Minnesota Health Care Programs (MHCP) is indeed the umbrella term for Minnesota’s Medicaid program, alongside other state and federal healthcare initiatives. For healthcare providers aiming to serve Minnesota’s Medicaid recipients and other eligible individuals, understanding the MHCP enrollment process is crucial. This guide provides a comprehensive overview of how to become an enrolled MHCP provider, ensuring you can effectively participate in this vital healthcare network.
This guide is based on the most recent guidelines from the Minnesota Department of Human Services (DHS), updated as of February 19, 2025, to provide you with the most accurate and up-to-date information.
MHCP Enrollment Process: A Step-by-Step Guide
Becoming an MHCP provider involves several key steps. The Minnesota Department of Human Services offers helpful quarterly webinars to guide new providers through the initial enrollment using the Minnesota Provider Screening and Enrollment (MPSE) portal. You can find more information and registration details on the MPSE training website.
Here are the essential steps to enroll as an MHCP provider:
1. Verify Status Against Excluded Provider Lists
Before initiating your MHCP enrollment application, it’s imperative to check both federal and state excluded provider lists. The Office of Inspector General (OIG) within the U.S. Department of Health and Human Services maintains a list of individuals and entities excluded from participation in federal healthcare programs like Medicare and Medicaid. Minnesota Health Care Programs adheres to these federal exclusions and also maintains its own state-level exclusion list.
MHCP is prohibited from enrolling or issuing payments to providers who, or whose employees or contractors, are on any federal or state exclusion lists. Engaging with excluded parties can lead to civil monetary penalties from the OIG.
To ensure compliance, providers must regularly consult the OIG’s List of Excluded Individuals and Entities (LEIE). It is recommended to search the LEIE:
- Prior to submitting an enrollment application.
- Before hiring new employees or contracting with new contractors.
- Monthly, to monitor for any updates since the last check.
Any exclusions identified should be immediately 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. Meet MHCP Rules and Provider Requirements
Eligibility for MHCP enrollment is contingent upon meeting specific requirements and certifications relevant to the type of healthcare service you intend to provide. Prior to submitting your enrollment application, ensure you fulfill all necessary criteria.
To determine the specific requirements for your provider type:
- Refer to the Eligible Providers section of this guide for links to service-specific requirements and provider types.
- Review the comprehensive Provider Screening Requirements page in the MHCP Provider Manual.
3. Obtain a Provider Identification Number: NPI or UMPI
A crucial step in the enrollment process is securing a provider identification number. The National Provider Identifier (NPI) is a unique, standard identification number mandated for healthcare providers for all health care claims and transactions. If you are eligible for an NPI, you must obtain it from the National Plan and Provider Enumeration System (NPPES) before applying for MHCP enrollment.
For certain provider types who may not be eligible for an NPI under HIPAA guidelines, MHCP assigns a Unique Minnesota Provider Identifier (UMPI). These provider types, which may opt to use an NPI if they have one, but are not required to, 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)
If these provider types do not possess an NPI, they can still enroll. MHCP will assign a 10-digit UMPI upon application processing and confirmation of enrollment in a Welcome letter.
Certain provider types are not eligible to obtain an NPI prior to enrollment and will be assigned a UMPI by MHCP. These include:
- 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, facilitating payment to providers for services rendered to eligible MHCP members.
4. Submit Enrollment Documents to Minnesota Health Care Programs
Providers can submit their enrollment applications to MHCP through two primary methods:
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Minnesota Provider Screening and Enrollment (MPSE) Portal: Register and access the MPSE portal (https://mn.gov/dhs/partners-and-providers/policies-procedures/minnesota-health-care-programs/provider/mpse/) to complete your enrollment online. This is the recommended method due to its efficiency, built-in guidance, error detection, and application tracking features.
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Fax Submission: Alternatively, you can complete the required documents 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 necessary forms.
Important Note: MHCP does not accept enrollment documents via email. Applications must be submitted through MPSE or by fax.
Application Fees for MHCP Enrollment
Certain MHCP provider types are required to pay a non-refundable application fee when initially enrolling, re-enrolling, or revalidating their enrollment. If applicable, the fee must be paid before submitting your enrollment application. Consult the Application Fees section within the Provider Screening Requirements page of the MHCP Provider Manual for details regarding fee requirements.
