MHCP provider news and updates

We have revised this message to include information about the Offline Manuals webpage. All sites hosted on the www.dhs.state.mn.us domain, including PartnerLink, Minnesota Department of Human Services manuals, and licensing information lookup documents, will not be available from 2 p.m. May 22 through 8 p.m. May 23, 2026, due to a web server migration. This includes, but is not limited to, the following:

• Aging and Adult Services Cost Reporting Tool Instruction Manual
• Community-Based Services Manual
• Community First Services and Supports (CFSS) Cost Reporting Tool Instruction Manual
• CFSS Policy Manual
• Consumer Directed Community Support Manual
• Combined Manual
• Disability Services Program Manual 
• Disability Waiver Rates System Cost Reporting Tool Instruction Manual
• Early Intensive Development and Behavioral Intervention Manual
• Health Care Programs Manual 
• ICF/DD Manual
• Managed Care Organization Manual
• Mental Health Information System Manual
• Mental Health Policy Manual
• Minnesota Health Care Programs Managed Care Manual
• Minnesota Health Care Programs Provider Manual
• Minnesota Provider Screening and Enrollment User Manual
• MMIS Long-Term Services and Supports Manual
• MN–ITS User Manual
• Moving Home Minnesota Program Manual
• Personal Care Assistance Program Manual
• Program HH Policy Manual
• Psychotropic Medication Manual
• Rate Management System User Manual

Published bulletins will also be unavailable. You may be able to download some manuals before 2 p.m. May 22 by visiting the Offline Manuals webpage. SIR, eDocs, and TrainLink will NOT be affected. (pub. 5/19/26, rev. 5/20/26)

MN–ITS will be moving to LoginMN soon. Log in to MN–ITS and validate your email and phone number. If you do not log in to MN–ITS to validate your email and phone number, your login information will not transfer to LoginMN and you will not be able to access MN–ITS. 

Before the move, you will receive a pop-up message in MN–ITS to enter and confirm your work email and phone number. You will only need to complete this once for each username you have for MN–ITS. The email address you use will be your username when we move to LoginMN. 

You must use an email address unique to a single user. Do not use a general business email address. For example: Use jane.biller@businessname.com, not info@businessname.com. You should use your same work email and phone number if you currently have multiple MN–ITS account logins. For example: You are a biller for five different providers (NPIs 1234567890, 2345678901, 3456789012, 4567890123, 5678901234), you should use the same email address for all five. Use an email address specific to you, such as jane.biller@businessname.com. (pub. 2/6/26)

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. 

You may also refer to the following webpages:

• MHCP billing resources webpage for billing resources 
• MHCP provider training webpage for free training sessions for specific provider types and services

We will offer free question and answer sessions for the MPSE Portal beginning Feb. 7, 2024. Refer to the Minnesota Provider Screening and Enrollment (MPSE) portal training webpage for more information about the sessions.

Any providers of the 13 high-risk services who received a Request for More Information (RFMI) letter must submit all the information requested within 30 days of the date on the letter. We sent the final batch of RFMI letters to providers’ MN–ITS mailboxes in April. Failure to submit all of your information within 30 days will result in disenrollment from providing services through MHCP. (pub. 5/13/26)

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The Minnesota Department of Human Services has extended the deadline for personal care assistance (PCA) and consumer support grant (CSG) members to transition to Community First Services and Supports (CFSS). Members who have not completed the transition to CFSS have until Sept. 30, 2027, to make this transition. 

Providers must review the current phase of the transition from PCA and CSG to CFSS to ensure their organization can provide CFSS services to PCA or CSG members when they transition. Providers can also review the following resources:

• What do current PCA provider agencies need to do?
• What do FMS providers need to do? 

The transition extension does not apply to the following:

• Members on Alternative Care can no longer use PCA services. So, this extension does not apply to them. 
• Members cannot use extended PCA services after Sept. 30, 2026. Extended PCA services are in addition to a member’s assessed services and are authorized by the member’s case manager. Providers will see extended PCA services on their authorization letters with a UC modifier code. 

