This page includes news and resources for providers enrolled to serve Minnesota Health Care Programs (MHCP) members. News articles are retained on the Minnesota Department of Human Services (DHS) website for one year. Current messages are linked below. Sign up to receive provider news and other MHCP notices through our free provider email lists.
Systems announcements
We will update this section with information about MN–ITS availability, technical information and other systems announcements when necessary.
Pharmacy services and 837 batch claims impacted by nationwide issue
We are aware of the ongoing difficulties for some providers resulting from the recent cyberattack on Change Healthcare. We are in communication with Centers for Medicare and Medicaid Services and local provider associations about the most effective ways to help impacted providers.
A few things to know:
Minnesota Health Care Programs (MHCP) claims processing and pharmacy point-of-sale systems are working properly. You may upload batch transactions or submit individual transactions through MN–ITS.
First time submitting 837 batch transactions in MN–ITS? You must first submit batch claims through the MN–ITS test region if you have never submitted claims using MN–ITS. Refer to the MN–ITS test region and Syntax testing – common errors sections of the 5010/D.0 compliance webpage for more information.
We are accepting pharmacy point of sale claims from the following value-added networks: Relay Health/McKesson and Red Sail Technologies.
If you want to add or change your billing organization, review the “Changing Your Billing Organization” section in the Billing Organizations/Responsibilities section of the MHCP Provider Manual.
Minnesota Medicaid fee-for-service providers are allowed 12 months from the date of service to submit claims. Review our timely billing requirements for more information.
Use the Electronic Remittance Advice Request (DHS-4087) (PDF) to add or remove an electronic RA on a provider’s MN–ITS account, to change the format you will receive your RA, or remove an RA affiliation with a billing organization.
Minnesota Health Care Programs (MHCP) has created a frequently asked questions resource about the Recuperative Care program as a follow-up to the general information webinar held on Feb. 15, 2024. We recommend reviewing Recuperative Care Program Frequently Asked Questions (PDF) if you are considering enrolling with MHCP as a recuperative care provider in the future. Note, we are temporarily holding on processing enrollment for recuperative care providers at this time. Refer to Revised: Recuperative care provider enrollment temporarily for more information. (pub. 4/26/24)
NEMT services providers cannot bill MHCP for Mode 3 – Unassisted transport (curb-to-curb) and Mode 4 – Assisted transport (door-to-door and door-through-door) services; and must contract with one of the following organizations for billing and reimbursement.
Medical Transportation Management – Minnesota Nonemergency Transportation (MTM-MNET)
SmartLink
Local county or tribal agency
MTM-MNET, SmartLink or the local county or tribal agency bills MHCP for Modes 3 and 4 services and reimburses the NEMT services provider. Refer to Overview under Local County or Tribal Agency NEMT Services in the MHCP Provider Manual for contact information. (pub. 4/24/24)
Some medical assistance enrollees will again be subject to an asset test in June to determine their eligibility for health insurance. If you serve aged, blind or disabled individuals you should be aware because this may impact people receiving your services. Please pass this information on to your patients. Visit the Income and asset limits webpage for more information about enrollees and asset limits. (pub. 4/23/24)
Minnesota Health Care Programs (MHCP) extended the deadline to receive updated testing results for incontinence products. We must receive new testing results by June 1, 2024, for products to be added to the MHCP Incontinence Products List by HCPCS or Manufacturer.
We will amend the Incontinence Products List on or before May 1 to update products that have received new testing results. We will revise the list again in mid-May and on June 1. For products that are currently on the Incontinence Products List and do not have new test results before May 1, the date column will show as “Pending” during the month of May while testing is being completed. We will remove “Pending” products from the list if we do not receive testing results by June 1.
Refer to MHCP Requirements for Incontinence Products (DHS-3811) to review testing requirements. Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 if you have any questions about incontinence product testing. (pub. 4/23/24)
Some RSC-Targeted Case Management claims incorrectly denied with claim status code 483 and remittance remark code N362 due to a system issue. We have fixed the issue and claims are now processing correctly. We reprocessed all RSC claims that incorrectly denied with this error code, and they will appear on the April 26, 2024, remittance advice. Call the Minnesota Health Care Programs Provider Resource Center at 651-431-2700 or 800-366-5411 if you have questions about this message. (pub. 4/19/24)
The deadline for traditional personal care assistance (PCA) workers to apply for a PCA training stipend is June 15, 2024. Traditional PCA workers provide PCA services through a personal care provider organization. Review the Reminder: Apply for the PCA training stipend by June 15, 2024, eList announcement from the Adult and Aging Services Division and Disability Services Division for more information. (pub. 4/9/24)
The Centers for Medicare and Medicaid Services (CMS) has approved rate increases for some behavioral health services provided on or after Jan. 1, 2024.
