Minnesota Health Care Programs (MHCP) are vital in providing access to healthcare services for eligible individuals and families in Minnesota. For healthcare providers, understanding the enrollment process and accessing support is crucial for effective participation. This guide offers a detailed overview of MHCP enrollment, designed to be your go-to resource. While navigating the process, you might need direct assistance. For immediate inquiries and support, the Minnesota Health Care Programs Phone Number is a key resource, and we’ll guide you on how to find and utilize it effectively, alongside comprehensive enrollment information.
Understanding the MHCP Enrollment Process
Enrolling with MHCP is a structured process designed to ensure that healthcare providers meet the necessary standards and requirements to serve MHCP members. Whether you are new to MHCP or need to re-enroll, understanding each step is essential.
Step 1: Verifying Exclusion Status
Before initiating the enrollment process, it is imperative to check both federal and state excluded provider lists. This step is crucial because MHCP cannot enroll or pay providers who are excluded from participation in Medicare, Medicaid, or other federal health care programs.
The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services maintains a List of Excluded Individuals and Entities (LEIE). MHCP mandates that all enrolling and enrolled providers, including their employees and contractors, must not be on this list.
Best Practices for Exclusion Checks:
- Pre-Enrollment: Conduct a thorough search of the LEIE before submitting your enrollment application.
- Pre-Hiring: Verify the exclusion status of all new employees and contractors before they begin providing services.
- Monthly Monitoring: Regularly check the LEIE (monthly is recommended) to identify any updates or changes since your last check.
Should you discover any exclusions during your checks, immediately report them to MHCP Provider Eligibility and Compliance via fax at 651-431-7462. Further information on excluded provider lists 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 meet specific rules and requirements based on the services they intend to offer. Prior to submitting any enrollment documents, ensure you comply with all relevant certifications and requirements.
Key Actions to Determine Requirements:
- Service-Specific Requirements: Consult the “Eligible Providers” section of this guide to find the specific licensure or certification needed for your provider type.
- Provider Screening Requirements: Review the comprehensive Provider Screening Requirements page in the MHCP Provider Manual for detailed information.
Understanding and adhering to these rules is crucial for a smooth enrollment process. If you have questions about specific requirements, utilizing the Minnesota Health Care Programs phone number listed on the official DHS website can provide direct clarification.
Step 3: Obtaining a Provider Identification Number (NPI or UMPI)
A crucial step in the enrollment process is obtaining the correct provider identification number. For most providers, this is the National Provider Identifier (NPI). The NPI is a unique, standard identification number for healthcare providers used for claims and transactions.
Eligible providers must obtain their NPI from the National Plan and Provider Enumeration System (NPPES) before enrolling with MHCP.
Unique Minnesota Provider Identifier (UMPI)
Certain provider types are not mandated to have an NPI but can use one if they possess it. If these provider types do not have an NPI, MHCP will assign a Unique Minnesota Provider Identifier (UMPI) upon application processing. These provider types include:
- 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 not meeting the HIPAA definition of a healthcare provider may not be NPI eligible. In such cases, they can still apply for enrollment, and MHCP will issue a UMPI upon approval, confirmed via a Welcome letter.
Provider Types Not Eligible for NPI Prior to Enrollment:
- Approved day treatment centers
- Children’s residential services providers
- Clearinghouses and billing intermediaries (not 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 (not for MCO-only enrollment)
- Clearing houses (not for MCO-only enrollment)
- Billing intermediaries (not for MCO-only enrollment)
- Non-emergency medical transportation (NEMT) drivers
The NPI or UMPI is mandatory for all fee-for-service claims submitted to MHCP, facilitating accurate provider payment for services rendered to MHCP members. If you are unsure about whether you need an NPI or UMPI, consider contacting MHCP directly using the Minnesota Health Care Programs phone number for guidance.
Step 4: Submitting Enrollment Documents to MHCP
Providers have two primary methods for submitting enrollment documents to MHCP:
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Minnesota Provider Screening and Enrollment (MPSE) Portal: Register and access the MPSE portal to complete your enrollment online. This is the recommended method due to its efficiency, built-in guidance, error review, and application status tracking.
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Fax Submission: Complete the necessary documents and fax them to MHCP’s Provider Eligibility and Compliance division. Refer to the “Eligible Providers” section to find service-specific requirements and required forms.
Important Note: MHCP does not accept enrollment documents via email. All submissions must be through MPSE or fax.