For more information, refer to the March 25, 2026 and May 12, 2026 eList announcements.

Call the MHCP Provider Resource Center with any questions about this message at 651-431-2700 or 800-366-5411. (pub. 5/22/26)

The Minnesota Department of Human Services has learned that some providers have received phone calls from unauthorized parties requesting details about enrollment records and private health information, under the guise of completing the revalidation process. 

This scam appears to be exploiting the fact that our Provider Resource Center is making outbound calls to providers about revalidation. 

Department staff will never request patient or recipient information. As part of the revalidation process, the department may request information related to staff; however, this will not be collected over the phone. Requests will be limited to individuals who meet disclosure requirements (for example, those with at least a 5% ownership interest). The department may also ask about required professional or licensed affiliated staff, including their roles, responsibilities, and any affiliations with other Medicaid-enrolled organizations.

Please call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 if you have questions or concerns. (pub. 5/22/26)

We have updated the MN–ITS eligibility response (271) to accurately show how many PT and OT visits members have used since Jan. 1, 2026. We reprocessed PT and OT claims with dates of service beginning Jan. 1, 2026. We have completed reprocessing claims and they will appear on the May 19, 2026, remittance advice. The claims reprocessing pulled a broad list of CPT codes which may have impacted services other than PT and OT, such as Early Intensive Developmental and Behavioral Intervention. There is no payment impact on non-PT and OT services.   

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. 5/22/26)

The Minnesota Department of Human Services sent certificates of completion to providers who completed either the May 5-6 or May 13-14, 2026, Waiver and Alternative Care (AC) Resources and MN–ITS Training sessions. 

We sent the certificates to providers’ MN–ITS mailbox under the national provider identifier (NPI) providers used to register for the training. Providers who completed the entire training should receive their certificate in their MN–ITS mailbox under “Miscellaneous Received” in the PRVLTR folder by the end of the business day May 20, 2026. 

Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411, option 4, if you have questions about this message. (pub. 5/20/26)

Minnesota Health Care Programs (MHCP) has resolved the system issue affecting certain EIDBI claims that may have incorrectly denied with an invalid Place of Service 11 edit.

The issue affected claims billed with the following EIDBI CPT codes with modifier UB:

• 0373T 
• 97151 
• 97153 
• 97154 
• 97155 
• 97156 
• 97157 
• H0032 
• T1024 

Providers who had claims incorrectly deny for dates of service beginning Jan. 1, 2025, through May 6, 2026, due to this issue may do one of the following:

• Let DHS reprocess claims

OR

• Resubmit claims

Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 if you have questions about this message. (pub. 5/20/26)

Minnesota Health Care Programs (MHCP) identified an issue affecting reimbursement rates for the following Early Intensive Developmental and Behavioral Intervention (EIDBI) service codes: 

• H0046 UB (Travel Time)
• H0032 UB (Individual Treatment Planning and Progress Monitoring)

Services billed under these EIDBI services codes from March 25, 2026, through April 28, 2026, were underpaid. We corrected the issue and the rates are paying appropriately as of April 29, 2026. Providers who have claims impacted by the underpayment can do one of the following: 

• Let DHS reprocess claims

OR

• Submit replacement claims

Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 if you have questions about this message. (pub. 5/20/26) 

Minnesota Health Care Programs (MHCP) has resolved the system issue that incorrectly denied some EIDBI claims for services billed with CPT code H0046 UB.

Providers who had claims incorrectly deny due to this issue with dates of service beginning Dec. 16, 2025, through Jan. 27, 2026, can do one of the following:

• Let DHS reprocess claims

OR

• Resubmit claims

Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 if you have questions about this message. (pub. 5/20/26)

The Minnesota Department of Human Services has contracted with Prime Therapeutics to serve as the single pharmacy benefit manager (sPBM) to administer the outpatient pharmacy benefit for Minnesota Health Care Programs members enrolled in managed care plans. The Minnesota Legislature during its 2025 session required we procure and implement a sPBM and we contracted with Prime Therapeutics after completing a competitive Request for Proposal process. 

