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... process, providers sign
the MHCP Provider Agreement (DHS-4138) and agree to comply with the data privacy ... process, providers sign
the MHCP Provider Agreement (DHS-4138) and agree to comply with the data privacy ...
Date:
November
17, 2025
... process, providers sign the MHCP Provider Agreement
(DHS-4138) and agree to comply with the data privacy ... process, providers sign the MHCP Provider Agreement
(DHS-4138) and agree to comply with the data privacy ...
Description: Application for 1915(c) HCBS Waiver: Draft MN.016.09.01
Date:
September
28, 2023
... Advice (RA) Request (DHS-4087) Provider Agreement (DHS-4138) ICF/DD Training and Habilitation Agreement (DHS-4224) ... Advice (RA) Request (DHS-4087) Provider Agreement (DHS-4138) ICF/DD Training and Habilitation Agreement (DHS-4224) ...
Description: This page lists all Provider Eligibility and Compliance (PEC) enrollment forms that accept electronic signatures
Date:
August
12, 2025
... Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF) , requiring providers to: “Comply with all federal ... such services.” The existing language in the DHS-4138 provider agreement allows the SMRT to obtain access ...
Date:
February
06, 2026
... Managed Care Organization In-Network
Provider Agreement (DHS-4138) (PDF)
, requiring providers to:
“Comply with all federal ... such services.”
The existing language in the DHS-4138 provider agreement allows the SMRT to obtain access ...
Description: December 30, 2025 MHCP Provider News
Date:
January
13, 2026
... Managed Care
Organization In-Network Provider Agreement (DHS-4138) (PDF)
and the following applicable forms:
o
Early ... Managed Care Organization In-Network Provider
Agreement (DHS-4138) (PDF)
and the following applicable forms:
o
Early ...
Description: November 4, 2025 MHCP Provider News
Date:
November
18, 2025
... Managed Care
Organization In-Network Provider Agreement (DHS-4138) (PDF)
and the following applicable forms:
o
Early ... Managed Care Organization In-Network Provider
Agreement (DHS-4138) (PDF)
and the following applicable forms:
o
Early ...
Description: October 21, 2025 MHCP Provider News
Date:
November
04, 2025
... Managed Care
Organization In-Network Provider Agreement (DHS-4138) (PDF)
and the following applicable forms:
o
Early ... Managed Care Organization In-Network Provider
Agreement (DHS-4138) (PDF)
and the following applicable forms:
o
Early ...
Description: October 7, 2025 MHCP Provider News
Date:
October
21, 2025
... Managed Care Organization In-
Network Provider Agreement (DHS-4138) (PDF)
and the following applicable forms:
o
Early ... Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF)
and the following applicable forms:
o
Early ...
Description: template
Date:
September
23, 2025
... Managed Care
Organization In-Network Provider Agreement (DHS-4138) (PDF)
and the following applicable forms:
o
Early ... Managed Care Organization In-Network Provider
Agreement (DHS-4138) (PDF)
and the following applicable forms:
o
Early ...
Description: September 23 2025 MHCP Provider News
Date:
October
07, 2025