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 claim payments. EFT enrollment can be initiated during the application process and doesn’t require prior enrollment approval. EFT offers several benefits:
- Faster Payments: Access funds sooner, eliminating mail delays and bank deposit trips.
- Enhanced Security: Reduced risk of lost, stolen, or misdirected checks.
- Simplified Cash Flow Management: Less paperwork and easier reconciliation.
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).
To establish a supplier ID for MHCP payments:
- Visit the Minnesota Supplier Portal and select “Register for an Account” to register as a “New Supplier” if you don’t already have one.
- To add or modify banking information for an existing supplier ID, refer to Update Supplier Profile 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 details. 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 within Minnesota Medicaid
Federal mandates, specifically the 21st Century Cures Act, require state Medicaid agencies like DHS to enroll 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 for MCO providers mirrors the general Enrollment Process outlined earlier.
For detailed information, refer to Enrollment process for MCO network providers and the Eligible Providers section for a list of enrollable provider types and their specific requirements.
Note: Providers currently enrolled for fee-for-service who also contract with an MCO are not required to re-enroll.
Providers interested in joining an MHCP managed care organization network must also directly contact the relevant health plan for participation and contract details. Additional information is available on the MCOs page in the MHCP Provider Manual.
MCO in-network provider enrollment instructions are detailed in the MCO In-Network Provider Enrollment page of the MPSE User Manual.
MHCP Enrollment Approvals and Effective Dates
Minnesota-Based Providers
For providers located within Minnesota, retroactive enrollment approvals are possible. If enrollment requirements are met, the effective date will be determined by one of the following:
- The provider-requested effective date in MPSE or the application.
- The first day of the month when the enrollment request is received.
- Up to 90 days prior to the effective date of Medicare certification.
- The retroactive date of member’s MHCP eligibility confirmation.
- The date all MHCP provider requirements are met.
For provider types 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 for specific dates of service to MHCP members. To qualify for MHCP payment, out-of-state providers must:
- Meet the licensing and certification standards of their state, except 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 with a copy of the Provider Agreement and necessary assurance statements and credentials, or fax required documents to Provider Eligibility and Compliance.
Refer to Billing Policy Overview and Out-of-State Providers sections in the MHCP Provider Manual for further details.
Consolidated Providers and Taxonomy Codes
A consolidated provider is defined as a provider with multiple enrollment records linked to a single National Provider Identifier (NPI).
While providers may offer diverse services, billing all services under a single enrollment record may not be feasible. Multiple enrollment records might be necessary based on service types. Provider Eligibility and Compliance will assess providers with multiple active credentials across different enrollment records to determine if consolidation is needed.
When a provider utilizes one NPI for multiple records due to multiple locations or service types, MHCP will consolidate these records under a provider type (PT) 33 record. The original records will remain active and linked to the PT33 record.
- If an NPI covers multiple records sharing a physical address or zip code, taxonomy codes for each record must be submitted post-enrollment and MN–ITS registration. If records are limited to and share the same taxonomy code, a custom taxonomy code can be entered. MHCP uses taxonomy codes for billing purposes only.
- Taxonomy or custom taxonomy codes must be submitted via MN–ITS. A tutorial is available: Adding Taxonomy Codes video.
- If an NPI encompasses multiple records each with a unique physical address, the service facility location where the service was rendered must be included on claims.
MN–ITS Registration for Fee-for-Service and MCO Providers within Minnesota Medicaid
MN–ITS (Minnesota Information Transfer System) is a free, HIPAA-compliant, web-based system essential for MHCP providers. Upon enrollment approval, Provider Eligibility and Compliance will send a Welcome letter containing an initial MN–ITS User ID and Password. Providers enrolling via fax will need to register for MN–ITS following the registration instructions. MPSE enrollees can use the credentials in the Welcome letter to log into MN–ITS.
Minnesota law mandates electronic claim submission for all healthcare providers and suppliers eligible for MHCP reimbursement. All providers and affiliated clinics or billing services must register for MN–ITS as MHCP does not process paper claims.
