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.
Log in to MN–ITS via the MN–ITS: Home webpage or new URL
Please access MN–ITS using this link to the MN–ITS Home webpage or the new URL, https://mn-its.dhs.state.mn.us. Do not access MN–ITS using bookmarks or links you have saved. (pub. 12/7/21, rev. 12/8/21, 12/9/21, 12/10/21, rev. 3/29/22)
This message has been revised to update the date the Minnesota Health Care Programs (MHCP) Provider Directory will be down for maintenance. The MHCP Provider Directory will be down for maintenance through at least Aug. 22, 2022. We will make the directory available before Aug. 22 if we finish our maintenance before then. (pub. 7/27/22, rev. 8/8/22, 8/16/22)
The Minnesota Legislature has amended Minnesota Statutes, section 256B.0625, to allow Minnesota Health Care Programs (MHCP) to cover enhanced asthma care services and related products provided in the homes of children with poorly controlled asthma effective Jan. 1, 2022. A child is defined as having poorly controlled asthma if the child received:
emergency care services or hospitalization for the treatment of asthma within the past year; and
a referral from a qualified health care provider stating enhanced asthma care is needed.
MHCP will cover retroactive to dates of service on or after Jan. 1, 2022. Use billing code T1028 with UA modifier to bill for enhanced asthma care services. You can find billing instructions under Enhanced Asthma Care Services in the Physicians and Professional Services section of the MHCP Provider Manual. Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 if you have questions about billing.
Refer to the Minnesota Department of Health (MDH) Asthma Home-Based Services webpage for more information about the service. Call MDH at 651-201-5909 or email health.asthma@state.mn.us if you have questions. (pub. 8/16/22)
Providers who have submitted claims for CLS that were denied must resubmit their claims. After CLS providers have renewed or updated their license with Minnesota Department of Health (MDH), CLS providers also need to submit an updated license to Provider Eligibility and Compliance at Department of Human Services (DHS). Provider Eligibility and Compliance is using the MDH public license database to update Assisted Facility Living licenses to expedite the denied CLS claims process due to expired licenses. We hope to have this completed by 4 p.m., Friday, Aug. 12. You may try to resubmit your claims after 4 p.m. We will not reprocess claims.
Providers must submit a copy of their license any time the license is renewed or if there are changes. You may submit your updated license to Provider Eligibility and Compliance either through fax at 651-431-7493 or through the Minnesota Provider Screening and Enrollment (MPSE) Portal. (pub. 8/12/22)
This message has been revised to update MPSE portal training times. Minnesota Health Care Programs (MHCP) will send revalidation notices in phases to residential and outpatient Substance Use Disorder treatment providers and Home and Community-Based Services providers (provider types 62 and 18) beginning Aug. 15, 2022.
Providers due for revalidation in this first phase will receive a revalidation notice in their MN–ITS PRVLTR folder. We will mail your revalidation notice to the credentialing address on your enrollment record if you have not set up a MN–ITS mailbox.
To ensure the most effective and efficient revalidation processing, and to prevent backlogs, do not send any revalidation documents until you receive your initial revalidation notice. You will receive a revalidation notice when you are due for revalidation. Review the Revalidation Schedule in the MHCP Provider Manual for more information. Do not call the MHCP Provider Resource Center unless you know you are due for revalidation and have not received a revalidation notice.
Sign up for the Minnesota Provider Screening and Enrollment (MPSE) portal training to learn how to complete your revalidation using the MPSE Portal. Trainings will be separated by provider type, however the only difference will be the examples used in the live demonstration of the MPSE portal.
Minnesota Department of Human Services has partnered with HMS-Permedion to conduct health care claim reviews to ensure compliance and accuracy.
You may have already received requests for medical records. However, beginning in September 2022, you may receive new or different letters from HMS-Permedion requesting records for different audit types. Each letter will outline the medical record information needed, the timeframe to submit, the options available to submit the documentation and contact information for your questions.
You will receive a determination letter from HMS-Permedion when the review is complete. If an overpayment is identified, the letter will explain next steps, including information regarding your rights to an additional review or appeal.
Call the HMS-Permedion provider relations team at 844-512-2675, Monday through Friday from 7 a.m. to 4 p.m. if you have questions about the review process. (pub. 8/3/22)
Minnesota Health Care Programs (MHCP) now covers stand-alone vaccine counseling visits for COVID-19 vaccinations and standard vaccines to children and adults. Effectively immediately, providers should use the new codes when billing for these stand-alone visits provided in person or via telehealth.
