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Understanding Minnesota Health Care Programs: Your Guide to Enrollment

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Minnesota Health Care Programs (MHCP) are a suite of public health insurance options designed to ensure that Minnesota residents have access to necessary medical care. Navigating the enrollment process can seem complex, especially if you’re a healthcare provider looking to participate in these vital programs. So, What Is Minnesota Health Care Programs and how can providers enroll? This article serves as a comprehensive guide to understanding MHCP enrollment, drawing from official resources to provide you with the most accurate and up-to-date information.

This guide will walk you through each step of the enrollment process, ensuring you are well-prepared to become an MHCP provider. Whether you are new to Minnesota’s healthcare system or looking to expand your participation, understanding the enrollment procedures is crucial.

MHCP Enrollment: A Step-by-Step Process

Enrolling with Minnesota Health Care Programs (MHCP) is essential for healthcare providers who wish to serve MHCP members. The process is managed through the Minnesota Provider Screening and Enrollment (MPSE) portal. MHCP also conducts quarterly webinars to assist providers in navigating the MPSE portal for first-time enrollments. You can find more details and registration information on the MPSE training website.

Here are the key steps to apply to become an enrolled MHCP provider:

1. Verifying Exclusion Status on Federal and State Lists

Before initiating your enrollment, 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 has the authority to exclude individuals and entities from participating in federal health care programs like Medicare and Medicaid. Minnesota Health Care Programs adheres to these federal exclusions and also maintains its own list of excluded providers.

MHCP is legally prohibited from enrolling or making payments to providers who, or whose employees or contractors, are excluded from participation in federal or state health care programs. Engaging with excluded parties can lead to civil monetary penalties from the OIG.

To ensure compliance, it’s necessary to regularly consult the OIG’s List of Excluded Individuals and Entities (LEIE). Enrolled or enrolling MHCP providers must verify that they, their company, owners, managers, employees, and contractors are not on this list. It is recommended to search the LEIE:

  • Prior to submitting an enrollment application.
  • Before hiring any new employees or contracting with new contractors.
  • Monthly, to monitor for any updates since the last check.

Any new exclusions discovered 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, which is an essential resource for understanding compliance requirements.

2. Meeting MHCP Rules and Requirements

Eligibility to enroll with Minnesota Health Care Programs requires providers to meet specific criteria and certifications based on the type of health service they intend to offer. Before submitting enrollment information, ensure you comply with all necessary prerequisites. To ascertain these requirements:

  • Consult the relevant service section under Eligible Providers on this page. This section details the licensure and certification requirements specific to each provider type.
  • Review the Provider Screening Requirements page of the MHCP Provider Manual. This document outlines the comprehensive screening procedures and standards that providers must meet to participate in MHCP.

By thoroughly reviewing these resources, providers can confirm their eligibility and prepare their enrollment application accurately, minimizing potential delays and ensuring a smoother enrollment process.

3. Obtaining a Provider Identification Number: NPI and UMPI

A crucial step in enrolling with Minnesota Health Care Programs is obtaining the correct provider identification number. The National Provider Identifier (NPI) is a unique identification number for health care providers. It is used for submitting and processing health care claims and other transactions. Providers who are eligible for an NPI are required to obtain it from the National Plan and Provider Enumeration System (NPPES) before enrolling with MHCP.

However, some provider types are not mandated to have an NPI. For these providers, MHCP may assign a Unique Minnesota Provider Identifier (UMPI). If the following provider types do not have an NPI, they can still enroll, and MHCP will assign them a UMPI upon application processing:

  • 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 who don’t meet the federal definition of a health care provider under HIPAA might not be eligible for an NPI. If NPI eligibility is not met, providers can still apply for enrollment, and MHCP will issue a Welcome letter confirming enrollment and assign a 10-digit UMPI.

Certain provider types are not eligible to obtain an NPI before submitting their enrollment forms, including:

  • 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 essential for all fee-for-service claims submitted to MHCP. This identifier enables MHCP to correctly process payments to providers for services rendered to eligible MHCP members.

4. Submitting Your Enrollment Documents to MHCP

Providers have two primary methods for submitting their enrollment documents to Minnesota Health Care Programs.

  1. Online Enrollment via MPSE Portal: The most efficient method is to register and use the Minnesota Provider Screening and Enrollment (MPSE) portal. This online portal (MPSE portal) offers built-in guidance throughout the application process, helps identify and correct common errors, and allows you to track your application status in real-time.

  2. Fax Submission: Alternatively, you can complete the required documents and fax them to MHCP’s Provider Eligibility and Compliance division.

To determine the specific documents needed for your provider type, refer to the service-specific manual section (listed under Eligible Providers on this page). These sections detail the MHCP requirements and list the necessary forms for enrollment.

Important Note: MHCP does not accept enrollment documents via email. All submissions must be made through either the MPSE portal or by fax.

