Navigating the landscape of healthcare payments can be complex, especially when it comes to institutional care programs. A common question for providers is: Is Institutional Care Program Paid By Check Or Eft? Understanding the payment methods is crucial for efficient revenue cycle management. This guide provides a comprehensive overview of enrollment with Minnesota Health Care Programs (MHCP) and how providers can receive payments, focusing on the modern and efficient method of Electronic Funds Transfer (EFT).
Enrollment Process for Minnesota Health Care Programs
Becoming an enrolled MHCP provider is a systematic process designed to ensure quality care and proper administration of healthcare services. For those new to MHCP, quarterly webinars are available, offering detailed guidance on using the Minnesota Provider Screening and Enrollment (MPSE) portal. These webinars, accessible through the MPSE training website, are an excellent resource for getting started.
To enroll as an MHCP provider, follow these essential steps:
1. Verifying Exclusion Status
Before initiating the enrollment process, it’s imperative to check both federal and state excluded provider lists. The Office of Inspector General (OIG) at the federal level maintains a list of excluded individuals and entities barred from participating in Medicare, Medicaid, and other federal healthcare programs. Minnesota Health Care Programs adheres to these federal guidelines and also maintains its own excluded provider list.
MHCP is prohibited from enrolling or issuing payments to providers who, or whose employees or contractors, appear on these exclusion lists. Engaging with excluded parties can lead to civil monetary penalties from the OIG.
Regular checks are necessary to maintain compliance:
- Prior to enrollment application
- Before hiring new staff or contracting with new entities
- Monthly thereafter to monitor for updates
The List of Excluded Individuals and Entities (LEIE) is publicly accessible and searchable by name. Any exclusions discovered must be promptly reported to MHCP Provider Eligibility and Compliance via fax at 651-431-7462. Further information can be found on the Excluded Provider Lists page within the MHCP Provider Manual.
2. Meeting Requirements and Regulations
Eligibility for MHCP enrollment hinges on meeting specific requirements and certifications relevant to the type of healthcare service being offered. Prospective providers must fulfill all prerequisites before submitting their enrollment application.
To ascertain the precise requirements:
- Consult the Eligible Providers section on the MHCP enrollment page, focusing on your specific provider type and its licensing or certification mandates.
- Review the Provider Screening Requirements page in the MHCP Provider Manual for a detailed overview.
3. Obtaining a Provider Identification Number (NPI)
A National Provider Identifier (NPI) is a unique, government-issued identification number for healthcare providers. This number is essential for submitting and processing healthcare claims and transactions. The National Plan and Provider Enumeration System (NPPES) is the authoritative source for obtaining an NPI. Generally, providers eligible for an NPI must secure one before enrolling with MHCP.
However, certain provider types are exempt from the NPI requirement and may be assigned a Unique Minnesota Provider Identifier (UMPI) by MHCP upon successful enrollment. These 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 (both individual and organizational)
Providers not meeting the HIPAA definition of a healthcare provider may also be ineligible for an NPI. In such cases, enrollment can proceed without an NPI, and MHCP will assign a 10-digit UMPI, communicated via a Welcome letter.
Certain provider categories are not eligible to obtain an NPI prior to enrollment and will be assigned a UMPI:
- Approved day treatment centers
- Children’s residential services providers
- Clearinghouses and billing intermediaries (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 (not eligible for MCO-only enrollment)
- Clearing houses (not eligible for MCO-only enrollment)
- Billing intermediaries (not eligible 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, enabling accurate payment processing for services rendered to MHCP members.
4. Submitting Enrollment Documents
Providers have two options for submitting enrollment documents to MHCP:
-
Online Enrollment via MPSE Portal: The most efficient method is through the Minnesota Provider Screening and Enrollment (MPSE) portal. Register here to access the portal and complete the application online. The MPSE portal (https://mn.gov/dhs/partners-and-providers/policies-procedures/minnesota-health-care-programs/provider/mpse/) offers built-in guidance, error detection, and application status tracking.
