Select Request Type

Revised: January 2, 2024

Overview

Use this page to select the correct request type to make a change to your profile, enrollment records and affiliations. The request type you make determines what information you can request changes to within your profile. Your user role within the Minnesota Provider Screening and Enrollment (MPSE) portal determines which types of requests you are able to make. The administrator of your organization’s MN–ITS account assigns user roles and is the only one who can change a user role.

Request Type Selection

Under Request Type Selection, use the option buttons to select the request type you want to make. You will only see the request types allowed based on your assigned user role.

Request Types

Global request: Manage profile information (ownership, business entity, personal information, FEIN, Social Security Number). Select Global request to change your profile information.

Review the Global Request page for details of the information you can edit in a global request.

Enrollment record request: Manage information that is specific to an enrollment record (practice addresses, services, credentials). Select Enrollment record request to change information in a specific enrollment record.

Review the Enrollment Record Request page for details of the information you can edit in an enrollment record request.

Individual to organization affiliation request: Manage a request by an individual provider to create or modify affiliations to an organization. Select Individual to organization affiliation request if you are an individual provider and would like to add a new individual provider to organization affiliation or modify an existing organization affiliation.

Review the Individual to Organization Affiliations page for details of the information you can edit in an individual to organization affiliation request.

Trading partner to service provider affiliation request: Manage a provider with a trading partner (EDI trading partner, Clearinghouse, Billing intermediary) enrollment record to create or modify an affiliation to a service provider. Select Trading partner to service provider affiliation request if you are a trading partner and would like to add a new trading partner to service provider affiliation or modify an existing service provider affiliation.

Review the Service Provider to Trading Partner Affiliations page for details of the information you can edit in a service provider to trading partner affiliation request.

Service provider to trading partner affiliation request: Manage a request to create or modify an affiliation to a trading partner (EDI trading partner, Clearinghouse, Billing intermediary). Select Service provider to trading partner affiliation request if you are a service provider and would like to add a new service provider to trading partner affiliation or modify an existing trading partner affiliation.

Review the Trading Partner to Service Provider Affiliations page for details of the information you can edit in an individual to organization affiliation request.

Request Effective Date

Enter the effective date of your request in the Request Effective Date box.

Manage Revalidation Request Indicator

When you are due for revalidation, you will receive a letter telling you that your enrollment record is due for revalidation. The letter provides you with instructions on how to complete your revalidation in MPSE.

Under Manage Revalidation Request Indicator, use the option buttons to indicate if the request you are making is for a revalidation of your enrollment record. The Manage Revalidation Request Indicator will only appear for global requests and enrollment record requests.

Is this a Revalidation Request?

Is this a Revalidation Request defaults to No. If your request is not to complete a revalidation, keep the selection as No.

Select the Yes option if your request is to complete a revalidation.

Continue

Click Continue to go to the next page.

Cancel

Click Cancel to cancel your request and go back to the Manage Portfolio page.