Enrolling as a provider with Minnesota Health Care Programs (MHCP) is a crucial step for healthcare professionals and organizations looking to serve Minnesota’s diverse patient population. This guide offers an in-depth look at the MHCP enrollment process, ensuring a smooth and efficient application experience. Understanding the requirements and procedures is essential, and this resource aims to clarify each step, from initial eligibility checks to maintaining your enrollment status. While the specific Minnesota Health Care Program Address for physical submissions may be less emphasized in favor of digital portals, knowing how to navigate the application process and where to direct inquiries is paramount.
This guide is designed to be your go-to resource, providing detailed information and practical advice to help you successfully enroll with MHCP and begin providing vital healthcare services to Minnesotans. We will cover everything from checking excluded provider lists and understanding eligibility rules to submitting your application and managing your enrollment details.
Understanding the MHCP Enrollment Process
Minnesota Health Care Programs (MHCP) facilitates a streamlined enrollment process through the Minnesota Provider Screening and Enrollment (MPSE) portal. For those new to MHCP, quarterly webinars are available, offering comprehensive guidance on utilizing the MPSE portal for initial enrollment. These sessions, accessible via the MPSE training website, are an invaluable resource to familiarize yourself with the system and process.
To become an enrolled MHCP provider, follow these essential steps:
Step 1: Verifying Exclusion Status on Federal and State Lists
Prior to initiating your enrollment, it’s imperative to verify that neither you nor any individuals or entities associated with your practice are included on federal or state excluded provider lists.
The Office of Inspector General (OIG) within the U.S. Department of Health and Human Services maintains a list of excluded individuals and entities barred from participating in Medicare, Medicaid, and other federal healthcare programs. MHCP adheres to these federal exclusions and also maintains its own state-level exclusion list.
Enrollment and payment from MHCP are contingent upon ensuring that providers, their employees, and contractors are not excluded from participation in these programs. Engaging with excluded parties can lead to civil monetary penalties imposed by the OIG.
Regularly checking the OIG’s List of Excluded Individuals and Entities (LEIE) is a mandatory practice for all MHCP providers, both during the initial enrollment phase and throughout their participation. It is recommended to search the LEIE by name:
- Before submitting your enrollment application.
- Prior to hiring new personnel or engaging contractors.
- Monthly, to monitor for any updates or changes.
Any exclusions identified through these searches must be promptly reported to MHCP Provider Eligibility and Compliance via fax at 651-431-7462.
Further details can be found on the Excluded Provider Lists page within the MHCP Provider Manual.
Step 2: Meeting MHCP Rules and Requirements
Eligibility for MHCP enrollment requires providers to fulfill all necessary prerequisites and certifications relevant to the specific healthcare services they intend to offer. Before submitting any enrollment documentation, ensure you meet these criteria. To determine the specific requirements:
- Consult the “Eligible Providers” section within this guide to identify licensure and certification mandates for your provider type.
- Review the Provider Screening Requirements page of the MHCP Provider Manual for a comprehensive overview of screening protocols.
Step 3: Obtaining a Provider Identification Number (NPI or UMPI)
A crucial step in the enrollment process is securing the correct provider identification number. The National Provider Identifier (NPI) is a unique identifier required for healthcare providers when submitting claims and other transactions. If you are eligible for an NPI, you must obtain it through the National Plan and Provider Enumeration System (NPPES) before enrolling with MHCP.
For certain provider types, a Unique Minnesota Provider Identifier (UMPI) may be assigned instead of an NPI. The following provider categories are not mandated to obtain an NPI, although they have the option to use one if registered to them. If these provider types do not possess an NPI, they can proceed with enrollment, and MHCP will assign a UMPI upon application processing:
- Home and community-based services providers
- Personal care provider organizations
- Day training and habilitation providers
- Early intensive developmental and behavioral intervention (EIDBI) Level II and III individuals
- Nonemergency medical transportation (NEMT) organizations
- Doula providers (Individual and organizational providers)
Providers who do not meet the HIPAA definition of a healthcare provider may not be eligible for an NPI. In such cases, enrollment can proceed without an NPI, and MHCP will issue a Welcome letter confirming enrollment and assigning a 10-digit UMPI.
