MHCP provider news and updates

Claims using HCPCS code G0463 modified with PO (Services, procedures and/or surgeries provided at off-campus provider-based outpatient departments) will be reduced to 70 percent of the Ambulatory Payment Classification (APC) allowable effective for dates of service on or after Jan. 1, 2019. Claims with dates of service on or after Jan. 1, 2020, will be reduced to 40 percent of the APC allowable. 

We have identified and reprocessed claims with dates of service from Jan. 1, 2019, through Apr. 10, 2019. The reprocessed claims will be reported on your May 29, 2019, remittance advice. See Page 6 of CMS MLN Matters MM11099 (PDF) for more information. (pub. 5/17/19)

We have updated system programming for HCPC code 90750 to allow billing for two shingles vaccine injections and have reprocessed claims from Jan. 1, 2017, through Apr. 3, 2019, impacted by the update. You do not need to resubmit claims. You will see the adjustment on the May 14, 2019, remittance advice. Claims submitted after Apr. 3, 2019, were paid the correct amount. (pub. 5/14/19)

The Minnesota Department of Human Services (DHS) will settle-up IEP services with IEP service providers for the 2017-18 school year after the June 30, 2019, claim submission deadline. You must submit a completed IEP Services Annual Data Report Form to DHS no later than July 5, 2019. Use this updated version of the IEP Services Annual Data Report Form (DHS-5052) (PDF).

For settle-up to occur, you must: 

• Bill, receive payments and report all required cost data through the Special Education Data Reporting Application (SEDRA) of the Minnesota Department of Education (MDE), and 
• Report the total direct service time and encounter data to DHS using the IEP Services Annual Data Report Form 

If you do not submit the required cost data for any of the IEP services listed below that were provided during 2017-18 and for which payments were received, the final rate for that service will be $0.00.

You must submit total direct service hours and encounters for each of these covered IEP services:

• Physical therapy 
• Occupational therapy
• Speech, language or hearing therapy
• Mental health services
• Nursing services
• Personal Care Assistance services
• Interpreter services

You must also report the total number of special transportation trips and the total number of Medical Assistance-eligible children who received special transportation during the 2017-18 fiscal year.

If you have questions about the required documentation, please call Jesusa Williams at 651-431-2538 or email jesusa.williams@state.mn.us. If you have questions about SEDRA, please contact the Special Education Funding and Data Team of MDE at mde.spedfunding@state.mn.us. (pub. 5/14/19)

The Minnesota Department of Human Services will be sending MN–ITS Registration Letters to all opioid-prescribing providers who do not currently have a MN–ITS account. We will mail the letter to you via the U.S. Postal Service this month. Please watch for this letter and notify your administrative staff or billing office to watch for it and route it to you so you can register your account. You will need a registered MN–ITS account to receive your individualized Opioid Prescribing Report, which we will send a couple weeks after the registration letters are mailed. (pub. 5/14/19)

Managed Care Organizations (MCOs) that offer drug benefits to Minnesota Health Care Programs (MHCP) members must use the Minnesota Department of Human Services’ (DHS) Uniform PDL beginning July 1, 2019. The Uniform PDL will ensure a more consistent drug benefit for all members and minimize disruptions if a member’s health plan changes. The Uniform PDL was reviewed and recommended by the Drug Formulary Committee and includes many commonly used medications. Members enrolled with an MCO will have access to all of the preferred drugs on the PDL as well as the other drugs on their plan’s List of Covered Drugs (formulary). This change does not apply to members with dual Medicare and Medicaid coverage. See the Minnesota Fee-for-Service Medicaid Preferred Drug List (PDF) to view the PDL.

If a member is currently using a nonpreferred drug, you must do one of the following:

• Request a one-time continuation of therapy override if the member meets the Continuation of Therapy Prior Authorization Criteria for coverage of the nonpreferred drug for 90 days. Make your request before July 1, 2019, to DHS if the member has fee-for-service coverage or to the MCO responsible for the member’s coverage.
• Request prior authorization (PA) for the nonpreferred drug if the member meets the Nonpreferred Drug Prior Authorization Criteria. Make your request to DHS if the member has fee-for-service coverage or the MCO responsible for the member’s coverage. You may request the PA before July 1, 2019, or during the 90-day continuation of therapy period. 
• Transition the member to a preferred drug on or after July 1, 2019.

If a member currently has an approved PA for a nonpreferred drug, DHS or the member’s MCO will honor the approved PA until the PA expires. After the PA expires, you must request a new PA to continue coverage or transition the member to a preferred drug.

We have created a Frequently Asked Questions for Providers Regarding the Uniform Preferred Drug List (PDF) guide to assist you in understanding your role in helping members remain on a nonpreferred drug or transition to a preferred drug on or after July 1, 2019.

If you have additional questions, please contact:

• MHCP Provider Call Center (for members in fee-for-service Medicaid) at 800-366-5411 or 651-431-2700 
• MCO responsible for the member’s coverage (for members in Managed Care Medicaid or MinnesotaCare). See the table below.

MCO Plan Pharmacy Contact Numbers

(pub. 4/30/19)

We will hold a one-day training session for CTSS providers May 15, 2019, from 9 a.m. to 4 p.m. The training focuses on provider resources, the provider manual, the MN–ITS online billing system and claim submissions. You may attend in person in Room 1235 of the Department of Human Services Building, 444 Lafayette Rd., St. Paul 55101 or through a webinar. See the Children's Therapeutic Services and Supports (CTSS) Billing webpage for registration and other information. (pub. 4/30/19) 

We will upgrade to the Excel XLSX version from the Excel XLS version beginning Apr. 22, 2019, for lists or reports posted in MN–ITS. If you need to open those files, you will need the Excel XLSX version. (pub. 4/16/19)

You may see duplicate X12 835 RAs in your MN–ITS mailbox on the Mar. 19 and Apr. 2, 2019, warrants. The data in the original is the same as the data in the duplicate. You can ignore the duplicate RAs. (pub. 3/21/19, rev. 4/3/19)

We revised the requirements for mental health practitioners providing services to MHCP members enrolled in fee-for-service and Managed Care Organizations effective May 12, 2018.

See the General MHCP Non-Enrollable Mental Health Provider Requirements provider manual webpage for more information. (pub. 3/14/19, rev. 4/30/19)