Along with Prime Therapeutics and the managed care organizations, we are working to implement the sPBM model on Jan. 1, 2028. Note, Prime Therapeutics processes claims for the fee-for-service program; however the sPBM contract and work is separate from the fee-for-service existing contract and system. We will provide additional information including timelines, milestones, billing instructions and provider training and materials throughout the next several months. (pub. 5/20/26)

Minnesota Health Care Programs (MHCP) is changing the authorization requirements for manual transanal irrigation systems (A4459) and rectal catheters (A4453) under the Urological and Bowel Supplies section of the MHCP Provider Manual effective July 1, 2026.

Manual transanal irrigation systems and catheters defined by HCPCS codes A4459 and A4453 currently require authorization always. Effective July 1, 2026, authorization is only required for excess quantities for manual systems and catheters. MHCP covers one manual system per dispensing, up to four systems per year. MHCP covers up to 31 rectal catheters per month before authorization is required.

Electronic transanal irrigation systems (A4479) always require authorization. Members must meet criteria. Documentation must show that the member cannot operate a manual system and can operate an electronic system independently.

Refer to information under the Covered Services heading in the Urological and Bowel Supplies section of the MHCP Provider Manual for coverage information. Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 with questions about this message. (pub. 5/19/26)

The Minnesota Department of Human Services Office of the Medicaid Medical Director (OMMD), in partnership with the University of Colorado Anschutz Medical School, is conducting a survey to understand how Minnesota Health Care Programs providers experienced the period of heightened federal immigration enforcement activity between December 2025 and February 2026. We are inviting providers to participate because your perspective as a health care professional is invaluable to the care Minnesotans receive. Refer to the Health care delivery during immigration enforcement activity in Minnesota (PDF) for more information and go to Immigration Enforcement Activity - Provider Survey to complete the survey. The survey closes June 26, 2026. We will not collect personally identifying information and survey respondents will remain anonymous. (pub. 5/18/26)

Eligible outpatient Minnesota pharmacies that meet requirements for the managed care organization (MCO) to pay the direct dispensing payment of $4.50 per filled prescription must complete the Directed Pharmacy Dispensing Payment Assurance Statement (DHS-8750) (PDF) and fax to 651-431-7462 by July 24, 2026, per Minnesota Statutes, 256B.69, subdivision 6i. MCOs will begin making payments to pharmacies as early as August 2026. 

To be eligible, pharmacies must be enrolled as an MHCP provider, be located in Minnesota, not be directly or indirectly owned by a pharmacy benefit manager or health carrier, and one of the following:

• Be located in a medically underserved area as defined by United States of Department of Health and Human Services Health Resources and Services Administration (United States Code, title 42, section 254).

OR

• Must not have more than 13 locations in Minnesota

Pharmacies must be enrolled with an MCO that contracts with the Minnesota Department of Human Services. Refer to the MCO contacts for MHCP providers webpage for a list of MCOs. (pub. 5/18/26)

The Minnesota Department of Human Services (DHS) has added a training opportunity for HCBS waiver providers who are currently completing revalidation requirements. The additional Waiver and AC Resources and MN–ITS Training session is scheduled June 2 and 3, 2026, from 9 a.m. to 1 p.m.

Providers who are interested in attending should register using the DHS Online Provider Registration System. Training details and information can be found on our Waiver and AC Resources and MN–ITS Training webpage. (pub. 5/18/26)

Minnesota Health Care Programs (MHCP) has rescheduled the May 21, 2026, Provider Basics Training to May 28, 2026. We rescheduled the original May 21, 2026, because our system will be down for maintenance at that time. 

Register for the rescheduled Thursday, May 28, 2026, webinar at: Provider Basics Training Registration.