Conversely, certain provider types are not eligible to obtain an NPI prior to enrollment and will be assigned a UMPI by MHCP:
- Approved day treatment centers
- Children’s residential services providers
- Clearinghouses and billing intermediaries (Note: Not eligible for MCO-only enrollment)
- Health care case coordinators
- Individual personal care assistants (PCAs)
- Community health workers
- Women, Infants and Children (WIC) programs
- Head Start programs
- Electronic Data Interchange (EDI) trading partners (Note: Not eligible for MCO-only enrollment)
- Clearing houses (Note: Not eligible for MCO-only enrollment)
- Billing intermediaries (Note: Not eligible for MCO-only enrollment)
- Non-emergency medical transportation (NEMT) drivers
Whether an NPI or UMPI is used, this identifier is mandatory for all fee-for-service claims submitted to MHCP, enabling accurate billing and payment for services rendered to MHCP members.
Step 4: Submitting Your Enrollment Documents to MHCP
Prospective MHCP providers have two primary methods for submitting their enrollment documents:
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Online Submission via MPSE Portal: The most efficient method is through the Minnesota Provider Screening and Enrollment (MPSE) portal. Registering for portal access allows for online application completion, offering built-in guidance, error detection, and application status tracking.
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Fax Submission: Alternatively, you can complete the necessary documents and fax them to MHCP’s Provider Eligibility and Compliance division.
To determine the specific documents required for your provider type, refer to the “Eligible Providers” section and click on the relevant service link for detailed instructions and forms.
Important Note: MHCP does not accept enrollment documents via email. Submissions must be made through either the MPSE portal or by fax. While the article does not explicitly list a Minnesota health care program address for mail-in applications, the focus is clearly on digital and fax submissions. For any uncertainties about document submission or needing to confirm if a physical Minnesota health care program address exists for specific purposes, contacting the MHCP Provider Resource Center is recommended.
Application Fees
Certain MHCP provider types are required to remit a nonrefundable application fee during initial enrollment, re-enrollment, or revalidation. Payment of this fee is a prerequisite for application submission. Details regarding application fee requirements can be found in the Application Fees section within the Provider Screening Requirements page of the MHCP Provider Manual.
Electronic Funds Transfer (EFT) for Payments
MHCP strongly encourages all fee-for-service providers to enroll in Electronic Funds Transfer (EFT), also known as direct deposit, for payment disbursement. EFT enrollment can be initiated during the application process itself and does not require prior enrollment approval. EFT offers numerous benefits over traditional paper checks:
- Faster Access to Funds: EFT payments are processed and available quicker, eliminating mail delays and bank deposit trips.
- Enhanced Security: EFT minimizes the risk of lost, stolen, or misdirected checks.
- Simplified Cash Flow Management: EFT streamlines financial administration with reduced paperwork.
To receive EFT payments from MHCP, providers must possess an active 10-digit supplier ID and a 3-digit supplier location code, both issued by Minnesota Management and Budget (MMB).
To establish a supplier ID for MHCP payments:
- Visit the Minnesota Supplier Portal and register as a “New Supplier” if you do not already have a supplier ID.
- To add or update banking information for an existing supplier ID, consult the Update Supplier Profile guide or submit the MMB EFT Bank Change Request (PDF). For supplier ID inquiries, contact MMB at 651-201-8106.
- Allow 10 business days for your supplier ID to become active after adding banking information. Subsequently, enter your EFT supplier ID and location code via the MPSE portal (instructions in the MPSE user manual for Enrollment Record Information) or fax a completed EFT Supplier ID Notification (DHS-3725) (PDF) to Provider Eligibility and Compliance at 651-431-7462.