Behavioral health Adult Day Treatment Services (ADT) rates have increased and are now paid at the base rate of $30.62 per 60 minutes. ADT services are billed using procedure code H2012.
Behavioral Health services rates also increased by 3% for other procedure codes. Review the codes in the following Codes with 3% rate increase table.
Call the Minnesota Health Care Programs Provider Resource Center at 651-431-2700 or 800-366-5411 if you have questions about this message. (pub. 4/9/24)
We updated testing for Cardinal Health and Essity products on the 2020-2024 Incontinence Products Lists by Manufacturer and HCPCS. We updated testing for 30 products. The updates are effective April 8, 2024.
Call the Minnesota Health Care Programs Provider Resource Center at 651-431-2700 or 800-366-5411 with questions about this message. (pub. 4/9/24)
Refer to Moving Expenses on the Housing Stabilization Services policy webpage for more information about Moving Expenses. Email hshousingstabilization@state.mn.us if you have questions about this message. (pub. 4/1/24)
This is a reminder that the screening and enrollment process for all contracted managed care organization (MCO) providers started July 17, 2023. The 21st Century Cures Act requires all Medicaid managed care network providers be screened and enrolled by the Minnesota Department of Human Services (DHS). This includes ordering, referring, and prescribing (ORP) providers furnishing services to managed care members.
Organizational providers must enroll each location that delivers services to MHCP members. All MCO in-network providers who already have an existing contract with an MCO and ORP providers furnishing services must enroll by July 15, 2024, except for the following provider types that will require a site visit from the Minnesota Department of Human Services (DHS):
Community Mental Health Center−Provider type 10
Rehab Agency− Provider type 11
Day Treatment− Provider type 46
Home Care Nursing Organization−Provider type 64-O
Medical Transportation−Provider type 82
MHCP will conduct an announced site visit within 60 days of the referral date (providers will receive a letter from MHCP). The providers in the bulleted list must complete both the enrollment process and site visit by Dec. 31, 2024.
Existing MCO providers who fail to comply with the federal enrollment mandate will be removed from the managed care MHCP provider network and will no longer be eligible to receive payments for MHCP members. To ensure you meet the enrollment deadline, submit your DHS enrollment application as soon as possible. Actively enrolled fee-for-service providers who have an existing contract with an MCO will not need to go through the screening and enrollment process again.
Attend a live demonstration to learn more about the enrollment requirements and how to enroll using the Minnesota provider Screening and Enrollment (MPSE) portal. You must register for the training webinar. The same information will be provided at each session:
The Minnesota Office of Higher Education’s (OHE) Dual Training Grant is open for applications through April 22, 2024. Refer to OHE’s Dual Training Grant and Dual Training Grant Request for Proposal webpages for information about the grant and application materials.
Up to $15,000, or 10% of a grant, to pay for trainee support
Minnesota Dual-Training Pipeline is pleased to continue partnering with OHE to expand dual training across Minnesota. Email Pipeline.Program@state.mn.us if you have any questions about dual training. (pub. 3/26/24)
The SASD support team will no longer have an active fax number beginning May 1, 2024. Several provider groups will now have to use online forms to submit materials that previously were faxed to the SASD support team. Refer to the following guidance.
Personal care assistance (PCA) – Use the following online form to request a technical change:
County public health agencies, tribal nations and PCA assessors contracted by a lead agency – Use the following online form to request a technical change:
When submitting forms, double-check that you have correctly entered your name and contact information, such as email address and phone number. This ensures you receive an auto-generated response that the form was successfully submitted and that the SASD support team can contact you about your request.
Only submit forms to the location and fax number as listed on the form or within the form instructions since the SASD support team fax number will be discontinued.
