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Managed care organizations - Encounter submissions

The Department of Human Services (DHS) requires that HIPAA standard transaction formats be applied to encounter submissions. This page includes Minnesota Health Care Programs (MHCP) guides and other documents that will assist you in understanding:

  • Encounter file submission requirements
  • Other encounter transactions
  • MHCP encounter claim processing cycles

Any questions on the content of this page should be directed to the following email mailbox: DHS.edqunit@state.mn.us.

Encounter data submissions instructions and references

MHCP Companion Guides

DHS requires MCOs to submit encounter professional/institutional/dental claims in the X12 format. Encounter pharmacy claims must be submitted in the NCPDP Batch format. (Please note that the companion guides referenced on the MN–ITS website are not encounter claim guides and should not be referenced for submitting your encounter claims.)

Frequently asked questions

Also see the frequently asked questions about encounter submissions.
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