Refer to Vaccine Counseling in the Immunizations and Vaccinations section of the MHCP Provider Manual for the new billing codes and billing information. (pub. 8/3/22)
CLS providers enrolled with Minnesota Health Care Programs (MHCP) may be eligible for a rate floor, or minimum daily rate, adjustment for members on EW receiving 24-hour CLS.
We will accept applications from Sept. 1-30, 2022. You must email your application before 11:59 p.m. on Sept. 30, 2022; applications received after that time will not be considered. See the Elderly Waiver Customized Living Services Rate Adjustment section of the MHCP Provider Manual for qualifications.
Minnesota Department of Human Services will reprocess previously paid SUD claims with dates of service between Jan. 1, 2022, and June 30, 2022, for the following services. We are reprocessing the claims because the Minnesota Legislature passed rate increases during the 2021 special session.
Email SUD.Direct.Access.DHS@state.mn.us with questions about this message. Contact the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 with billing questions. (pub. 8/1/22)
The following training sessions and events are scheduled for all EIDBI providers during August.
EIDBI Provider Office Hours
When: Aug. 23, 2022, from noon - 1 p.m.
Description: This event offers an opportunity for EIDBI providers to give input or ask policy, clinical and training questions related to the benefit with members of the Minnesota Department of Human Services EIDBI team.
Join the event, no registration required.
Early Intensive Developmental and Behavioral Intervention (EIDBI) Provider Input session
When: Aug. 25, 2022, from 10 a.m. - noon
Description: This is an opportunity for current and potential EIDBI providers to hear updates, provide input and discuss current and proposed EIDBI policies and practices. All EIDBI agencies are highly encouraged to send at least one staff member from their organization to attend. This is also an opportunity to network with and hear from other EIDBI agencies.
Register on the Minnesota Autism Resource Portal EIDBI Provider Input Session webpage.
Visit the Minnesota Autism Resource Portal Training and events and Calendar webpages for descriptions and information about other events. Complete the Event Request Form to request specific training sessions or events for your organization or group. (pub. 7/28/22)
Minnesota WIC Program will offer Enfamil milk-based infant formulas and will no longer offer Similac milk-based infant formulas beginning Oct. 1, 2022. This is the result of a contract bidding cycle that occurs every five years, not a result of the recent Abbott recall. The soy formula contract will remain with Abbott and Isomil (Similac) will continued to be offered. You may contact your health care provider with any questions.
Continue following existing COVID-19 policies and procedures for Minnesota Health Care Programs until further notice. We will provide more guidance as it becomes available. (pub. 7/18/22)
You are no longer required to use the Level of Care Utilization System (LOCUS) to provide adult mental health services. You may also complete the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) on the World Health Organization’s website to determine a member’s level of care beginning July 14, 2022. Our license with Deerfield Solutions has ended and we have removed the LOCUS Recording Form (DHS-6249) from our searchable documents library (eDocs). Additional level of care assessments may be authorized at a later date. Refer to the Level of Care Assessment section of the Minnesota Health Care Programs Provider Manual for more information. (pub. 7/14/22)
The Consent for Sterilization (PDF) linked to in the Sterilization section of the Minnesota Health Care Programs Provider Manual expired April 30, 2022. This form comes from the federal Health and Human Services Office of Population Affairs and a new form will be posted when it is available. Continue to use this form until the new form is posted. (pub. 5/2/22)
This message has been revised to remove the requirement skilled nursing facilities will have to demonstrate that they have unsuccessfully sought staff through Aladtec or pursued 12A funding to meet their staffing needs. Providers of residential services can now request short-term emergency staffing if they’re experiencing a COVID-19 outbreak at their facility. Providers must show that they have exhausted all available measures to identify staff and are at risk for closure, or at risk of placing residents in situations with unsafe staffing levels.
The purpose of the emergency staffing pool is to give providers time to either:
Identify, hire and onboard appropriate staff for the current number of residents, or
Reduce the number of residents to levels that can be appropriately managed with the current level of staffing.
Eligible providers will receive temporary staff for up to 21 days from a third-party staffing agency selected by the State of Minnesota at no cost to the provider. While the State of Minnesota will try to meet providers’ appropriate requests for temporary COVID-19 staffing, the provider remains responsible for all requirements of their license and continuity of services for their residents.
MHCP covers OTC antigen and polymerase chain reaction (PCR) tests according to the American Rescue Plan Act of 2021. The coverage of the OTC COVID-19 tests applies to members covered under the fee-for-service (FFS) program as well those covered through Managed Care Organizations (MCOs).