We apologize for any inconvenience this may cause and appreciate your understanding.

Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 with questions about this message. (pub. 5/13/26)

The Minnesota Department of Human Services has sent providers who registered for the May 13-14 Waiver and Alternative Care (AC) Resources and MN–ITS Training their invitation links. You will receive two separate email invitations, one for each day. We sent the invite links May 12, 2026, via email to the email address you entered during the registration process. You will need to use the correct invitation link to join on the appropriate day.

Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411, option 4, if you have questions about this message. (pub. 5/12/26)

Minnesota Health Care Programs (MHCP)-enrolled providers can currently bill obstetric services either globally (bundled coding) or by component; however, the American Medical Association (AMA) is eliminating the global CPT codes effective Jan. 1, 2027. Providers have until Dec. 31, 2026, to access the global codes.

Global codes bundle all prenatal visits, delivery, and postpartum care into a single claim. Under the new system, each phase of care — prenatal, labor management, delivery, and postpartum — will be billed separately as services are provided. The Minnesota Department of Human Services will follow updated billing guidance from the American College of Obstetricians & Gynecologists (ACOG). 

ACOG recommends providers switch to billing by component for members who begin prenatal care in 2026 and are expected to deliver in 2027. 

• For members who begin prenatal care in 2026 and are expected to deliver in 2027, providers should bill each prenatal visit using the appropriate Evaluation and Management (E/M) code (99202–99499); and append the TH modifier to indicate the visit is for obstetric care. ACOG recommends providers begin this by June 1, 2026, and no later than Sept. 1, 2026.
• Providers can separately bill services that were previously bundled into the global code, including nutrition counseling and other medically necessary services, in the new coding structure. Bill these using the appropriate codes with the E/M visit.

Timeline

• June 1, 2026: Providers are encouraged to begin billing prenatal visits with E/M codes (99202–99499) + TH modifier 
• Sept. 1, 2026: Providers are encouraged to fully transition to using the appropriate E/M codes (99202-99499) + TH modifier.
• Jan. 1, 2027: Global obstetric care services codes are no longer valid. The Minnesota Department of Human Services fully transitions to the new AMA coding methodology. 
• Refer to ACOG Maternity Care Coding Resources for guidance and tools to support this transition. 

For providers who are unable to meet this timeline, ACOG issued the following recommendations for how to continue billing bundled codes in 2026 for pregnant people who are expected to deliver in 2027:

• May 15 to July 14, 2026: Use CPT code 59426 with new delivery only codes to account for anticipated 7 or more prenatal visits 
• July 15 to Sept. 1, 2026: Use CPT code 59425 with new delivery only codes to account for anticipated 4 to 6 prenatal visits
• Sept. 1, 2026, and onward: Full transition to Evaluation and Management (E/M) codes as it is likely obstetric providers will only provide 1 to 3 prenatal visits before delivery

Informational meetings

The Minnesota Department of Human Services will host informational meetings to educate providers on the upcoming coding changes. We invite you to attend one of the following meetings for more information.

• May 14, 2026, from 12:15 to 1 p.m. (central time). Register for the May 14, 2026, meeting. 
• May 21, 2026, from 12:15 to 1 p.m. (central time). This meeting will include an ACOG representative. Register for the May 21, 2026, meeting. 

Future trainings will be provided this summer. 

Call the MHPC Provider Resource Center at 651-431-2700 or 800-366-5411 with questions about this message. (pub. 5/8/26)

Minnesota Health Care Programs (MHCP) requires providers to use modifier GO to indicate occupational therapy services and GP to indicate physical therapy services for fee-for-service claims. GO and GP are used whether the service was provided by a therapist or an assistant. Use modifier U7 when an assistant provides services at any time without the supervising therapist on site. 

You must include appropriate modifiers on the authorization request and claim, and the authorization request and claim must match. Contact the medical review agent Acentra or by calling 866-433-3658 if an authorization is approved and the claim gets denied due to modifiers not matching the authorization.