MN–ITS functionalities for registered users include:
- Verifying program eligibility for MHCP members.
- Retrieving enrollment-related letters and notices.
- Submitting authorization requests for medical, dental services, or medical supplies.
- Submitting service agreement (SA) requests for home care services.
- Retrieving authorization and service agreement letters and other items in the MN–ITS mailbox.
- Submitting claims (including claims with third-party insurance or Medicare).
- Copying prior MN–ITS claims or replacing incorrectly submitted paid claims.
- Checking claim status (paid or denied).
- Accessing the MN–ITS Mailbox for information, including Remittance Advices (RAs).
- Accessing MPSE to manage enrollment records.
MCO in-network only providers also utilize MN-ITS to access the MPSE portal for MHCP enrollment management and to retrieve enrollment-related communications.
Managing Changes to Your MHCP Enrollment
Maintaining up-to-date enrollment information is the provider’s responsibility. The most efficient method for reporting changes is through MPSE. MHCP provides quarterly webinars on managing enrollment changes via the MPSE portal, accessible through the MPSE Training site.
Alternatively, providers can fax specific forms to report changes:
- Individual Practitioner MHCP Provider Profile Change Form (DHS-3535) (PDF): For individual enrollment changes or affiliation updates.
- Organization MHCP Provider Profile Change Form (DHS-3535A) (PDF): For organization contact or 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): To manage electronic RA settings (not for MCO-only providers).
- EFT bank change form (PDF): For direct deposit information changes (submitted to MMB).
- EFT Supplier ID Notification (DHS-3725) (PDF): To update MMB-issued EFT Vendor Number or Location Code (not for MCO-only providers).
- Provider Entity Sale or Transfer Addendum (DHS-5550) (PDF): For reporting ownership changes due to sale or transfer. Requires submission of new enrollment documents at least 30 days prior to the sale date to avoid billing disruptions.
Provider Eligibility and Compliance will process change requests and contact providers if additional documentation is needed. Enrollment status letters are sent to providers to confirm changes in participation, such as service expansions or reductions.
MHCP Processing Timelines and Actions
Provider Eligibility and Compliance aims to process complete requests within 30 days of receipt, regardless of submission method (MPSE or fax). This 30-day timeline applies to new, corrected, and resubmitted requests.
Complete Enrollment Requests
A complete request includes all required fields and documents. MPSE users can monitor the Request Submitted and Next Steps section of the MPSE user manual for status updates.
For incomplete new enrollment requests, Provider Eligibility and Compliance will issue a request for more information (RFMI) letter via the provider’s MN–ITS mailbox or U.S. mail. Providers have 60 days to respond and provide the missing information using the original application method (MPSE or fax). Failure to provide complete information within 60 days may result in denial. Partial submissions will trigger a follow-up RFMI with an additional 30-day response window before potential denial.
If corrections or additional information are required, allow up to 30 days from the most recent submission date for processing.
Inactive Enrollment Records
If an enrollment record becomes inactive, re-enrollment is necessary through the MPSE portal or by faxing a new application to Provider Eligibility and Compliance.
Billing Organizations for Minnesota Medicaid Claims
MHCP-enrolled providers can utilize clearinghouses or billing intermediaries as billing agents for electronic claim and transaction submissions to MHCP.
Clearinghouses and billing intermediaries submitting claims on behalf of enrolled providers must enroll as a billing organization with MHCP.
Eligible Providers for Minnesota Health Care Programs
To participate in Minnesota Medicaid (MHCP), providers must meet specific professional certification and licensure requirements as defined by state and federal regulations relevant to their service type. Upon meeting these prerequisites, providers can apply for MHCP enrollment via the Minnesota Provider Screening and Enrollment (MPSE) portal or by faxing the required application materials.
Providers with MCO contracts should also verify enrollment requirements with each MCO.
Fee-for-service providers marked with ‘¹’ in the list below do not receive direct payments and must bill through an organization. Providers marked with ‘²’ are not eligible for MCO-only enrollment.
Eligible Health Care Provider Types for MHCP Enrollment:
| 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 |