-
Fax Submission: Alternatively, providers can complete the required forms and fax them to MHCP’s Provider Eligibility and Compliance division.
To determine the specific forms required for your service type, refer to the Eligible Providers section and click on the relevant service link for MHCP requirements and forms.
Important Note: MHCP does not accept enrollment documents via email. 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 a prerequisite for submitting the enrollment application. Details regarding application fee requirements are available in the Application Fees section of the Provider Screening Requirements page in the MHCP Provider Manual.
Electronic Funds Transfer (EFT) for Payments
Addressing the Key Question: Is Institutional Care Program Paid by Check or EFT?
While historically, payments might have been issued by check, MHCP strongly encourages and facilitates payments via Electronic Funds Transfer (EFT), also known as direct deposit, for all fee-for-service providers. For institutional care programs and other healthcare services, EFT is the recommended payment method due to its efficiency, speed, and security. Providers can enroll in EFT during the application process itself, without waiting for enrollment approval.
EFT offers numerous benefits:
- Faster Access to Funds: EFT payments are significantly faster than paper checks, eliminating mail delays and bank deposit trips. Providers gain quicker access to their revenue.
- Enhanced Security: EFT reduces the risk of lost, stolen, or misdirected checks, ensuring secure and reliable payment delivery.
- Streamlined Cash Flow Management: EFT simplifies cash flow management with less paperwork and predictable deposit schedules.
To receive EFT payments from MHCP, providers 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 MHCP EFT payments:
-
Visit the Minnesota Supplier Portal and register as a “New Supplier” to obtain a supplier ID if you don’t already have one.
-
To add or modify banking information associated with an existing supplier ID, consult the Update Supplier Profile guide or submit the MMB EFT Bank Change Request (PDF). For supplier ID or direct deposit activation queries, contact MMB at 651-201-8106.
-
Allow 10 business days for banking information to activate within the supplier ID system. After activation, input your EFT supplier ID and supplier location code via the MPSE portal (instructions in the MPSE user manual under 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 (21st Century Cures Act) necessitate the enrollment of all Medicaid providers, 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 supplementary details and the Eligible Providers section for provider type lists and enrollment prerequisites.
Currently enrolled fee-for-service providers with MCO contracts are exempt from re-enrollment.
Providers opting for MHCP managed care organization networks must also contact the relevant health plan for participation and contract information. A directory of health plans is available here. Additional MCO information is in the MCOs page of the MHCP Provider Manual.
MCO in-network provider enrollment instructions are located on the MCO In-Network Provider Enrollment page of the MPSE User Manual.
Enrollment Approvals
Minnesota-Based Providers
Retroactive approvals are possible for Minnesota providers. If enrollment criteria are met, approval will be granted with an effective date determined by:
- The provider’s requested effective date in MPSE or application.
- The first day of the month of application receipt.
- Up to 90 days prior to Medicare certification effective date.
- The retroactive date of member MHCP eligibility confirmation.
- The date of MHCP provider requirement fulfillment.
Providers requiring site visits or background checks will be approved upon completion of these additional screenings. Risk levels and associated screening requirements are detailed in 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 necessitates:
- Compliance with licensing and certification standards of their state, except for home and community-based waiver service providers who must meet Minnesota waiver plan requirements.
- Submission of an enrollment request via the MPSE portal with a Provider Agreement copy and necessary assurances and credentials, or faxing documents to Provider Eligibility and Compliance.
Further requirements are outlined in Billing Policy Overview and Out-of-State Providers sections of the MHCP Provider Manual.
Consolidated Providers
A consolidated provider is defined as having multiple enrollment records under a single National Provider Identifier (NPI). While providers may offer diverse services, billing under a single enrollment record is not always permissible, potentially necessitating multiple records based on service type. Provider Eligibility and Compliance assesses providers with multiple credentials for consolidation needs.
MHCP utilizes taxonomy codes (not applicable to MCO in-network only providers) to categorize provider type, classification, and specialization. Taxonomy code details are available on the X12 External Codes List website.