Application Fees
Certain MHCP provider types are required to pay a nonrefundable application fee during initial enrollment, re-enrollment, or revalidation. Payment of this fee is mandatory before submitting the enrollment application. Details about application fee requirements can be found in the Application Fees section of the Provider Screening Requirements page.
Electronic Funds Transfer (EFT)
MHCP encourages all fee-for-service providers to enroll in Electronic Funds Transfer (EFT) for payments. EFT, or direct deposit, offers numerous benefits over traditional paper checks:
- Faster Payments: Access funds more quickly without waiting for mail delivery or bank deposits.
- Enhanced Security: Reduced risk of lost, stolen, or misdirected checks.
- Simplified Cash Flow Management: Less paperwork and easier reconciliation.
Providers can enroll in EFT during the application process itself. To receive EFT payments, you need an active 10-digit supplier ID and a 3-digit supplier location code from Minnesota Management and Budget (MMB).
Steps to Establish a Supplier ID for EFT:
- Supplier Portal Registration: Go to the Minnesota Supplier Portal and register as a “New Supplier” if you don’t have a supplier ID.
- Update Banking Information: To add or update banking information, refer to Update Supplier Profile or submit the MMB EFT Bank Change Request (PDF). For supplier ID inquiries, call MMB at 651-201-8106.
- Activation Time: Allow 10 business days for your supplier ID to become active after adding banking information. Then, input your EFT supplier ID and location code via the MPSE portal (instructions in the Enrollment Record Information MPSE user manual) or fax the EFT Supplier ID Notification (DHS-3725) (PDF) to Provider Eligibility and Compliance at 651-431-7462.
Enrollment for Managed Care Organization (MCO) Providers
The 21st Century Cures Act mandates that all Medicaid providers, including those in both fee-for-service and Managed Care Organization (MCO) networks, must be enrolled with the state agency (DHS). Enrollment for MCO in-network only providers began on July 17, 2023.
To enroll as an MCO in-network provider, follow the general Enrollment Process outlined earlier. For more details, refer to Enrollment process for MCO network providers and the Eligible Providers section for provider-specific requirements.
Important Notes for MCO Providers:
- Currently active fee-for-service providers contracting with an MCO do not need to re-enroll.
- Providers in an MCO network must also contact the relevant health plan for participation and contract details. See the MCOs page in the MHCP Provider Manual for further information.
- MCO in-network provider enrollment instructions are available on the MCO In-Network Provider Enrollment page of the MPSE User Manual.
Enrollment Approvals and Retroactivity
Minnesota Providers
For providers located in Minnesota, retroactive enrollment approvals are possible. If all enrollment criteria are met, the effective date will be determined using one of the following:
- Provider-requested effective date in MPSE or application.
- First day of the month when the enrollment request is received.
- Up to 90 days before Medicare certification effective date.
- Retroactive date of MHCP member eligibility confirmation.
- Date of meeting all MHCP provider requirements.
Providers requiring additional screening (site visits, background checks) will be approved upon completion of these screenings. These provider types are categorized as moderate or high-risk on the Risk Levels section of the Provider Screening Requirements page.
Out-of-State Providers
Out-of-state providers can apply for MHCP enrollment for specific dates of service to MHCP members. Eligibility requires:
- Compliance with licensing and certification of their state, except for home and community-based waiver services providers, who must meet Minnesota’s requirements.
- Submission of a request via the MPSE portal with a Provider Agreement copy and necessary assurances, or faxing documents to Provider Eligibility and Compliance.
Refer to Billing Policy Overview and Out-of-State Providers in the MHCP Provider Manual for further details.
Consolidated Providers
A consolidated provider is defined as one NPI linked to multiple enrollment records. This can occur when a provider offers various services but needs different enrollment records for billing purposes.
MHCP will consolidate records under provider type (PT) 33 when a provider uses one NPI for multiple records (locations or service types). These linked records remain active under the PT33 umbrella.
Taxonomy Codes:
- For multiple records under one NPI sharing a physical address or zip code, taxonomy codes are required for each record post-enrollment and MN–ITS registration. Custom taxonomy codes are allowed if records share the same limited taxonomy code. MHCP uses these for billing.
- Taxonomy or custom taxonomy codes must be submitted through MN–ITS. A tutorial is available: Adding Taxonomy Codes.
- If records under one NPI have unique physical addresses, the service facility location must be on claims.
MN–ITS Registration for Fee-for-Service and MCO Providers
MN–ITS (Minnesota Information Transfer System) is a free, HIPAA-compliant, web-based system. Registration is mandatory for both fee-for-service and MCO in-network only providers.
