Bill MH-TCM services online using MN–ITS 837P
Counties and county-contracted vendors: Bill one claim per month.
Tribes and FQHCs: Bill one claim per encounter. Enter the date of service.
Do not enter a treating provider NPI number on each line item.
MH-TCM claims will deny when a face-to-face contact occurs within the preceding two months prior to a change in eligibility status and the first contact under the new eligibility status (if client changes provider agency, county, MCO) is a telephone contact. For reimbursement during the month, there needs to be a face-to-face contact in the month when there is a change in eligibility state. Providers must resubmit the claim with case notes documenting the face-to-face contact using the AUC cover sheet.
Mental Health Codes and Rates – open the PDF, click on the first link, go to page 2 of 6 to view the Case Manager Codes.
Note: In “pre-paid managed care” model, the MCO-contracted provider of MH-TCM is reimbursed a monthly rate negotiated between the provider agency and the MCO. The monthly rate is paid if at least one case management core service component is provided consistent with the recipient’s ICSP in at least one face-to-face contact with the recipient during the month. MCOs have the option to reimburse with “tiered” monthly rates based on the MH-TCM service intensity or recipient level of care need. The MCO determines if telephone contact with the recipient will be a reimbursed service.
The provider agency bills and is reimbursed by the MCO; not DHS. DHS pays the MCO a capitation to manage health care services, including MH-TCM, for the enrollees of the MCO.
Contact
· For Behavioral Health Administration Rates, contact BHDRates.DHS@state.mn.us
· For Minnesota Health Care Programs (MHCP) enrollment, claims, and policy questions, contact the MHCP Provider Resource Center (PRC) at 651-431-2700 or 800-366-5411.
o If you are unable to reach the PRC, submit a Contact Request and a PRC representative will call you back.