MHCP members are not able to receive direct reimbursement from Minnesota Department of Human Services (DHS) or MCOs for OTC COVID-19 tests purchased by the member; the provider must bill DHS or the MCOs directly for the OTC tests. Providers submitting claims for OTC tests must have an order from a prescriber for the OTC tests.
The federal Public Readiness and Emergency Preparedness Act expanded prescriptive authority for OTC COVID-19 tests to pharmacists during the public health emergency.
MHCP covers vaccine counseling-only visits effective Jan. 1, 2022. Providers may counsel for COVID-19 vaccinations and standard vaccines to children and adults. You may provide counseling both in-person and via telehealth, and providers billing for counseling services must be able to administer the vaccine for which they are counseling. Vaccine counseling-only visits cannot be billed separately if vaccine counseling is a required component of another service provided in the same visit. Refer to the Immunizations and Vaccinations section of the MHCP Provider Manual for billing information. (pub. 2/4/22)
You will see cost-sharing co-pay or family deductible charges for COVID-19 vaccine administration code 0051A-0054A incorrectly displaying on your claim and remittance advice. The cost-sharing co-pay or family deductible will be deducted from the allowable amount until system changes are made. Providers should not collect the co-pay or family deductible amount from the member. We will reprocess claims after the system changes are complete to bypass cost-sharing and family deductible for the COVID-19 administration codes. Watch for a future provider news message on this webpage regarding updates and billing.
You can find the covered codes and MHCP COVID-19 vaccine billing instructions in the Coronavirus (COVID-19) Billing section of the MHCP Provider Manual. (pub. 2/1/22)
We are aware of cost-sharing co-pay or family deductible charges for COVID-19 vaccine administration codes 0004A and 0034A incorrectly displaying on your claim and remittance advice. The cost-sharing copay or family deductible will be deducted from the allowable amount until system changes are made. Providers should not collect the co-pay or family deductible amount from the member. We will reprocess claims after the system changes are complete to bypass cost-sharing and family deductible for the COVID-19 administration codes. Watch for a future provider news message on this webpage regarding updates and billing. (pub. 1/25/22)
The American Medical Association approved Current Procedural Terminology (CPT) COVID-19 vaccine booster shot codes for Pfizer, Moderna and Janssen. The Pfizer COVID-19 vaccine booster shot CPT code is effective beginning Sept. 22, 2021. The Janssen and Moderna COVID-19 vaccine booster shot CPT codes are effective beginning Oct. 20, 2021. The Centers for Disease Control and Prevention (CDC) has issued recommendations for COVID-19 vaccine booster shots. Visit the CDC’s Choosing Your COVID-19 Booster Shot webpage for more information.
Minnesota Health Care Programs (MHCP) will only reimburse for the administration of the vaccine. As a reminder, vaccines are exempt from cost-sharing. Use the following administration codes to report the administration of the booster dose for Pfizer, Moderna and Janssen COVID-19 vaccines:
You may now submit claims. MHCP will cover administration code 0004A retroactive to dates of service beginning Sept. 22, 2021. MHCP will cover administration codes 0064A and 0034A retroactive to dates of service beginning Oct. 20, 2021. You can find the covered codes on the MHCP fee schedule. You can find COVID-19 vaccine billing instructions under Billing in the Coronavirus (COVID-19) section of the MHCP Provider Manual. (pub. 11/15/21, rev. 11/23/21)
The American Medical Association approved a new Current Procedural Terminology (CPT) code for COVID-19 Pfizer vaccine (91307) and administration codes (0071A and 0072A) for ages 5-11 years. The Advisory Committee on Immunization Practices (ACIP) has issued recommendations for children between the ages of 5 and 11 years receiving the Pfizer-BioNTech pediatric COVID-19 vaccine. Visit the Centers for Disease Control and Prevention COVID-19 ACIP Vaccine Recommendations webpage for more information.
Minnesota Health Care Programs (MHCP) will only reimburse for the administration of the vaccine. As a reminder, vaccines are exempt from cost-sharing. Use the following administration codes to report the administration of the Pfizer vaccine for ages 5-11:
You may now submit claims. MHCP will cover administration code 0071A and 0072A retroactive to dates of service beginning Oct. 29, 2021. You can find the covered codes on the MHCP fee schedule. You can find COVID-19 vaccine billing instructions under Billing in the Coronavirus (COVID-19) section of the MHCP Provider Manual. (pub. 11/15/21)
Beginning with claims paid on or after Oct. 1, 2021, coinciding with the beginning of the federal fiscal year until the end of the federal fiscal year 2022 (Sept. 30, 2022), regular FMAP increases from 50% to 50.51% (1905(b) of Social Security Act).
