Understanding Minnesota Health Care Programs: A Comprehensive Guide for Providers

Minnesota Health Care Programs (MHCP) are a suite of public health insurance programs designed to ensure access to quality healthcare for eligible Minnesota residents. As a healthcare provider, understanding MHCP is crucial, whether you are looking to enroll as a provider, manage your existing enrollment, or simply want to understand the landscape of healthcare programs in Minnesota. This guide provides a detailed overview of MHCP, focusing on enrollment processes, requirements, and essential information for healthcare providers.

What are Minnesota Health Care Programs?

Minnesota Health Care Programs encompass several state and federally funded initiatives aimed at providing healthcare coverage to specific populations. These programs are administered by the Minnesota Department of Human Services (DHS) and include:

Medical Assistance (Medicaid in Minnesota): This program provides healthcare coverage to low-income individuals and families, children, pregnant women, seniors, and people with disabilities. Eligibility is primarily based on income and asset limits, as well as categorical requirements.
MinnesotaCare: This program is designed for Minnesotans with modest incomes who do not qualify for Medical Assistance and do not have access to affordable health insurance through their employer. MinnesotaCare offers a range of health plans and aims to make healthcare accessible and affordable.
Minnesota Family Planning Program (MFPP): This program provides family planning services to eligible low-income Minnesota residents, regardless of age or family status. MFPP ensures access to contraception, reproductive health screenings, and related healthcare services.

These programs are vital components of Minnesota’s healthcare safety net, ensuring that vulnerable populations have access to necessary medical services. For healthcare providers, participation in MHCP not only aligns with the mission of providing broad access to healthcare but also opens up opportunities to serve a significant portion of the Minnesota population and ensure sustainable practice revenue through reimbursements for provided services.

Enrollment Process for MHCP Providers

To participate in Minnesota Health Care Programs and receive reimbursement for services provided to MHCP members, healthcare providers must enroll with MHCP. The enrollment process is managed through the Minnesota Provider Screening and Enrollment (MPSE) portal. This online system streamlines the application process and allows providers to manage their enrollment information efficiently.

Step-by-Step Enrollment Guide

Check Excluded Provider Lists: Before initiating the enrollment process, it is imperative to verify that neither you nor any of your employees or contractors are listed on federal or state excluded provider lists.
- Federal Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE): The OIG maintains a list of individuals and entities excluded from participation in federal healthcare programs like Medicare and Medicaid. MHCP also prohibits enrollment and payment to providers on this list. Regularly checking the LEIE is essential:
  - Prior to enrollment.
  - Before hiring new employees or contractors.
  - Monthly, to monitor for any updates.
  Any exclusions must be immediately reported to MHCP Provider Eligibility and Compliance.
- Minnesota Excluded Provider List: In addition to the federal list, Minnesota also maintains its own excluded provider list. Ensure you are not listed on either.
Alt: Screenshot of the Office of Inspector General List of Excluded Individuals and Entities (LEIE) website, showing the search interface.
Meet MHCP Rules and Requirements: Eligibility for MHCP enrollment requires adherence to specific rules and requirements based on the type of services you intend to provide.
- Licensure and Certification: Ensure you meet all necessary licensure and certification requirements for your provider type as mandated by Minnesota and federal regulations. Refer to the Eligible Providers section of this guide and the MHCP Provider Manual for details specific to your service category.
- Provider Screening Requirements: Familiarize yourself with the Provider Screening Requirements outlined in the MHCP Provider Manual, which details the background checks and screenings necessary for enrollment.
Obtain a Provider Identification Number (NPI): A National Provider Identifier (NPI) is a unique 10-digit identification number for healthcare providers. Most providers are required to obtain an NPI from the National Plan and Provider Enumeration System (NPPES) before enrolling with MHCP.
- NPI Requirement: If you meet the federal definition of a healthcare provider under HIPAA, you are likely eligible and required to obtain an NPI. Apply for your NPI through the NPPES website.
- Unique Minnesota Provider Identifier (UMPI): Certain provider types who may not be eligible for an NPI will be assigned a Unique Minnesota Provider Identifier (UMPI) by MHCP upon successful enrollment. These provider types often include:
  - Home and community-based services providers
  - Personal care provider organizations
  - Day training and habilitation providers
  - Nonemergency medical transportation (NEMT) organizations
  - Doula providers
The NPI or UMPI is essential for submitting claims to MHCP and receiving payments for services.
Submit Enrollment Documents via MPSE Portal: The most efficient method for enrollment is through the Minnesota Provider Screening and Enrollment (MPSE) portal.
- MPSE Portal Registration: Register for an MPSE account to begin your online enrollment application. The portal provides step-by-step guidance, error checks, and application status tracking.
- Alternative Submission (Fax): While MPSE is preferred, you can also submit enrollment documents via fax. Download the necessary forms based on your provider type from the Eligible Providers section and fax them to MHCP’s Provider Eligibility and Compliance division. Note that MPSE is generally faster and more efficient.
Alt: Screenshot of the Minnesota Provider Screening and Enrollment (MPSE) portal interface, showing the login page.
Application Fees (If Applicable): Some provider types are required to pay a nonrefundable application fee during enrollment, re-enrollment, or revalidation. Check the Application Fees section of the Provider Screening Requirements page to determine if a fee applies to your provider type and ensure payment is made before submitting your application.
Electronic Funds Transfer (EFT) Enrollment: MHCP encourages all providers to enroll in Electronic Funds Transfer (EFT) for claim payments, which is faster, safer, and more efficient than paper checks.
- EFT Setup: You can enroll in EFT during the application process. To set up EFT, you need a Supplier ID and Location Code from Minnesota Management and Budget (MMB).
  - Minnesota Supplier Portal: Register for a Supplier ID at the Minnesota Supplier Portal if you do not already have one.
  - Banking Information: Add or update your banking information in the Supplier Portal.
  - EFT Supplier ID Notification: After your Supplier ID is active (takes about 10 business days after adding bank information), submit your EFT Supplier ID and Location Code to MHCP via the MPSE portal or by faxing the EFT Supplier ID Notification (DHS-3725) (PDF) form.

