For out-of-state providers needing to submit claims to the Minnesota Health Care Program (MHCP), paper claim submissions are accepted under specific conditions. This guide outlines when and how to submit paper claims to MHCP, ensuring your claims are processed efficiently.
Eligibility for Paper Claim Submissions
Generally, MHCP prefers electronic claim submissions through MN–ITS. However, paper claims are permitted in limited situations for providers located outside of Minnesota. To be eligible to submit paper claims, out-of-state providers must meet the following criteria:
- Be actively enrolled with Medicare or another state Medicaid agency.
- Be submitting to MHCP on a one-time basis before MHCP enrollment is required.
If ongoing billing is necessary, out-of-state providers are required to complete the MHCP screening and enrollment process and submit claims electronically through MN–ITS. Resources for electronic submissions include the MN–ITS direct data entry User Guides and Minnesota’s Uniform Companion Guides for x12 transactions.
Guidelines for Completing Paper Claim Forms
When submitting paper claims, adhere to the following guidelines to ensure proper processing and avoid claim denials:
Acceptable Claim Forms
- Use original claim forms only. MHCP accepts the following standard forms:
- ADA Dental Claim Form
- CMS-1500 Health Insurance Claim Form
- UB-04 Uniform Billing Claim Form
- MHCP does not accept faxed, copied, or screen-printed claim forms.
General Formatting Requirements
- Printing: Claims must be typed or computer-printed.
- Authorization Forms: Include appropriate authorization request forms when required, ensuring all necessary information is complete.
- Margins and Boxes: Do not write or make any marks outside of the designated boxes on the claim form.
- Ink and Print: Use only black ink and a black print ribbon.
- Font and Typestyle:
- Use standard fonts and typestyles.
- Do not use bold, compressed, cubic, enlarged, italic, mixed, or script typestyles or fonts.
- Capitalize all alpha characters.
- Avoid using symbols such as #, $, &, @, !, and %.
- Handling: Do not fold or staple paper claims.
Submitting Claim Attachments
In some instances, claim attachments may be necessary. Refer to the MHCP Attachment Criteria to determine if your claim requires an attachment. Submitting unnecessary attachments can lead to claim denials.
If attachments are required, please follow these guidelines:
- Use clean 8 ½ x 11-inch paper for all attachments.
- Paperclip all pages of the attachment together with the claim form. Do not use staples.
Minnesota Health Care Program Claims Address
All paper claims, including any necessary attachments, should be mailed to the following address:
Minnesota Department of Human Services
MHCP Claims Processing
PO Box 64993
St Paul, MN 55164-0993
Ensure accuracy when completing claim forms and addressing your submissions to facilitate timely and accurate processing by the Minnesota Department of Human Services.
For further information, refer to the MN–ITS User Guide and the Remittance Advice webpage for details on reading your Remittance Advice.