The Minnesota Department of Human Services offers quarterly webinar sessions to providers required to use EVV. The webinar sessions cover updates, resources, and Q&A. The sessions are scheduled from 1 to 2 p.m. on the following dates:
Doula services providers wanting to enroll with Minnesota Health Care Programs (MHCP) must confirm they are active and registered with the Minnesota Department of Health (MDH) Doula Registry before submitting MHCP provider enrollment materials. An enrollment application will be denied if a doula is not listed on the MDH Doula Registry and does not meet all rules and requirements. If the request is denied, a new provider enrollment request will need to be submitted with MHCP after the doula is registered with the MDH Doula Registry. Refer to Doula Enrollment Criteria and Forms under the Provider Basics section in the MHCP Provider Manual for more information. (pub. 3/21/24)
We have identified and reprocessed SUD nonresidential (outpatient) group and individual treatment claims with dates of service on or after Jan. 1, 2024, through March 5, 2024, billed during March 5 - 14, 2024, that denied when service exceeded six hours a day or 30 hours per week. The reprocessed claims will appear on the March 29, 2024, remittance advice.
Contact the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 with any questions about this message. (pub. 3/21/24)
Effective Sept. 1, 2023, MHCP covers the administration of the pneumococcal vaccine (PCV20), CPT code 90677 available through the Minnesota Vaccines for Children program for children ages 0-18 years. Refer to Billing for Child Vaccines under the Immunization and Vaccinations section of the MHCP Provider Manual for more information. (pub. 3/20/24)
We have revised this message to remove some information about previously submitted enrollment materials. Minnesota Health Care Programs is temporarily holding on processing enrollment for recuperative care services providers. We ask that you do not submit materials to enroll as a recuperative care provider at this time. Previously submitted enrollment materials will be reviewed when processing resumes.
If you are considering enrolling as recuperative care provider, review the following key information.
Staffing Requirement
If the recuperative care facility will also provide the professional services, the recuperative care facility must employ an advanced practice medical professional (physician, physician assistant or nurse practitioner) in a medical director type role to oversee the facility. The recuperative care facility can also contract with an outside provider, such as a licensed home care provider, for the professional services.
A registered nurse or licensed practical nurse is not a considered a qualified advanced practice medical professional to oversee a facility.
Eligible MHCP Members (individuals that can receive care in the recuperative care facility)
Eligible members need to have a physical medical condition and be referred to recuperative care by a provider from a hospital or clinic. Refer to Eligible Members in the Recuperative Care section of the MHCP Provider Manual for more information.
Billing and Rates
Recuperative care professional services rate: The recuperative care professional services rate is a bundled rate of $300 per day, and covers services provided by a medical professional. Services provided within the bundled payment may include, but are not limited to, the covered services.
Recuperative care facility rate: The recuperative care facility rate is the room and board daily rate and is currently $34 per day. The recuperative care facility rate is only paid when the system recognizes the recuperative care professional services claim for the same day.
We will post a message on this webpage when we resume recuperative care provider enrollment. (pub. 3/14/24, rev. 3/20/24)
Minnesota Health Care Programs (MHCP) reprocessed previously denied nitrous oxide claims for dates of service on or after Sept. 1, 2022.
Effective Sept. 1, 2022, one unit of nitrous oxide, CDT code D9230, is allowed one unit per member, per day in conjunction with a covered dental service for MHCP members. Reprocessed claims will appear on your March 12, 2024, remittance advice.
Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 with questions about this message. (pub. 3/14/24)
On Jan. 17, 2024, the Centers for Medicare & Medicaid Services (CMS) approved the Elderly Waiver (EW) amendment package.
Review the Aging and Adult Services Division (AASD) eList announcement CMS approved EW amendment package for information about the implementation of changes and clarifications.
Due to new legislative updates and revalidations, the MHCP Provider Resource Center is experiencing high call volume. You may experience a longer wait time or you will have to call back at a different time.
Minnesota Health Care Programs (MHCP) is updating our system with the following new current procedural terminology (CPT) codes for reporting monovalent (single strain) COVID-19 vaccines and new single administration code. We will reprocess claims back to Sept. 11, 2023, when the update is completed.
The following new COVID-19 vaccines CPT codes are effective for dates of service on, or after, Sept. 11, 2023.