Since Jan. 1, 2020, until the end of the quarter the COVID-19 federal public health emergency ends, the Families First Coronavirus Response Act (Public Law No. 116-127, section 6008) provides a temporary increase of 6.2% in the FMAP rate for the following services for children, parents or guardians with children under 19, individuals 65 and older and individuals blind or disabled:
Individualized Education Program
Rule 5 Children’s Residential includes Institutions for Mental Disease, which receives an increase in state funds equal to the federal fund increase.
County-provided Targeted Case Management services (Child Welfare, Mental Health and Vulnerable Adult-Developmental Disability)
The 6.2% COVID-19 FMAP increase and the Federal Fiscal Year FMAP increase to 50.51% does not apply to adults without children whose eligibility was gained under the Affordable Care Act and some other populations already receiving an enhanced FMAP.
Minnesota Health Care Programs (MHCP) will automatically reprocess paid claims from warrant date Oct. 12, 2021. Counties and providers do not need to do anything to receive the increased FMAP. Claims paid from Oct. 27, 2021, until the end of the quarter the COVID-19 federal public health emergency has ended (defined by federal government) will be paid at the higher 56.71% rate. If the COVID-19 federal public health emergency ends before Sept. 30, 2022, the percentage paid will be 50.51%.
Contact the MHCP Provider Call Center at 651-431-2700 or 800-366-5411 if you have questions about this message. (pub. 11/9/21)
Federally approved policy modifications to targeted case management (TCM) services to temporarily allow telephone and video-conferencing in place of in-person face-to-face contact during the COVID-19 pandemic have been extended until the end of the federal public health emergency.
The change was effective Mar. 19, 2020, and allows case managers to conduct targeted case management visits by phone or video with adults receiving services or their legal guardians, and with children receiving services and their parents or legal guardians. The change runs through the end of the public health emergency.
The affected services include:
Child welfare targeted case management
Children’s mental health targeted case management
Adult mental health targeted case management
Vulnerable adult or adult with developmental disabilities (VA/DD) targeted case management
Tribal provider requirements
This change means that Indian Health Services (IHS), Sec. 638 Tribal providers, may receive the daily encounter payment when the contact between the case manager and the person receiving services happens by telephone instead of through an in-person face-to-face visit. Although the mode of how a service may be delivered is temporarily changing (for example, targeted case management services can be delivered via telephone temporarily), there are no changes to the payment methodology for the daily encounter payment. The same services and types of providers that are required to generate a daily encounter payment continue to be required when targeted case management services are delivered during the federal public health emergency. (pub. 10/22/21)
Third dose for COVID-19 vaccines approved for certain immunocompromised individuals
The American Medical Association approved Current Procedural Terminology COVID-19 vaccine third dose codes 0003A for Pfizer and 0013A for Moderna for only certain immunocompromised individuals effective Aug. 12, 2021. The Centers for Disease Control and Prevention (CDC) has issued guidance on people recommended to receive a third dose of the COVID-19 vaccine. See the COVID-19 Vaccines for Moderately to Severely Immunocompromised People and How to Talk with Patients Who Are Immunocompromised CDC webpages. The CDC-recommended third dose of an mRNA COVID-19 vaccine is to be administered 28 or more days from administration of the second dose. However, the physician or other qualified health care professional should use clinical judgment to determine whether a third dose is appropriate for the patient.
Minnesota Health Care Programs (MHCP) will only reimburse for the administration of the vaccine. As a reminder, vaccines are exempt from cost-sharing. Use the following administration codes to report the administration of the third dose for only Pfizer and Moderna COVID-19 vaccines:
You may now submit claims. MHCP will cover administration codes 0003A and 0013A retroactive to dates of service on or after Aug. 12, 2021.
You can find the covered codes on the MHCP fee schedule webpage. The MHCP COVID-19 vaccine billing instructions are in the Coronavirus (COVID-19) Billing section of the MHCP Provider Manual. (pub. 9/10/21)
DHS will make one final round of add-on payments after Sept. 30, 2021, based on any eligible fee-for-service claims submitted before Sept. 30, 2021. DHS has informed managed care organizations (MCOs) of its plan to end payment processing for this program. MCOs will determine when they will stop processing add-on payments for services they coordinate.
We revised language to clarify that the policy is in effect now and remains in effect; it does not begin Sept. 1, 2021. A temporary peacetime emergency waiver allowing the member’s verbal or electronic written approval of the ITP or change in the ITP for mental health services or assessments delivered through telehealth remains in effect Sept. 1, 2021, based on new legislation. You may document the member's verbal approval or electronic written approval of the treatment plan or change in the treatment plan instead of obtaining the member’s signature.