Authorization requests made to MHCP when a member has third-party liability (TPL) or Medicare must exactly match what was billed or requested through the TPL or Medicare. This includes using modifiers KX, CO and CQ when appropriate. Refer to the TPL and Medicare policy for specific guidelines. Review the Codes and Modifiers section of the Rehabilitation Services section of the MHCP Provider Manual for a full list of modifiers. 

Example of an authorization request
CPT 97161 1 unit GP 5/1/2026 – 6/30/2026
CPT 97110 14 units GP U7 5/1/2026 – 6/30/2026
CPT 97110 4 units GP 5/1/2026 – 6/30/2026
CPT 97140 14 units GP U7 5/1/2026 – 6/30/2026
CPT 97140 4 units GP 5/1/2026 – 6/30/2026

(pub. 5/5/26)

The 2025 legislative session included multiple changes that have a planned effective date of July 1, 2026, which affect all providers of SUD services. The following changes are pending federal approval before becoming effective:

• New types and descriptions for SUD treatment services for all SUD providers
• New billing codes and procedures for outpatient SUD providers

Refer to the Information on 2026 Changes (PDF) listed under the News and Current Reminders heading on the Substance Use Disorder Reform webpage for information about and to prepare for the upcoming planned SUD changes.

Email questions about this message to sud.direct.access.dhs@state.mn.us or contact the Minnesota Department of Human Services policy area that oversees your program type. (pub. 5/5/26)

All Early Intensive Developmental and Behavioral Intervention (EIDBI) provider agencies that have not yet submitted a provisional license application must submit an application immediately to remain enrolled and eligible to provide EIDBI services through Minnesota Health Care Programs (MHCP).

Deadline: May 31, 2026
Your agency must submit a complete provisional license application on or before May 31, 2026. Failure to meet this deadline will result in termination from being an enrolled MHCP EIDBI provider agency effective June 1, 2026.

If your agency is terminated:

• You must immediately cease providing all EIDBI services through MHCP of June 1, 2026
• You must not bill MHCP for any EIDBI services provided on or after June 1, 2026
• Claims submitted for dates of service on or after June 1, 2026, will be denied and subject to recoupment

No exceptions or extensions will be granted.

Required Action

• Verify whether your agency has submitted a provisional license application
• If you have not submitted an application, create a Provider Hub account and submit your application immediately to ensure it is received by the deadline

Agencies that fail to submit a provisional license application by May 31, 2026, will not be authorized to operate or receive reimbursement through MHCP for EIDBI services beginning June 1, 2026. Additionally, failure to comply with this requirement will result in enforcement action, including termination of enrollment and recovery of funds for noncompliant billing.

Submit your provisional license application now to avoid disruption to your agency’s operations and services.

Contact the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 if you have questions about this message. Contact DHS EIDBI Licensing at 651-431-6500 or eidbi.licensing.dhs@state.mn.us if you have questions about submitting an application for a provisional license. (pub. 5/1/26)

We recommend providers check their MN–ITS mailbox regularly for important correspondence from Minnesota Health Care Programs (MHCP). MHCP delivers the following provider information electronically to each provider’s MN–ITS mailbox account. 

• Provider news and updates
• Enrollment letters
• Medical, dental and service authorization letters
• Remittance advices

Providers are required to verify member eligibility. Use MN–ITS or call the automated Eligibility Verification System at 651-431-2700 or 800-366-5411 option 1. Review the Verifying MHCP Eligibility in MN–ITS and Understanding Eligibility Results in MN–ITS videos for more information.

The department is launching a new e-newsletter for providers titled MHCP Provider Connect: A weekly roundup of news, updates and reminders to keep Minnesota Health Care Programs providers informed of developments at the Minnesota Department of Human Services. Our goal is help keep you aware of changes that impact your work and the communities we serve together. Sign up for email alerts on the Email Updates webpage to have these emails sent directly to your inbox.

View all news and updates.

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. (rev. 1/13/26)