91304 (SARS-COV-2 VAC 5MCG/0.5ml IM Novavax COVID-19 Vaccine)
91321 (SARSCOV2 VACCINE 25 MCG/0.25 ML Moderna COVID-19 Vaccine)
91322 (SARSCOV2 VACCINE 50 MCG/0.5 ML Moderna COVID-19 Vaccine)
The following new COVID-19 vaccine administration code is effective for dates of service on, or after, Sept. 11, 2023.
90480 immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-COV2) (coronavirus disease [covid-19]) vaccine, single dose
Report the administration code for the administration of vaccine CPT code 91304, 91318, 91319, 91320, 91321 and 91322
We will post a Provider News message on this webpage when claims are reprocessed. Note, we do not guarantee payment after reprocessing if the claim is not submitted following MHCP guidelines.
For eligible MHCP members ages 0-18, MHCP will only reimburse for the administration of the COVID-19 vaccines available through Minnesota Vaccines for Children (MnVFC). Refer to Billing for Child Vaccines for billing instructions.
For eligible MHCP members ages 19 and older, MHCP reimburses for COVID-19 vaccines and vaccine administration. Refer to Billing for Adult and Non MnVFC Vaccines for billing instructions. (pub. 1/25/24)
The Minnesota Health Care Programs (MHCP) dental benefits for 2024 have been implemented and reflect there are no longer age or pregnancy status as qualifiers effective Jan. 1, 2024, because of legislation passed during the 2023 Session (Minnesota Statutes, 256B.0625, subdivision 9).
We are currently experiencing a processing delay which may cause claims to pay incompletely. We will automatically reprocess all dental claims that were paid incompletely when the system update is completed. No action is needed at this time from providers.
We will post a message on this webpage with updated claim and billing information when available. (pub.1/4/24)
We explained on Sept. 27 on this webpage that the temporary waiver allowing personal care assistance (PCA) agencies to hire certain family members to be paid to provide PCA services ended Nov. 11, 2023. This is a reminder this temporary waiver ended Nov. 11, 2023.
The family members that the waiver allowed to be paid for providing PCA services were:
Parents of minors
Stepparents of minors
Legal guardians of minors
Spouses
The Minnesota Department of Human Services (DHS) previously announced an extension of the end date for this waiver in a May 12, 2023, eList.
Effective Nov. 12, 2023, Minnesota Health Care Programs (MHCP) or a person’s managed care organization (MCO) cannot pay PCA agencies for claims with dates of service provided after Nov. 11, 2023, by these family members.
People and families should work together with their PCA agency to develop an alternative plan for providing PCA services. They can contact their lead agency (county, tribal government, or managed care organization) for additional support if they continue to struggle with staffing.
Contact the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 or use the Disability Services Division Contact Form to submit an inquiry with questions. (pub. 9/27/23 and 10/24/23, rev. 12/5/23)
Minnesota Department of Human Services refreshed the Renew My Coverage webpage and will launch new tools in the coming weeks to make it easier for Minnesotans to keep their health insurance now that annual member eligibility renewals have resumed in public health care programs. Please share this information with the members you serve.
Members should look for:
A new envelope design to help renewal paperwork stand out better in mailboxes. Envelopes are now marked with a blue circle with the text “Important information enclosed.”
A new document upload tool that allows members to skip the postage and upload their annual eligibility renewal documents online. Enrollees can also submit renewal paperwork by postal mail, dropping it off at their county or tribal office, fax or by giving their information verbally over the phone.
Members will soon be able to:
Use a new renewal date lookup tool to find out when to watch their mail for renewal information.
Receive text messages from the number “28343” when it’s time to fill out and submit their renewal paperwork.
We are committed to ensuring that eligible Minnesotans retain their public coverage when renewal processes resume as required by Congressional legislation that states to return to standard Medicaid eligibility procedures. On the Renew my coverage webpage, we have created a one-stop shop for Medical Assistance and MinnesotaCare members with all the information they need about how to keep their insurance.
The most important thing enrollees can do now to prepare for their renewal is to Update their contact information. Members who have moved in the last three years should update their address, phone number and email, so they can be reached.