This is effective Sept. 1, 2021, for providers of the following services:
Intensive Rehabilitative Mental Health Services
Children’s Therapeutic Support Services
Intensive Treatment Foster Care
Adult Rehabilitative Mental Health Services
Adult Mental Health Mobile Crisis Services
Children’s Mental Health Mobile Crisis Services
Outpatient Mental Health
Call the Minnesota Health Care Programs Provider Call Center at 651-431-2700 or 800-366-5411 if you have questions about this message. (pub. 8/25/21, rev. 8/26/21)
Parents of minors and spouses may care for their family members and be paid for PCA services effective July 1, 2021, through the end of the Federal Public Health Emergency. Parents and spouses must be enrolled with Minnesota Health Care Programs (MHCP) as an individual PCA.
Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411, option #4, if you have questions about this message. (pub. 8/4/21, rev. 7/6/22)
On June 30, the Minnesota Legislature voted to end the state peacetime emergency effective Thursday, July 1, 2021, at 11:59 p.m. This will end the COVID-19 Peacetime Emergency authority the Department of Human Services (DHS) has under Executive Orders 20-11 and 20-12 to seek federal authority to change or waive federal requirements and to modify and waive certain statutes and rules related to DHS programs. We have used this authority to respond to the COVID-19 pandemic. We are quickly working to analyze the language in the 2021 HHS Omnibus bill that modified the transition timeline for a number of the COVID-19 “CV waivers and modifications” and also made several pandemic changes a part of permanent state law. We will be making updates to our DHS waivers and modifications webpage to reflect revised dates soon. Please watch DHS bulletins, manuals and other regular communication channels for program-specific guidance over the coming weeks. (pub. 7/2/21)
Training
Minnesota Health Care Programs (MHCP) offers free training for MHCP enrolled providers.
Minnesota Department of Human Services (DHS) is offering an online Webex training on the basics of the MPSE Portal on June 21, 2022, from 1 to 4 p.m. This training is free to attend.
Advantages to using the MPSE portal include:
Having a complete record of all information Minnesota Health Care Programs (MHCP) has for your organization or individual enrollment records in one place online
Having access to real-time updates on requests made to DHS including
Status of the request
Submission date
Requests for More Information (RFMI) data
No more faxing!
Who should attend?
Owners of MHCP-enrolled provider organizations
Employees who maintain provider enrollment records
Employees responsible for organization compliance
Anyone interested in learning more about the MPSE portal
Register for this training on the MPSE portal training webpage where you can also find on-demand videos and links to more information about the MPSE portal. (pub. 6/2/22)
Minnesota Health Care Programs (MHCP) has scheduled two free Webex training sessions for transportation providers about the MPSE portal. The training will feature a demonstration on how to complete an Organization to Individual affiliation for enrolling your individual drivers. The goal of this training is to clarify the enrollment process through the MPSE portal. Training is scheduled for June 7 and June 13, 2022.
As a reminder, on July 1, 2021, Minnesota legislation required all Non-Emergency Medical Transportation individual drivers to enroll with MHCP and become affiliated with their transportation organization by July 1, 2022. (pub. 5/27/22)
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. Due to COVID-19, all instructor-led training is online only. We will update you on this webpage when, and if, we will continue in-person training. We have recently updated the look of the provider-specific training webpages and added the 2021 training dates. (pub. 12/22/20)
Minnesota Health Care Programs (MHCP) offers free online training for MHCP-enrolled providers. Go to the MHCP provider training webpage to see the list of available training. (pub. 6/22/21)
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 10 minutes or less and provides instructions on a concept or technique.
New videos:
How to Read Your Payer Claim Control Number, PCN – A PCN is a 17-digit claim number that is automatically generated by our system when a claim is submitted to Minnesota Health Care Programs for processing. This video will focus on the individual components of the PCN that are the most important for billers to understand.
How to Read the Payment and Claim Cut-off Calendars – MHCP uses a Payment and Claim Cut-off Calendar to determine the cut-off date that we must receive a provider’s claims to ensure they will be processed in a timely manner. Knowing how to read the calendar will help you submit claims so they are processed in a timely fashion and you can be paid sooner.
Adding an Organization to Individual Provider Affiliation in MPSE – This video demonstrates how an organization adds an affiliation to an individual provider who is already registered with MPSE and has an active enrollment status with the Minnesota Health Care Programs, or MHCP.
Minnesota Health Care Programs is providing free online training for our MPSE online portal.
See 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)
