Minnesota Health Care Programs providers: Policies and procedures

Find information on how to enroll with Minnesota Health Care Programs (MHCP):

• MHCP Provider
• Managed Care Organization In-Network Provider

Find quick links to information for your provider type on the comprehensive list of provider types.

Also see information for:

• Home and community-based services (HCBS) providers
• Managed care organizations

Fee-for-service (FFS) providers enrolled with MHCP must use MN–ITS, our secure, online billing system, to submit claims and view their remittance advice from the MN–ITS mailbox. Also see the MHCP billing resources webpage.

Some MHCP providers can determine temporary eligibility for limited types of coverage, as follows:

• Hospital Presumptive Eligibility: Qualified hospitals determine presumptive eligibility for Medical Assistance (MA)
• Minnesota Family Planning Program (MFPP): Certified providers determine presumptive eligibility for MFPP

Most covered services and authorization requirements are explained in the Minnesota Health Care Programs (MHCP) Provider Manual. Here are links to new or frequently requested information:

• Behavioral health home services
• Interpreter services
  • MHCP Provider Manual: Access Services
  • Minnesota Department of Health Spoken Language Interpreter Roster
  • Deaf and hard of hearing services
  • Sign language interpreter referral
• MinnesotaCare expanded eligibility for certain populations
• Prescription drug prior authorization criteria

Individual providers or entities may be temporarily or permanently ineligible to work in any capacity at any location that receives payment from MHCP. 

Check both the federal and state provider exclusion lists:

• Before enrolling individuals or entities with MHCP
• Periodically to find out whether an individual or entity has been removed from or added to either list

The Payment Error Rate Measurement (PERM) program measures improper payments in Medicaid and the Children’s Health Insurance Program (CHIP). PERM audits paid claims, medical necessity and member eligibility for Medical Assistance (MA) and CHIP. Claims are audited for correct dates of service, and accurate and complete documentation according to MA policies, state laws and federal laws.

Refer to Payment Error Rate Measurement (PERM) 2018 (PDF) for details.