory to locate service providers in Minnesota. Your contact information is automatically added to these directories when you are approved to be an MHCP-enrolled CMDE provider or EIDBI agency. It is critical to keep your information updated to ensure efficient access to services.
Updating Minnesotahelp.info profile
Update or add information to your Minnesotahelp.info profile via chat or email through the Minnesotahelp.info Provider Portal. You can add details such as your company website, insurance coverage you accept, counties you serve, treatment methods you provide and your current intake capacity.
The following are additional instructions for ongoing reporting requirements to keep the MHCP directories up to date.
Ongoing Reporting Requirements
MHCP requires all providers to notify us when a change occurs. Report changes by completing the appropriate form and submitting it to DHS through the MPSE portal or by fax.
Updating individual provider contact information
Use the MPSE portal or complete and submit the Individual Practitioner - MHCP Provider Profile Change Form (DHS-3535) (PDF) to update provider contact information. Use this form to report changes of individual provider names, addresses, ending or adding affiliation to an agency and so on.
Updating agency contact information
Use the MPSE portal or complete and submit the Organization - MHCP Provider Profile Change Form (DHS-3535A) (PDF) to update agency contact information. Use this form to report you are no longer providing EIDBI services, changes in affiliated providers, addresses and so on.
Changes in Ownership
An MHCP provider who sells or transfers ownership or control of a provider entity enrolled in MHCP, must notify DHS no later than 30 days before the effective date of the sale or transfer by submitting a Provider Entity Sale or Transfer Addendum (DHS-5550) (PDF). MHCP may stop or withhold payments effective the date the sale or transfer takes place if the new entity’s enrollment is not complete. Please review information regarding a Provider Entity Sale or Transfer on our Provider Requirements webpage.
Other updates
MHCP will process change information and notify the agency if any further documentation is needed to maintain enrollment with MHCP.
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