Renewal information will be mailed to members in monthly waves or “cohorts” each month for the next 12 months. The first group of Minnesotans due for their renewal paperwork will get their renewal information mailed within the next few weeks. (pub. 4/27/23)
Minnesota Health Care Programs (MHCP) posted a Provider News message on October 25, 2022, about the category of service edit occurring for the following COVID-19 vaccines and administration codes:
Vaccine 91304
administration codes 0041A and 0042A
Vaccine 91308
administration codes 0081A, 0082A and 0083A
Vaccine 91311
administration codes 0111A, 0112A and 0113A
Vaccine 91307
administration codes 0071A, 0072A, 0073A, and 0074A
The category of service edit is now fixed. We reprocessed claims back to the effective dates for the covered codes included in this message.
Find the effective dates for the covered codes on the MHCP fee schedule webpage or under Vaccines in the Billing section under Coronavirus (COVID-19) in the MHCP Provider Manual. (pub. 1/31/23)
Training
Minnesota Health Care Programs (MHCP) offers free training for MHCP enrolled providers.
Minnesota Health Care Programs (MHCP) will host free online trainings for doula organizations and individual providers wanting to enroll with MHCP. You will learn about the MHCP provider enrollment manual and view a live demonstration of the enrollment process in the Minnesota Provider Screening and Enrollment (MPSE) portal.
Participants need the following to attend the webinar.
Ability to connect to the webinar from their own computers. You do not need special hardware or software. We recommend not using a phone or tablet.
Ability to communicate with presenters using the chat feature available as part of the webinar session.
Internet access.
Speakers or a headset.
Register for the doula provider enrollment MPSE live demonstration on the MPSE portal training webpage.
The Minnesota Department of Human Services will be offering weekly questions and answers sessions for the MPSE Portal. Questions and answers sessions take place every Wednesday from 1 to 2 p.m. starting on Feb. 7, 2024. These sessions are free and no registration is required.
MPSE questions and answers sessions will be held virtually using the Microsoft Teams platform, but attendees do not need to have Microsoft Teams installed. Participants can use the browser version. Find the link to join the questions and answers session on the MPSE portal training webpage.
Who should attend?
Owners of MHCP-enrolled organizations.
Individual providers who maintain their own MHCP enrollment records.
Employees of MHCP-enrolled organizations who maintain provider enrollment records.
Employees of MHCP-enrolled organizations who process affiliations or do credentialing.
Employees of MHCP-enrolled organizations responsible for MHCP compliance.
Individuals or organizations interested in becoming an MHCP provider for the first time.
Anyone interested in learning more about the MPSE portal.
MHCP offers training for providers who provide services for members enrolled in MHCP. We have updated on-demand and online training opportunities on the MHCP provider training webpage.
On-demand videos
On-demand videos are arranged by category, including Minnesota Provider Screening and Enrollment Portal (MPSE), MN–ITS and Billing. Each video can be viewed in 10 minutes or less and provides instructions on a concept or technique.
Online training
Online training is arranged by content for all providers or specific providers. Training is led by an instructor who will help attendees navigate the Minnesota Department of Human Services website and locate and use MHCP provider information and other related webpages or internet-based applications such as MN–ITS. All instructor-led training is online only. (pub. 11/22/22)
Minnesota Health Care Programs (MHCP) offers free online training for MHCP-enrolled providers. Go to the MHCP provider training webpage to review the list of available training.
Minnesota Health Care Programs (MHCP) is offering free online Provider Basics Resources and MN–ITS training to all enrolled MHCP providers who bill fee-for-services claims. This training is being offered monthly beginning Mar. 10, 2021.
You will learn how to navigate the MHCP provider webpages and the MHCP provider manual, and how to use MN–ITS administration, mailbox and eligibility requests (270/271) features. Go to the Provider Basics webpage to register for this training.
Claim training is not provided in this training. See our MHCP provider training webpage to register for provider-specific claim training. (pub. 2/11/21)
Minnesota Health Care Programs (MHCP) offers free on-demand training videos arranged by category on the MHCP provider training webpage. Each video can be viewed in about 10 minutes and provides instructions on a concept or technique.
New video:
Verifying MHCP Eligibility in MN–ITS - This video shows a consolidated provider how to determine eligibility for a subscriber (member) receiving care. This video explains how to fill out the 270 screen for one or multiple subscribers (members) and read the results on the 271 screen.
Minnesota Health Care Programs is providing free online training for our MPSE online portal.
Visit the MPSE portal training webpage for registration, brief online tutorials to help prepare you for class and more information. (pub. 2/1/20, rev. 2/19/20, 7/27/22)
