Enrolling as a provider with Minnesota Health Care Programs (MHCP) is a crucial step for healthcare professionals and organizations looking to serve Minnesota residents through Medicaid and other state-funded health programs. This guide provides an in-depth look at the MHCP enrollment process, designed to help providers navigate each step effectively. While this document outlines the process, for specific inquiries or to mail physical documents (if necessary), understanding the Minnesota Health Care Program Address and relevant contact information is essential, though online portals and fax are primary methods for submission.
Navigating the MHCP Enrollment Process
Becoming an MHCP provider involves several key stages, each designed to ensure that enrolled providers meet the necessary standards and are properly vetted. The Minnesota Department of Human Services (DHS) manages MHCP, and the enrollment process is facilitated through the Minnesota Provider Screening and Enrollment (MPSE) portal. For providers new to MHCP, quarterly webinars are available to guide them through the MPSE portal. Registration for these valuable sessions can be found on the MPSE training website.
The enrollment journey is structured into clear, manageable steps:
Step 1: Exclusion List Verification
Prior to initiating your MHCP enrollment, it is imperative to verify that neither you nor your entity, including employees and contractors, appear on any federal or state excluded provider lists. The Office of Inspector General (OIG) at the federal level maintains a List of Excluded Individuals and Entities (LEIE). Inclusion on this list prohibits participation in Medicare, Medicaid, and all federal health care programs. Minnesota Health Care Programs adheres to these federal exclusions and also maintains its own state exclusion lists.
Alt Text: Official seal of the Office of Inspector General, emphasizing the importance of checking the OIG exclusion list before Minnesota Health Care Programs enrollment.
MHCP is legally obligated to deny enrollment and payments to providers who, or whose employees or contractors, are on these exclusion lists. Engaging with excluded individuals or entities can lead to significant civil monetary penalties from the OIG.
To ensure compliance, regularly check the LEIE database by name search:
- Before submitting your enrollment application.
- Before hiring any new employees or contractors.
- Monthly, to stay informed of any updates.
Any discovered exclusions 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.
Step 2: Meeting MHCP Rules and Requirements
Eligibility for MHCP enrollment hinges on meeting specific rules and requirements tailored to the type of services you intend to provide. Before beginning the enrollment process, ensure you fulfill all necessary certifications and criteria. To identify these specific requirements:
- Consult the Eligible Providers section on this page, which lists provider types and their respective licensure and certification needs.
- Review the Provider Screening Requirements page in the MHCP Provider Manual for a comprehensive overview.
Step 3: Obtaining a Provider Identification Number (NPI or UMPI)
A crucial step in the enrollment process is securing the correct provider identification number. The National Provider Identifier (NPI) is a unique identifier required for submitting healthcare claims. Eligible providers must obtain their NPI from the National Plan and Provider Enumeration System (NPPES) prior to MHCP enrollment.
However, certain provider types are not mandated to have an NPI and may be assigned a Unique Minnesota Provider Identifier (UMPI) by MHCP upon successful application. 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 (Individual and organizational)
Providers ineligible for an NPI under HIPAA can still apply for enrollment and will receive a UMPI upon approval, confirmed via a Welcome letter.
The following provider types are not eligible to obtain an NPI before enrolling:
- 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 essential for all fee-for-service claims submitted to MHCP, ensuring accurate billing and payment for services rendered to MHCP members.
Step 4: Submitting Your Enrollment Application
Providers have two primary methods for submitting their MHCP enrollment documents:
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Online via MPSE Portal: The most efficient method is through the Minnesota Provider Screening and Enrollment (MPSE) portal. Register for access to complete the application online. The MPSE portal offers built-in guidance, error detection, and application status tracking.
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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 provider type, refer to the Eligible Providers section and select the relevant service to find MHCP requirements and necessary forms.
Important Note: MHCP does not accept enrollment documents via email. Use either the MPSE portal or fax for all submissions. For any queries regarding where to physically send documents, or for general correspondence, you may need the Minnesota health care program address. However, for application submissions, online or fax methods are prioritized.
Application Fees
Certain MHCP provider types are required to pay a nonrefundable application fee during initial enrollment, re-enrollment, or revalidation. Payment must be completed before submitting the enrollment application. Details regarding fee requirements are available in the Application Fees section of the Provider Screening Requirements page.
Electronic Funds Transfer (EFT)
MHCP strongly encourages all fee-for-service providers to enroll in Electronic Funds Transfer (EFT) for direct deposit payments. EFT enrollment can be initiated during the application process. EFT offers numerous benefits:
- Faster Access to Funds: Quicker receipt of payments 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.
To enroll in EFT, 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” if you don’t have an existing ID.
- To update banking details 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 banking information to activate. Then, enter your EFT supplier ID and location code in 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 enrollment for all Medicaid providers, including those within Managed Care Organization (MCO) networks. Enrollment for MCO in-network providers began on July 17, 2023. The enrollment process mirrors the steps outlined in the Enrollment Process section.
Refer to Enrollment process for MCO network providers and the Eligible Providers section for further details and provider-specific requirements.
Existing fee-for-service providers contracting with an MCO do not need to re-enroll.
For MCO network participation and contract details, contact the relevant health plan listed here. Additional MCO information is available on the MCOs page of the MHCP Provider Manual.
MCO in-network provider enrollment instructions are found on the MCO In-Network Provider Enrollment page of the MPSE User Manual.
