Provider Manual

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Provider Manual

Provider Manual

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MHCP Provider Manual – Home

Revised: July 1, 2025

Note: We recently made updates to the page. We added additional links under Resources and the Provider Manual Table of Contents.

This online Minnesota Health Care Programs (MHCP) Provider Manual is your primary information source for MHCP coverage policies, rates and billing procedures and is updated on an ongoing basis.

Review a complete list of the MHCP Provider Manual Table of Contents.

As an enrolled provider, you are responsible to check for updates, changes and additions frequently. Sign up to get email notices of revisions specific to the services you provide.

MHCP wants your feedback

MHCP wants feedback from enrolled providers and invites you to take the MHCP Provider Survey. We want to hear from you about what works well, what needs improvement, and what else we should be considering when we work with you to accomplish our shared goals.

Resources

· County and Tribal Nation offices for access to public assistance benefits in Minnesota

· Latest revisions to this Manual

· MN–ITS – Home page, most compatible using a Chrome browser

· MN–ITS User Manual – most compatible using a Chrome browser

· MPSE User Manual

· Payment and Claim Cut-off Calendars

· Provider Directory – Enrolled MHCP providers

· Provider Training for fee-for-service providers

Provider Manual Table of Contents

The following is a list of links to the MHCP Provider Manual sections.

Member Evidence of Coverage (EOC)

Latest revisions to this Manual

Coronavirus (COVID-19)

Enrollment with MHCP

Provider Basics

Provider Requirements

· Access Services

· Billing Organizations/Responsibilities

· Excluded Provider Lists

· Provider Participation Requirements - Rule 101

· Provider Screening Requirements

· Risk Levels and Enrollment Verification Requirements

Health Care Programs and Services

· Emergency Medical Assistance (EMA)

· MHCP Benefits at-a-glance

Managed Care Organizations (MCOs)

Billing Policy Overview

· Billing the Member (Recipient)

· Medicare and Other Insurance

· Out-of-State Providers

· Payment Methodology - Hospital

· Payment Methodology - Non-Hospital

· Supplemental Payments – Non-Hospital and Hospital

· Drug Authorizations

· MHCP Pharmacy Quick Reference

Acupuncture Services

Ambulatory Surgical Centers

Anesthesia Services

Behavioral Health Home Services

Certified Community Behavioral Health Clinic (CCBHC)

Child and Teen Checkups (C&TC)

· Abbreviations and Acronyms

· C&TC Health Insurance Portability and Accountability Act (HIPAA) Referral Coding Information

· Helpful Website Links

Chiropractic Services

Clinic Services

· Federally Qualified Health Center and Rural Health Clinics

· FQHC and RHC Global Encounters for MCO Enrollees – Examples

Community Emergency Medical Technician (CEMT) Services

Community First Services and Supports

Community Health Worker (CWH)

Community Paramedic Services

Day Training & Habilitation (DT&H) Day Services

Dental Services

· Advanced Dental Therapist (ADT)

· Allied Oral Health Professional (Overview)

· Dental Authorization Requirement Tables

· Collaborative Practice Dental Hygienists (was Limited Authorization Dental Hygienists)

· Critical Access Dental Payment Program (CADPP)

· Dental Benefits

· Dental Therapist (DT)

· Non-Dental Health Providers

Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit

· EIDBI Benefit Billing Grid (PDF)

· EIDBI Managed Care Organization (MCO) Contact Information Grid (PDF)

Elderly Waiver and Alternative Care Program (EW and AC)

· Specialized Supplies & Equipment Authorization & Billing Responsibilities

Equipment and Supplies

Essential Community Supports (ECS)

HCBS Waiver Services

· Billing for Waiver and Alternative Care (AC) Program

· HCBS Waiver and AC Training Requirements

· Void (“Take-Back”) Waiver and AC Service Claims for Fee-for-Service

Hearing Aid Services

· Bone-Anchored Hearing Aids (BAHA)

· Cochlear Implants

· Hearing Aid Services Codes Table

Home Care Services

· Home Care Nursing (HCN) Services

· Home Health Aide Services

· Rehabilitation Therapy Services

· Skilled Nurse Visits (SNV) Services

Hospice Services

Hospital Services

· Critical Access Hospital (CAH) Services

· Hospital In-reach Service Coordination (IRSC)

· Inpatient Hospital Authorization

· Inpatient Hospitalization for Detoxification Guidelines

· Inpatient Hospital Services

· Outpatient Hospital Services

Housing Stabilization Services

Housing Support Supplemental Services

Immunizations and Vaccinations

· Immunization and Vaccine Benefits Codes for Children

· Immunization and Vaccine Benefits Codes for Adults

Individualized Education Program (IEP) Services

Intermediate Care Facilities (ICF/DDs)