When a provider bills under one NPI for multiple records (due to locations or service types), MHCP consolidates records under provider type (PT) 33, maintaining active linked records.
- For multiple records under one NPI sharing a physical address or zip code, taxonomy codes for each record are required post-enrollment and MN–ITS registration. Custom taxonomy codes can be used if records share the same taxonomy code. These codes are for billing purposes only.
- Taxonomy or custom taxonomy codes are submitted via MN–ITS. A tutorial is available: Adding Taxonomy Codes.
- For records under one NPI 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 enrollment approval, providers receive a Welcome letter with MN–ITS login credentials. Fax enrollees must register for MN–ITS using registration instructions. MPSE enrollees can use the credentials in the Welcome letter.
Minnesota law mandates electronic claims submission for MHCP reimbursement eligibility. All providers and billing services must register for MN–ITS as paper claims are not processed.
MN–ITS functionalities include:
- Verifying program eligibility
- Retrieving enrollment letters/notices
- Submitting authorization requests
- Submitting service agreement (SA) requests for home care
- Retrieving authorization and service agreement letters
- Submitting claims
- Copying or replacing claims
- Checking claim status
- Accessing the MN–ITS Mailbox including Remittance Advices (RAs)
- Accessing MPSE for enrollment management.
MN-ITS Registration for MCO In-Network Only Providers
MN–ITS is also mandatory for MCO in-network only providers. Upon approval, a Welcome letter with MN–ITS credentials and registration instructions is provided. MN–ITS for MCO providers facilitates access to the MPSE portal for enrollment information management and retrieval of enrollment-related notices.
Changes to Enrollment
Providers are responsible for maintaining up-to-date enrollment information. MPSE is the most efficient method for reporting changes via MPSE requests. Quarterly webinars on MPSE enrollment changes are available 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 management, board, or ownership changes.
- Electronic Remittance Advice (RA) Request Form (DHS-4087) (PDF) (not for MCO in-network) for electronic RA setup or billing organization RA affiliations. Remittance advice information is here.
- EFT bank change form (PDF) for direct deposit changes (submitted to MMB).
- EFT Supplier ID Notification (DHS-3725) (PDF) (not for MCO in-network) 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 30 days prior to sale with new enrollment documents). Payment reversal risks for terminated providers are noted here.
Provider Eligibility and Compliance processes changes and requests additional information if needed, sending enrollment status letters for participation changes.
Processing Timelines and Actions
Complete requests, whether via MPSE or fax, are processed within 30 days of receipt. This timeline applies to new, corrected, and resubmitted requests.
Complete Requests
Complete requests include fully filled fields and all required documents. MPSE users can review the Request Submitted and Next Steps section for status details.
For incomplete new enrollment requests, Provider Eligibility and Compliance issues a request for more information (RFMI) via MN–ITS mailbox or mail, specifying missing information. Providers have 60 days to respond using the original application method (MPSE or fax – methods should not be mixed). Incomplete responses trigger further RFMIs with an additional 30-day deadline. Continued incompleteness leads to request denial.
For incomplete or incorrect enrollment documents requiring corrections, allow up to 30 days from the latest submission date for processing.
Inactive Enrollment Records
Inactive enrollment records necessitate re-enrollment via MPSE or faxing a new application to Provider Eligibility and Compliance.
Billing Organizations (not applicable to MCO in-network only providers)
MHCP-enrolled providers can utilize clearinghouses or billing intermediaries for electronic claims submission. These entities must enroll as billing organizations.
Eligible Providers
MHCP participation requires meeting professional certification and licensure standards based on state and federal regulations for the intended services. Post-qualification, providers can apply via the Minnesota Provider Screening and Enrollment (MPSE) portal or faxing enrollment materials.
Contacting contracted Managed Care Organizations (MCOs) for their specific enrollment requirements is also necessary.
Fee-for-service providers marked with ¹ 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 |