Enrollment Approvals and Retroactivity
Minnesota Providers
Enrollment for Minnesota-based providers may be approved retroactively. If enrollment requirements are met, the effective date will be determined by:
- The provider’s requested effective date in MPSE or on the application.
- The first day of the month of application receipt.
- Up to 90 days prior to Medicare certification effective date.
- The date of confirmed MHCP eligibility for a member.
- The date of meeting all MHCP provider requirements.
Providers requiring additional screening like site visits or background checks will be approved upon completion of these screenings. These provider types are classified 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 in their state, except for home and community-based waiver services providers who must meet Minnesota requirements.
- Submission of an application via the MPSE portal with the Provider Agreement and required documents, or fax to Provider Eligibility and Compliance.
Refer to Billing Policy Overview and Out-of-State Providers in the MHCP Provider Manual for additional requirements.
Consolidated Providers and Taxonomy Codes
A consolidated provider manages multiple enrollment records under a single National Provider Identifier (NPI). While providers may offer various services, billing under a single enrollment record may not always be possible. Provider Eligibility and Compliance reviews providers with multiple active credentials to determine if record consolidation is needed.
MHCP utilizes taxonomy codes to categorize provider types and specializations. These codes are available on the X12 External Codes List.
When consolidating records under one NPI (PT33 record), providers must submit taxonomy codes for each record via MN–ITS, especially if locations or service types vary. A tutorial on Adding Taxonomy Codes is available. For multiple records with unique physical addresses under one NPI, the service facility location must be submitted on claims.
MN–ITS Registration for Fee-for-Service and MCO Providers
MN–ITS is a free, HIPAA-compliant, web-based system mandatory for claim submissions and other transactions with MHCP. Upon enrollment approval, providers receive a Welcome letter with MN–ITS login credentials. Fax enrollees must register via registration instructions. MPSE enrollees can use the credentials provided in the Welcome letter.
Minnesota law mandates electronic claim submissions for MHCP reimbursement. All providers and billing services must register for MN–ITS; paper claims are not processed.
MN–ITS functionalities include:
- Verifying program eligibility
- Retrieving enrollment letters and 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 for Remittance Advices (RAs)
- Accessing MPSE to manage enrollment records
MCO in-network only providers also utilize MN-ITS to access the MPSE portal for enrollment management and to retrieve important notices.
Managing Changes to Enrollment
Providers are responsible for maintaining up-to-date enrollment information. The most efficient way to report changes is through MPSE. MHCP provides quarterly webinars on managing enrollment changes via MPSE, with registration available on the MPSE Training site.
Alternatively, providers can fax specific forms for changes:
- Individual Practitioner MHCP Provider Profile Change Form (DHS-3535) (PDF)
- Organization MHCP Provider Profile Change Form (DHS-3535A) (PDF)
- Disclosure of Ownership and Control Interest of an Entity (DHS-5259) (PDF)
- Electronic Remittance Advice (RA) Request Form (DHS-4087) (PDF) (not for MCO in-network only)
- EFT bank change form (PDF) (for MMB submission)
- EFT Supplier ID Notification (DHS-3725) (PDF) (not for MCO in-network only)
- Provider Entity Sale or Transfer Addendum (DHS-5550) (PDF) (for ownership changes, submit 30 days prior to sale)
Provider Eligibility and Compliance processes changes and will request additional documentation if needed. Providers receive enrollment status letters, including updates on service expansions or reductions.
Processing Timelines and Actions
Provider Eligibility and Compliance aims to process complete enrollment requests within 30 days of receipt, whether submitted via MPSE or fax. This timeline applies to new, corrected, and resubmitted requests.
Complete requests include all required fields and documents. MPSE users can track statuses and outcomes in the Request Submitted and Next Steps section of the user manual.
For incomplete requests, a request for more information (RFMI) letter is sent via MN–ITS mailbox or U.S. mail. Providers have 60 days to respond using the original submission method (MPSE or fax). Failure to provide complete information within 60 days may lead to request denial. If information remains incomplete after the initial RFMI response, a second RFMI is issued with an additional 30-day deadline.
Processing time is up to 30 days from the latest submission date for corrected or additional materials.
Inactive enrollment records require providers to re-enroll via MPSE or faxing a new application.
Billing Organizations
MHCP-enrolled providers can utilize clearinghouses or billing intermediaries as billing agents for electronic claims submission. These entities must enroll as a billing organization with MHCP.
Eligible Providers
Participation in MHCP requires providers to meet professional certification and licensure standards according to state and federal regulations. After meeting these prerequisites, providers can apply for MHCP enrollment via the MPSE portal or by faxing required application materials. Contact your contracted Managed Care Organizations (MCOs) for their specific enrollment requirements as well.
Fee-for-service providers marked with ‘¹’ in the list below bill through an organization and do not receive direct payments. Providers marked with ‘²’ are not eligible for MCO-only enrollment.
Eligible Provider Types:
| Organization Providers | Individual Providers |
|---|---|
| Adult Day Treatment – 46 Allied Oral HealthProfessional Group – 31 Ambulatory Surgical Center – 22 Birthing Center – B1 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 | 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 |
For specific questions or if physical document submission is absolutely required, although online and fax are preferred, you may need to know the Minnesota health care program address. While direct physical addresses for submission are less emphasized due to the efficiency of digital methods, general inquiries can often be directed to the Minnesota Department of Human Services main offices. Always prioritize official channels like the MPSE portal and designated fax lines for application materials to ensure timely and secure processing.