Application Fees for MHCP Enrollment

Certain MHCP provider types are required to pay a nonrefundable application fee. This fee is applicable for new enrollments, re-enrollments, and revalidations. If an application fee is required, it must be paid before submitting the enrollment application. For detailed information regarding application fee requirements, please refer to the Application Fees section within the Provider Screening Requirements page of the MHCP Provider Manual. Understanding these fees is a crucial part of the initial enrollment process.

Electronic Funds Transfer (EFT) for Payments

Minnesota Health Care Programs recommends that all fee-for-service providers enroll in Electronic Funds Transfer (EFT), also known as direct deposit. This payment method, not applicable to MCO in-network only providers, offers a more efficient and secure way to receive payments. Providers can enroll in EFT during the application process itself, without waiting for enrollment approval.

EFT payments offer several advantages:

  • Faster Access to Funds: EFT allows providers to access their payments sooner, eliminating the wait time associated with mailed checks and bank deposit trips.
  • Enhanced Security: EFT reduces the risk of lost, stolen, or misdirected checks, providing a safer payment method.
  • Simplified Cash Flow Management: EFT streamlines financial processes with less paperwork, making cash flow management easier.

To receive EFT payments from MHCP, providers must have an active 10-digit supplier ID and a 3-digit supplier location code issued by Minnesota Management and Budget (MMB).

To establish your supplier ID for MHCP payments, follow these steps:

  1. Visit the Minnesota Supplier Portal website and select “Register for an Account.” Register as a “New Supplier” if you do not already possess a supplier ID.
  2. To add or update banking information for an existing supplier ID, you can use the Supplier Portal (refer to Update Supplier Profile) or submit the MMB EFT Bank Change Request (PDF). For questions about your supplier ID’s direct deposit status, contact MMB at 651-201-8106.
  3. Allow 10 business days for your supplier ID to become active after adding your banking details. Once active, input your EFT supplier ID and supplier location code through the MPSE portal. Instructions are available in the MPSE user manual page for Enrollment Record Information. Alternatively, 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 law, specifically the 21st Century Cures Act, mandates that state agencies like DHS enroll all Medicaid providers, including those participating in both fee-for-service Medicaid and managed care organization (MCO) networks. Enrollment for MCO in-network only providers commenced on July 17, 2023. To enroll as an MCO provider, follow the general Enrollment Process steps outlined earlier.

For more detailed information, refer to Enrollment process for MCO network providers. Consult the Eligible Providers section to see the list of provider types enrolled by DHS and their specific enrollment requirements.

Note: Providers currently enrolled for fee-for-service who also contract with an MCO are not required to undergo the screening and enrollment process again.

Providers who choose to join an MHCP managed care organization network must also contact the relevant health plan directly for participation and contract details. Additional information about MCOs is available on the MCOs page in the MHCP Provider Manual.

For specific instructions on enrolling as an MCO in-network provider, consult the MCO In-Network Provider Enrollment page of the MPSE User Manual.

Understanding Enrollment Approvals

Approval Processes for Minnesota-Based Providers

Providers located within Minnesota may receive retroactive enrollment approvals. If a provider meets all enrollment requirements for their provider type, the enrollment application will be approved with an effective date determined by one of the following criteria:

  • The effective date requested by the provider in MPSE or on the enrollment application.
  • The first day of the month in which the enrollment request or application is received.
  • Up to 90 days prior to the effective date of the provider’s Medicare certification.
  • The retroactive date the member is confirmed eligible for MHCP.
  • The date the provider is confirmed to meet all MHCP provider requirements.

For Minnesota providers requiring additional screening, such as site visits and background checks (typically providers in moderate- or high-risk categories as listed on the Risk Levels section of the Provider Screening Requirements page), approval will be granted upon completion of these screenings.

Approval for Out-of-State Providers

Out-of-state providers can apply for MHCP enrollment for specific dates of service provided to an MHCP member. To be eligible for payment, out-of-state providers must:

  • Comply with the licensing and certification standards of their state of location. An exception applies to home and community-based waiver services providers, who must meet Minnesota’s federally approved waiver plan requirements.
  • Submit an enrollment request to MHCP through the MPSE portal with a copy of the Provider Agreement and any required assurance statements and credentials. Alternatively, required documents can be faxed to Provider Eligibility and Compliance at the fax number listed on MHCP forms.

Refer to the Billing Policy Overview and Out-of-State Providers sections in the MHCP Provider Manual for further details on requirements.

Consolidated Providers and MHCP Enrollment

A consolidated provider is defined as a provider entity that has multiple enrollment records linked to a single National Provider Identifier (NPI).

While a provider may offer various types of services, not all can be billed under a single enrollment record. Depending on the services offered, multiple enrollment records might be necessary. Provider Eligibility and Compliance reviews enrollment records for providers with multiple active credentials across different enrollment records to determine if consolidation is needed.