Laboratory and Pathology Services

Medication Management Therapy Services

Mental Health Services

· Adult and Children's Crisis Response Services

· Adult Day Treatment

· Adult Mental Health Targeted Case Management (AMH-TCM) and Children’s Mental Health Targeted Case Management (CMH-TCM)

· Adult Rehabilitative Mental Health Services (ARMHS)

· Adult Residential Crisis Stabilization Services (RCS)

· Assertive Community Treatment (ACT)

· Certified Family Peer Specialist

· Certified Peer Specialist Services

· Children’s Mental Health Clinical Care Consultation

· Children’s Mental Health Residential Treatment

· Children’s Therapeutic Services and Supports (CTSS)

· Clinical Supervision of Outpatient Mental Health Services

· CTSS Children's Day Treatment

· Diagnostic Assessment

· Dialectical Behavior Therapy Intensive Outpatient Program (DBT IOP)

· Explanation of Findings

· Family Psychoeducation

· Functional Assessments

· General MHCP Non-Enrollable Mental Health Provider Requirements

· Health Behavior Assessment/Intervention

· Inpatient Visits

· Intensive Residential Treatment Services (IRTS)

· Children's Intensive Behavioral Health Services

· Level of Care Assessment

· Mental Health Diagnostic Code Ranges

· Mental Health Provider Travel Time

· MHCP Professional Certification and Enrollment Requirements

· Neuropsychological Services

· Partial Hospitalization Program

· Physician Consultation, Evaluation and Management

· Psychiatric Consultations to Primary Care Providers

· Psychiatric Residential Treatment Facility (PRTF)

· Psychological Testing

· Psychotherapy

· Psychotherapy for Crisis

· Telehealth Delivery of Mental Health Services

· Youth Assertive Community Treatment (Youth ACT)/Intensive Rehabilitative Mental Health Services (IRMHS)

Moving Home Minnesota

· Moving Home Minnesota Demonstration and Supplemental Services Table (PDF)

· Moving Home Minnesota Supported Employment Services (MHM SES)

Nursing Facilities

Officer-Involved Community-Based Care Coordination Services

Optical Services

Pharmacy Services

· 340B Drug Pricing Program

· Compound Drugs

· Drug Categories with Limited Coverage

· Home Infusion Therapy

· Long Term Care (LTC)

· Minnesota Covered Active Pharmaceutical Ingredient (API) and Excipient List

· NCPDP Payer Sheets Guidelines

· Pharmacy Early-Refill Overrides

· Point of Sale Diabetic Testing Supply Program

· Pro-DUR Conflict Codes

· Quantity Dispensing Limits Table

Physician and Professional Services

· Gender-Affirming Surgery

· Transplant Authorization Code List

· Health Care Homes (HCH)

Program HH (HIV/AIDS) Services

· Program HH Dental Authorization Requirement Chart

Radiology/Diagnostic Services

· Authorization Criteria: Cardiac Magnetic Resonance Imaging of the Coronary Arteries

· Coverage Criteria: Computed Tomography Colonography

Rehabilitation Services

· Audiology Services Procedure Codes

· Augmentative Communication Devices

· Casting & Strapping Services/Supplies

· Orthotic Procedures

· Rehabilitative and Therapeutic Services Authorization Criteria

· Rehabilitative Services Procedure Codes

Renal Dialysis Overview

· Renal Dialysis Billing

Reproductive Health/OB-GYN

· Abortion Services

· Breast and Cervical Cancer (BRCA) Genetic Testing and Presumptive Eligibility Services

· Doula Services

· Family Planning

· Family Planning Codes with Increased Rates

· Free-Standing Birth Center Services

· Hysterectomy

· ICD-9 to ICD-10 Diagnosis Conversion Table

· Minnesota Family Planning Program (MFPP)

· Minnesota Family Planning Program (MFPP) Procedure Codes

· Obstetrics Services and HIV Counseling

· Sterilization

School-Based Community Services (SBCS)

Screening, Brief Intervention, and Referral to Treatment (SBIRT)

Substance Use Disorder Services (SUD)

· Substance Use Disorder (SUD) Withdrawal Management Services

· Telehealth Delivery of Substance Use Disorder Services

Targeted Case Management

Transportation Services

· Nonemergency Medical Transportation (NEMT) Services (Overview)

· Access Services Ancillary to Transportation

· Ambulance Transportation Services

· Ancillary Services Claim and Rate Information for Counties and Tribes

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Transportation Services

· Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information

· Protected Transportation Services

· State-Administered NEMT

· State-Administered Transportation Procedure Codes, Modifiers and Payment Rates

Tribal and Federal Indian Health Services

CPT codes, descriptions and other data only are copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/HHSAR apply.

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