Enrollment for Managed Care Organization (MCO) Providers
Federal mandates under the 21st Century Cures Act necessitate the enrollment of all Medicaid providers by the state agency (DHS), encompassing both fee-for-service and Managed Care Organization (MCO) network providers. Enrollment for MCO in-network only providers commenced on July 17, 2023. The enrollment process mirrors the steps outlined in the Enrollment Process section.
Refer to Enrollment process for MCO network providers for additional information and the Eligible Providers section for a list of enrolled provider types and their specific requirements.
Providers already active in fee-for-service and contracting with an MCO are exempt from re-enrollment.
For participation in an MHCP managed care organization network, providers must also contact the relevant health plan directly for contract details. Additional information is available on the MCOs page within the MHCP Provider Manual.
MCO in-network provider enrollment follows specific instructions detailed in the MCO In-Network Provider Enrollment page of the MPSE User Manual.
Enrollment Approvals and Effective Dates
Minnesota-Based Providers
Providers located within Minnesota may receive retroactive enrollment approvals. If enrollment criteria are met, the effective date will be determined using one of the following methods:
- The provider-requested effective date in MPSE or the enrollment application.
- The first day of the month in which the enrollment request is received.
- Up to 90 days prior to the effective date of Medicare certification (if applicable).
- The retroactive date of the member’s MHCP eligibility confirmation.
- The date of confirmation that the provider meets all MHCP requirements.
For Minnesota providers requiring additional screening, such as site visits or background checks (categorized as moderate or high-risk on the Risk Levels section of the Provider Screening Requirements page), approval will be granted upon completion of these screenings.
Out-of-State Providers
Out-of-state providers can apply for MHCP enrollment specifically for dates of service provided to MHCP members. Eligibility for payment requires out-of-state providers to:
- Comply with licensing and certification standards of their state of location, with exceptions for home and community-based waiver services providers who must adhere to Minnesota’s federally approved waiver plan requirements.
- Submit an enrollment request via the MPSE portal along with a copy of the Provider Agreement and any necessary assurance statements and credentials, or fax documents to Provider Eligibility and Compliance at the fax number on MHCP forms.
Additional requirements are detailed in the Billing Policy Overview and Out-of-State Providers sections of the MHCP Provider Manual.
Consolidated Providers and Taxonomy Codes
A consolidated provider is defined as one utilizing a single National Provider Identifier (NPI) for multiple enrollment records.
While providers may offer diverse services, billing all services under a single enrollment record is not always feasible. Depending on service types, multiple enrollment records may be necessary. Provider Eligibility and Compliance reviews provider types with multiple active credentials across different enrollment records to determine if consolidation is required.
MHCP Use of Taxonomy Codes (Fee-for-Service Only): A taxonomy code classifies the provider or organization type, specialization, and classification. A comprehensive list is available on the X12 External Codes List website.
When a provider opts to bill under one NPI for multiple records due to multiple locations or service types, MHCP consolidates records under provider type (PT) 33. Original records remain active and linked to the PT33 record.
- For NPIs representing multiple records sharing a physical address or zip code, taxonomy codes for each record are required post-enrollment and MN–ITS registration. If records share the same taxonomy code, a custom code can be entered. MHCP uses these codes solely for billing purposes.
- Taxonomy or custom taxonomy codes must be submitted to MHCP through MN–ITS. A tutorial is available: Adding Taxonomy Codes.
- If an NPI represents multiple records with unique physical addresses, the service facility location must be submitted on claims.
MN–ITS Registration for Fee-for-Service Providers
MN–ITS is a free, HIPAA-compliant, web-based system. Upon application approval, Provider Eligibility and Compliance sends a Welcome letter with initial MN–ITS User ID and Password. Providers who applied via fax must register for MN–ITS using registration instructions. MPSE users can log in to MN–ITS with credentials from the Welcome letter.
Minnesota law mandates electronic claim submissions for all MHCP-eligible providers and suppliers. Registration with MN–ITS is compulsory for all providers and affiliated clinics or billing services; paper claims are not processed.