MHCP Use of Taxonomy Codes (Not applicable to MCO in-network only providers): A taxonomy code is a code that classifies the provider or organization type, specialization, and classification. Provider taxonomy codes and descriptions are available on the X12 External Codes List webpage.

When a provider uses one NPI for billing across 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 this PT33 record.

  • If an NPI represents multiple records sharing a physical address or zip code, the provider must submit taxonomy codes for each record post-enrollment and MN–ITS registration. For records with identical taxonomy codes, a custom taxonomy code can be entered. MHCP uses taxonomy codes exclusively for billing purposes.
  • Providers must submit taxonomy or custom taxonomy codes to MHCP via MN–ITS. A tutorial is available in the Adding Taxonomy Codes video for consolidated providers.
  • If an NPI represents multiple records each with a unique physical address, the provider is required to include the service facility location on all claims.

MN–ITS Registration for Fee-for-Service Providers

MN–ITS is a free, HIPAA-compliant, web-based system. Once Provider Eligibility and Compliance approves your application, you will receive a Welcome letter confirming enrollment, which includes an initial MN–ITS User ID and Password. If you enrolled by fax, you’ll need to register for MN–ITS using the registration instructions. If you enrolled via MPSE, you can log into MN–ITS using the credentials provided in the Welcome letter.

Minnesota law mandates electronic claim submissions for all health care providers and suppliers eligible for MHCP reimbursement. Registration with MN–ITS is mandatory for all providers and their affiliated clinics or billing services, as MHCP does not process paper claims.

As a registered MN–ITS user, providers can:

  • Verify program eligibility for MHCP members.
  • Retrieve enrollment-related letters and notices.
  • Submit authorization requests for medical, dental services, or medical supplies.
  • Submit service agreement (SA) requests for home care services.
  • Retrieve authorization and service agreement letters and other communications from the MN–ITS mailbox.
  • Submit claims, including those with third-party insurance or Medicare.
  • Copy previously submitted claims or replace incorrectly paid claims.
  • Check claim status for payment or denial.
  • Use the MN–ITS Mailbox to access information, including Remittance Advices (RAs).
  • Access MPSE to manage enrollment records.

MN-ITS Registration for MCO In-Network Only Providers

MN–ITS is also essential for MCO in-network only providers. Upon MHCP approval of an MCO in-network only provider application, a Welcome letter with MN–ITS login credentials and registration instructions will be sent. MCO in-network providers use MN–ITS to access the MPSE portal for managing their MHCP enrollment information and retrieving important enrollment-related communications.

Managing Changes to Your Enrollment

Providers are responsible for maintaining up-to-date enrollment information. The most efficient way to report changes is through MPSE. MHCP offers quarterly webinars on managing enrollment changes via the MPSE portal, details and registration are available on the MPSE Training site.

Alternatively, providers can fax relevant forms to report changes:

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.

Processing Timelines and Actions for Enrollment

Provider Eligibility and Compliance aims to process complete enrollment requests within 30 days of receipt, whether submitted via MPSE or fax. This 30-day timeline applies uniformly to new, corrected, and resubmitted requests.

Understanding Complete Requests

A complete request includes all required fields accurately filled and all necessary documents provided. If submitting via MPSE, the Request Submitted and Next Steps section of the MPSE user manual details statuses and outcomes.

For incomplete new enrollment requests, Provider Eligibility and Compliance sends a request for more information (RFMI) via the provider’s MN–ITS mailbox or U.S. mail. Providers have 60 days to respond with the missing information, using the original submission method (MPSE or fax). Incomplete responses may lead to additional RFMIs, granting an extra 30 days to provide the required information. Failure to provide complete information within these timelines will result in denial of the enrollment request.

If enrollment documents are incomplete or incorrect and require additional information or corrections, allow up to 30 days from the latest submission date for processing.

Handling Inactive Enrollment Records

If an enrollment record becomes inactive, providers must re-enroll with MHCP, either through the MPSE portal or by faxing a new application to Provider Eligibility and Compliance.

Billing Organizations and MHCP

MHCP-enrolled providers can use clearinghouses or billing intermediaries as billing agents for electronic claim submissions and transactions.

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

Providers participating in MHCP must meet specific professional certification and licensure requirements based on state and federal laws and regulations for their services. After meeting these prerequisites, providers can apply for MHCP enrollment via the Minnesota Provider Screening and Enrollment (MPSE) portal or by faxing the necessary application materials.

Providers should also contact any managed care organizations (MCOs) they contract with to understand their specific enrollment requirements.

Fee-for-service providers marked with ‘¹’ do not receive direct payments and must bill through an organization. Providers marked ‘²’ are not eligible for MCO-only enrollment.

The table below lists health care provider types potentially eligible for MHCP enrollment:

### Organization Providers ### Individual Providers
Adult Day Treatment – 46 Allied Oral HealthProfessional Group – 31 Ambulatory Surgical Center – 22 Birthing Center – B1 (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 (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

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