Enrollment for Managed Care Organization (MCO) Providers

Federal regulations now require all Medicaid providers, including those participating in Managed Care Organization (MCO) networks, to be enrolled with the state Medicaid agency (DHS). This requirement ensures proper oversight and screening of all providers within the MHCP system.

MCO In-Network Enrollment: If you are an MCO in-network provider, you must still enroll with MHCP following the general enrollment process outlined above. This process began on July 17, 2023.
Existing Fee-for-Service Providers: If you are already enrolled as a fee-for-service provider and also contract with an MCO, you generally do not need to re-enroll.
MCO Network Participation: Enrollment with MHCP is separate from contracting with individual MCOs. To participate in an MCO network, you must also contact the specific health plan(s) you wish to contract with. A list of MCOs in Minnesota is available on the DHS website.

Enrollment Approvals and Effective Dates

MHCP reviews enrollment applications to ensure compliance with all requirements. The effective date of your enrollment can vary based on several factors.

Minnesota Providers

For providers located within Minnesota, retroactive enrollment may be granted. The effective date will be determined based on the earliest of the following:

The requested effective date in your MPSE application.
The first day of the month in which MHCP receives your enrollment application.
Up to 90 days prior to the effective date of your Medicare certification (if applicable).
The date the member receiving services was confirmed eligible for MHCP.
The date you met all MHCP provider requirements.

Providers requiring additional screening, such as site visits or background checks (typically moderate- to high-risk provider types), will be approved after these screenings are completed.

Out-of-State Providers

Out-of-state providers can enroll with MHCP to provide services to Minnesota MHCP members. To be eligible for payment, out-of-state providers must:

Meet the licensing and certification requirements of their state, except for home and community-based waiver services providers, who must meet Minnesota’s requirements.
Submit an enrollment request via the MPSE portal or fax, including a copy of their Provider Agreement and any necessary assurance statements and credentials.

Consolidated Providers and Taxonomy Codes

A consolidated provider is one with multiple enrollment records linked to a single National Provider Identifier (NPI). This situation can arise when a provider offers multiple service types or operates from multiple locations.

PT33 Record: MHCP may consolidate multiple records under a Provider Type (PT) 33 record when a provider bills under one NPI for various services or locations.
Taxonomy Codes: Taxonomy codes classify provider type, specialization, and classification. For consolidated providers billing under a single NPI for multiple records sharing a physical address, taxonomy codes are required for each record. These codes are submitted via MN–ITS. In cases where records share the same taxonomy code, a custom taxonomy code can be used.
Service Facility Location: If a provider has multiple records under one NPI, each with a unique physical address, the specific service facility location must be indicated on claims.

MN–ITS Registration for Claim Submission

MN–ITS (Minnesota Information Transfer System) is a free, web-based system used for electronic data interchange with MHCP. Registration for MN–ITS is mandatory for all fee-for-service and MCO in-network providers.

Welcome Letter: Upon enrollment approval, you will receive a Welcome letter containing your initial MN–ITS User ID and Password.
Electronic Claim Submission: Minnesota law mandates electronic claim submission for MHCP reimbursement. MN–ITS is the platform for submitting claims, verifying eligibility, submitting service authorizations, and accessing remittance advices.
MN–ITS Functions: As a registered MN–ITS user, you can:
- Verify member eligibility.
- Submit and track claims.
- Request service authorizations.
- Access enrollment-related notices and letters.
- Manage your MPSE enrollment records.
- Retrieve Remittance Advices (RAs).