MN–ITS enables providers to:
- Verify program eligibility for MHCP members.
- Retrieve enrollment-related letters and notices.
- Submit authorization requests for services or supplies.
- Submit service agreement (SA) requests for home care services.
- Retrieve authorization and service agreement letters and other communications via the MN–ITS mailbox.
- Submit claims, including those with third-party insurance or Medicare.
- Copy or replace incorrectly submitted paid claims.
- Check claim status.
- Access the MN–ITS Mailbox for information, including Remittance Advices (RAs).
- Access MPSE to manage enrollment records.
MN-ITS Registration for MCO In-Network Only Providers
MN–ITS registration is also mandatory for MCO in-network only providers. Upon MHCP approval, a Welcome letter with MN–ITS credentials and registration instructions will be sent. MCO in-network providers utilize MN–ITS to access the MPSE portal for managing MHCP enrollment information and retrieving important enrollment-related communications.
Maintaining and Changing Enrollment Information
Providers are responsible for maintaining up-to-date enrollment information. The most efficient method for reporting changes is through MPSE. MHCP offers quarterly webinars on managing enrollment changes via the MPSE portal, accessible through the MPSE Training site.
Alternatively, providers can fax relevant forms to report changes:
- Individual Practitioner MHCP Provider Profile Change Form (DHS-3535) (PDF) for individual enrollment and affiliation changes.
- Organization MHCP Provider Profile Change Form (DHS-3535A) (PDF) for organizational contact and enrollment information updates.
- Disclosure of Ownership and Control Interest of an Entity (DHS-5259) (PDF) for changes in management, board composition, or ownership.
- Electronic Remittance Advice (RA) Request Form (DHS-4087) (PDF) (not for MCO in-network only providers) to manage electronic RA on MN–ITS accounts or RA affiliations. More information on remittance advice.
- EFT bank change form (PDF) for direct deposit updates (submitted to Minnesota Management and Budget – MMB).
- EFT Supplier ID Notification (DHS-3725) (PDF) (not for MCO in-network only providers) for MMB-issued EFT Vendor Number or Location Code changes.
- Provider Entity Sale or Transfer Addendum (DHS-5550) (PDF) for ownership changes due to sale or transfer. Submit with new enrollment documents at least 30 days prior to the sale date. Note: Credentialing requirements apply, and processing time is similar to new enrollments, potentially leading to payment reversals for terminated providers.
Provider Eligibility and Compliance processes change requests and will contact providers for additional information if needed. Enrollment status letters are issued to providers, especially when participation changes occur.
Processing Timelines and Request Status
Provider Eligibility and Compliance aims to process complete enrollment requests within 30 days of receipt, regardless of submission method (MPSE or fax). This timeline applies to new, corrected, and resubmitted requests.
Complete Requests
A complete request includes all necessary fields and documents. MPSE users can refer to the Request Submitted and Next Steps section of the MPSE user manual for status updates and outcomes.
For incomplete new enrollment requests, a request for more information (RFMI) letter will be sent via MN–ITS mailbox or U.S. mail, detailing missing information. Providers have 60 days to respond using the original submission method (MPSE or fax). Partial responses will trigger a subsequent RFMI with an additional 30-day response window. Failure to provide complete information will result in request denial.
For submissions requiring corrections or additional information, allow up to 30 days from the most recent submission date for processing.
Inactive Enrollment Records
Inactive enrollment records necessitate re-enrollment with MHCP, either through the MPSE portal or by faxing a new application to Provider Eligibility and Compliance.
Billing Organizations
MHCP-enrolled providers can utilize clearinghouses or billing intermediaries for electronic claim submissions and transactions.
Clearinghouses and billing intermediaries acting on behalf of enrolled providers must enroll as billing organizations.
Eligible Provider Types
Participation in MHCP requires providers to meet professional certification and licensure standards as per state and federal regulations relevant to their services. Upon meeting these prerequisites, providers can apply for MHCP enrollment via the Minnesota Provider Screening and Enrollment (MPSE) portal or by faxing required application materials.