Upon application approval, providers receive a Welcome letter with a MN–ITS initial User ID and Password. Providers enrolling via fax need to register using registration instructions. MPSE enrollees can use the login details from the Welcome letter.
MN–ITS Functions:
- Verify MHCP member eligibility.
- Retrieve enrollment letters and notices.
- Submit authorization requests for services or supplies.
- Submit service agreement (SA) requests for home care.
- Retrieve authorization and service agreement letters.
- Submit claims (including with third-party insurance or Medicare).
- Copy or replace incorrectly submitted claims.
- Check claim status (paid or denied).
- Access the MN–ITS Mailbox for Remittance Advices (RAs).
- Access MPSE to manage enrollment records.
Minnesota law 62J.536 mandates electronic claim submission for all MHCP-eligible providers. Paper claims are not processed.
Changes to 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 MPSE; details are on the MPSE Training site.
Alternatively, providers can fax forms for specific changes:
- Individual Practitioner MHCP Provider Profile Change Form (DHS-3535) (PDF): For individual enrollment changes or affiliations.
- Organization MHCP Provider Profile Change Form (DHS-3535A) (PDF): For organization contact or enrollment changes.
- Disclosure of Ownership and Control Interest of an Entity (DHS-5259) (PDF): For changes in management, board, or ownership.
- Electronic Remittance Advice (RA) Request Form (DHS-4087) (PDF): To manage electronic RA settings (not for MCO-only providers).
- EFT bank change form (PDF): For direct deposit changes (sent to MMB).
- EFT Supplier ID Notification (DHS-3725) (PDF): For MMB-issued EFT Vendor Number or Location Code changes (not for MCO-only providers).
- Provider Entity Sale or Transfer Addendum (DHS-5550) (PDF): For ownership changes due to sale or transfer (submit 30 days prior to sale, requires new enrollment documents and credentialing).
Provider Eligibility and Compliance will process changes and request additional documentation if needed, sending enrollment status letters for changes in participation.
Processing Timelines and Actions
Provider Eligibility and Compliance aims to process complete requests within 30 days, regardless of submission method (MPSE or fax). This timeline applies to new, corrected, and resubmitted requests.
Complete Requests:
A complete request includes all required fields and documents. MPSE users can track statuses and outcomes in the “Request Submitted and Next Steps” section of the MPSE user manual (Request Submitted and Next Steps).
Incomplete Requests:
For incomplete new enrollment requests, Provider Eligibility and Compliance sends a Request for More Information (RFMI) letter via MN–ITS mailbox or U.S. mail. Providers have 60 days to respond using the original submission method (MPSE or fax, not interchangeably). A 30-day extension is given for second RFMIs. Failure to provide complete information leads to denial. Processing time is up to 30 days from the latest submission date when additional information is needed.
Inactive Enrollment Records:
Inactive enrollment records require providers to re-enroll via MPSE or faxing a new application to Provider Eligibility and Compliance.
Billing Organizations
MHCP-enrolled providers can use clearinghouses or billing intermediaries to submit claims electronically. These billing agents must enroll as billing organizations.
Eligible Providers and Contact Information
To participate in MHCP, providers must meet professional certification and licensure requirements per state and federal regulations. After meeting these, application for MHCP enrollment can be made via the MPSE portal or fax with required materials. Contact your contracted MCOs for their specific enrollment needs.
Need Assistance? Contact Minnesota Health Care Programs
For direct assistance and answers to your questions, reaching out to MHCP is straightforward. The primary contact method is the Minnesota Health Care Programs phone number:
MHCP Provider Resource Center:
- Phone: 651-431-2700 or 1-800-366-5411 (Toll-Free)
- Website: MHCP Provider Homepage
- Fax for Enrollment Documents: 651-431-7462
- Address: Minnesota Department of Human Services
P.O. Box 64983
St. Paul, MN 55164-0983
The Provider Resource Center is equipped to assist with enrollment inquiries, navigating the MPSE portal, understanding requirements, and directing you to the right resources within MHCP. Keep the Minnesota Health Care Programs phone number handy throughout your enrollment journey for quick support.
Eligible Provider Types
The following tables list eligible provider types for MHCP 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 |
By following this comprehensive guide and utilizing the Minnesota Health Care Programs phone number when needed, healthcare providers can navigate the MHCP enrollment process effectively and ensure they can provide crucial services to Minnesota communities.