Managing Changes to Your Enrollment

Maintaining up-to-date enrollment information is the provider’s responsibility. Changes must be reported to MHCP promptly.

MPSE for Updates: The most efficient way to report changes is through the MPSE portal. You can submit requests for changes to your profile information, affiliations, and other enrollment details online.
Change Request Forms: Alternatively, you can use specific forms to report changes via fax:
For changes in ownership, it is crucial to submit complete documentation at least 30 days prior to the effective date to avoid billing interruptions.

Processing Timelines and Actions

MHCP Provider Eligibility and Compliance aims to process complete enrollment requests within 30 days of receipt, whether submitted through MPSE or fax. This timeline applies to new applications, corrections, and resubmissions.

Complete Requests: A complete request includes all required fields and necessary documentation.
Requests for More Information (RFMI): If an application is incomplete, MHCP will issue an RFMI letter via MN–ITS mailbox or U.S. mail, detailing the missing information. Providers have 60 days to respond to the initial RFMI and an additional 30 days for subsequent RMFIs. Failure to provide complete information within these timeframes may result in denial of the application.
Inactive Enrollment Records: If your enrollment record becomes inactive, re-enrollment is required through MPSE or by submitting a new application via fax.

Billing Organizations

Billing organizations, such as clearinghouses and billing intermediaries, that submit claims on behalf of MHCP-enrolled providers must also enroll with MHCP as billing organizations. This ensures proper accountability and compliance within the billing process.

Eligible Provider Types

Minnesota Health Care Programs enrolls a wide range of provider types, both organizations and individuals, spanning medical, dental, mental health, and social services. The following table lists many of the eligible provider types. For detailed enrollment requirements and specific application forms for each provider type, refer to the linked pages or contact the MHCP Provider Resource Center.

### Organization Providers	### Individual Providers
Adult Day Treatment – 46	Acupuncturist – AP
Allied Oral HealthProfessional Group – 31	Alcohol and Drug Counselor – DC
Ambulatory Surgical Center – 22	Allied Oral HealthProfessional– 31
Birthing Center – B1	Audiologist – 43
Certified Registered Nurse Anesthetist Organization – 67	Certified Mental Health Rehabilitation Professional¹- 26
Child and Teen Checkup Clinic – 16	Certified Nurse Midwife – 66
Children’s Residential Treatment Facility¹- 06	Certified Professional Midwife – C1
Community First Services and Supports (CFSS) – CFSS	Certified Registered Nurse Anesthetist – 67
Community Health Clinic – 58	Chiropractor – 37
Community Mental Health Center – 10	Clinical Nurse Specialist – 68
County Case Manager²- 23	Community Health Worker¹ – 55
County Human Services Agency² – 45	Dentist – 30
Day Training and Habilitation for ICF/DD– 19	Direct Support Worker, Individual¹, ² – 38
Dental Group – 30	Doula – DA
Doula Entity – DA	Early Intensive Developmental and Behavioral Intervention² – EI
Durable Medical Equipment – 76	Health Care Case Coordinator – 27
Early Intensive Developmental and Behavioral Intervention² – EI	Hearing Aid Dispenser – 77
Electronic Data Interchange (EDI) Trading Partner² – 28, 95, 98	Home Care Nurse – 64
Family Planning Agency – 54	Licensed Independent Clinical Social Worker – 14
Federally Qualified Health Center – 52	Licensed Marriage and Family Therapist – 25
Home and Community-Based Services (HCBS) – 18	Licensed Professional Clinical Counselor- 63
Moving Home Minnesota – 18	Licensed Psychologist – 42
Housing Stabilization Services – 18-HSS	Nurse Practitioner – 65
Housing Support Supplemental Services – 18	Occupational Therapist – 29
Home Care Nursing Agency Group – 64	Optometrist – 35
Home Health – 60	Pharmacist¹ – 70
Hospice – 02	Physical Therapist – 39
Hospital – 01	Physician – 20
Independent Diagnostic Testing Facility – 32	Physician Assistant – 69
Independent Laboratory – 80	Podiatrist – 36
Independent X-ray – 81	Registered Dietician or Licensed Nutritionist – 15
Indian Health Services – 51	Speech-Language Pathologist – 40
Individualized Education Program – 09	Transportation Driver¹ – DR
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

By understanding the intricacies of Minnesota Health Care Programs and diligently following the enrollment guidelines, healthcare providers can effectively participate in these vital programs, ensuring access to care for Minnesota residents and building sustainable practices.