Providers with managed care organization (MCO) contracts should also verify MCO-specific enrollment requirements.
Fee-for-service providers marked with ¹ in the list below do not receive direct payment and must bill through an organization. Providers marked with ² are not eligible for MCO-only enrollment.
| ### Organization Providers | ### Individual Providers |
|---|---|
| Adult Day Treatment – 46 Allied Oral HealthProfessional Group – 31 Ambulatory Surgical Center – 22 Birthing Center – B1 (Enrollment webpage to come. Contact the MHCP Provider Resource Center for enrollment information.) Certified Registered Nurse Anesthetist Organization – 67 Child and Teen Checkup Clinic – 16 Children’s Residential Treatment Facility¹- 06 Community First Services and Supports (CFSS) – CFSS Community Health Clinic – 58 Community Mental Health Center – 10 County Case Manager²- 23 County Human Services Agency² – 45 Day Training and Habilitation for ICF/DD– 19 Dental Group – 30 Doula Entity – DA Durable Medical Equipment – 76 Early Intensive Developmental and Behavioral Intervention² – EI Electronic Data Interchange (EDI) Trading Partner² – 28, 95, 98 Family Planning Agency – 54 Federally Qualified Health Center – 52 Home and Community-Based Services (HCBS) – 18 Moving Home Minnesota – 18 Housing Stabilization Services – 18-HSS Housing Support Supplemental Services – 18 Home Care Nursing Agency Group – 64 Home Health – 60 Hospice – 02 Hospital – 01 Independent Diagnostic Testing Facility – 32 Independent Laboratory – 80 Independent X-ray – 81 Indian Health Services – 51 Individualized Education Program – 09 Institution for Mental Disease¹ – 03 Intensive Residential Treatment Services – 50 Intermediate Care Facilities – 05 Medical Services Group – 49 Medical Transportation – 82 Mental Health Group – 34 Non-Profit Dental Organization Nursing Facility – 00 Optical Company – 75 Personal Care Provider Organization² – 38 Pharmacy¹ – 70 Psychiatric Residential Treatment Facility – PR Physician Clinic – 20 Public Health Clinic – 57 Public Health Nursing Organization – 61 Recovery Community Organization – RC Recuperative Care Services – RE Regional Treatment Center – 17 Rehabilitation Agency – 11 Rehabilitation Group – 48 Renal Dialysis Center – 04 Rural Health Clinic – 53 Substance Use Disorder – 62 Targeted Case Management – 44 or 18 Transportation Coordinator² – 72 (Enrollment webpage to come. Contact the MHCP Provider Resource Center for enrollment information.) |
Acupuncturist – AP Alcohol and Drug Counselor – DC Allied Oral HealthProfessional– 31 Audiologist – 43 Certified Mental Health Rehabilitation Professional¹- 26 Certified Nurse Midwife – 66 Certified Professional Midwife – C1 Certified Registered Nurse Anesthetist – 67 Chiropractor – 37 Clinical Nurse Specialist – 68 Community Health Worker¹ – 55 Dentist – 30 Direct Support Worker, Individual¹, ² – 38 Doula – DA Early Intensive Developmental and Behavioral Intervention² – EI Health Care Case Coordinator – 27 Hearing Aid Dispenser – 77 Home Care Nurse – 64 Licensed Independent Clinical Social Worker – 14 Licensed Marriage and Family Therapist – 25 Licensed Professional Clinical Counselor- 63 Licensed Psychologist – 42 Nurse Practitioner – 65 Occupational Therapist – 29 Optometrist – 35 Pharmacist¹ – 70 Physical Therapist – 39 Physician – 20 Physician Assistant – 69 Podiatrist – 36 Registered Dietician or Licensed Nutritionist – 15 Speech-Language Pathologist – 40 Transportation Driver¹ – DR |
For any further inquiries, especially concerning the Minnesota health care program address for specific submissions or general contact, please reach out to the MHCP Provider Resource Center.
