The Minnesota Health Care Programs (MHCP) Provider Manual serves as the definitive online resource for healthcare providers participating in MHCP. Regularly updated, this manual is your primary source for navigating MHCP policies, understanding coverage guidelines, determining accurate rates, and ensuring compliant billing procedures within Minnesota’s health care landscape.
For healthcare professionals dedicated to serving Minnesota residents, the MHCP Provider Manual is an indispensable tool. It consolidates all essential information regarding the Minnesota Health Care Programs, enabling providers to deliver the best possible care while adhering to program requirements.
Understanding the MHCP Provider Manual
Think of the MHCP Provider Manual as your comprehensive roadmap to successfully participating in Minnesota Health Care Programs. Whether you are a seasoned provider or new to MHCP, this manual offers detailed guidance on a wide array of topics, including:
- Coverage Policies: Gain clarity on what services and treatments are covered under MHCP, ensuring you provide appropriate and reimbursable care.
- Rate Information: Access the most current rate schedules for services rendered, allowing for accurate financial planning and billing.
- Billing Procedures: Master the correct billing processes and requirements to ensure timely and accurate claim submissions and payments.
Staying informed about MHCP is crucial. As an enrolled provider, you are accountable for regularly checking the MHCP Provider Manual for the latest updates, changes, and additions. Proactive monitoring helps you maintain compliance and optimize your practice within the MHCP framework.
To simplify staying current, MHCP offers an email notification service. By signing up for email notices, you will receive timely alerts about revisions specific to the health care services you provide, directly from Minnesota Department of Human Services.
Key Resources within the MHCP Provider Manual
The MHCP Provider Manual is designed for easy navigation, ensuring you can quickly find the information you need. Here are some essential resources readily available:
- MHCP Provider Manual Table of Contents: Provides a complete and structured overview of all sections within the manual, allowing you to directly access specific areas of interest.
- Latest Revisions to this Manual: Quickly see the most recent updates and changes made to the manual, ensuring you are always working with the latest information.
- MN–ITS: Access the Minnesota Information Transfer System (MN–ITS) homepage, your gateway for electronic transactions with MHCP. Chrome browser is recommended for optimal compatibility.
- MN–ITS User Manual: Get detailed instructions and support for using the MN–ITS system effectively.
- Provider Directory: Locate enrolled MHCP providers, useful for referrals and networking within the Minnesota health care community.
- Provider Training: Explore available training opportunities designed to enhance your understanding of MHCP guidelines and best practices for fee-for-service providers.
- Payment and Claim Cut-off Calendars: Stay on top of critical deadlines for payment and claim submissions to ensure timely reimbursement.
- County and Tribal Nation offices: Connect with local offices for assistance with public assistance benefits in Minnesota, supporting holistic patient care.
Your Feedback Matters to MHCP
MHCP values the insights and experiences of enrolled providers. To ensure the MHCP Provider Manual and related services effectively meet your needs, you are encouraged to participate in the MHCP Provider Survey. Your feedback on what works well, areas for improvement, and future considerations is vital for the continuous enhancement of MHCP and its services.
Provider Manual Table of Contents
Below is a comprehensive table of contents providing direct links to each section of the MHCP Provider Manual. Use this table to navigate directly to the specific information you require.
| Member Evidence of Coverage (EOC) Latest revisions to this Manual Coronavirus (COVID-19) |
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| Enrollment with MHCP Provider Basics |
| Provider Requirements 2. · Access Services 3. · Billing Organizations/Responsibilities 4. · Excluded Provider Lists 5. · Provider Participation Requirements – Rule 101 6. · Provider Screening Requirements 7. · Risk Levels and Enrollment Verification Requirements |
| Health Care Programs and Services 2. · Emergency Medical Assistance (EMA) 3. · MHCP Benefits at-a-glance |
| Managed Care Organizations (MCOs) |
| Billing Policy Overview 2. · Billing theMember (Recipient) 3. · Medicare and Other Insurance 4. · Out-of-State Providers 5. · Payment Methodology – Hospital 6. · Payment Methodology – Non-Hospital 7. · Supplemental Payments – Non-Hospital and Hospital |
| Authorization 2. · Drug Authorizations 3. · MHCP Pharmacy Quick Reference |
| Acupuncture Services |
| Ambulatory Surgical Centers |
| Anesthesia Services |
| Behavioral Health Home Services Certified Community Behavioral Health Clinic (CCBHC) |
| Child and Teen Checkups (C&TC) 2. · Abbreviations and Acronyms 3. · C&TC Health Insurance Portability and Accountability Act (HIPAA) Referral Coding Information 4. · Helpful Website Links |
| Chiropractic Services |
| Clinic Services 2. · Federally Qualified Health Center and Rural Health Clinics 3. · FQHC and RHC Global Encounters for MCO Enrollees – Examples |
| Community Emergency Medical Technician (CEMT) Services |
| Community Health Worker (CWH) |
| Community Paramedic Services |
| Day Training & Habilitation (DT&H) Day Services |
| Dental Services 2. · Advanced Dental Therapist (ADT) 3. · AlliedOral Health Professional (Overview) 4. · Dental Authorization Requirement Tables 5. · Collaborative Practice Dental Hygienists (was Limited Authorization Dental Hygienists) 6. · Critical Access Dental Payment Program (CADPP) 7. · Dental Benefits 8. · Dental Therapist (DT) 9. · Non-Dental Health Providers |
| Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit 2. · EIDBI Benefit Billing Grid (PDF) 3. · EIDBI Managed Care Organization (MCO) Contact Information Grid (PDF) |
| Elderly Waiver and Alternative Care Program (EW and AC) 2. · Specialized Supplies & Equipment Authorization & Billing Responsibilities |
| Equipment and Supplies 2. · Airway Clearance Devices 3. · Allergen-Reducing Products for Children 4. · Ambulatory Assist Equipment 5. · Apnea Monitors 6. · Bath and Toilet Equipment 7. · Bone Growth Stimulators 8. · Breast Pumps 9. · Diabetic Equipment and Supplies 10. · Electrical Stimulation Devices 11. · External Defibrillators 12. · Gloves 13. · Hospital Beds 14. · Humanitarian Use Devices 15. · Incontinence Products 16. · Lower Limb Prosthetics 17. · Mobility Devices 18. · Nebulizers 19. · Non-Mobility Equipment Repairs 20. · Nutritional Products and Related Supplies 21. · Orthopedic and Therapeutic Footwear 22. · Orthotics 23. · Oximeters 24. · Oxygen Contract Regions and Price Schedule (PDF) 25. · Oxygen Equipment |
| Essential Community Supports (ECS) |
| HCBS Waiver Services 2. · Billing for Waiver and Alternative Care (AC) Program 3. · HCBS Waiver and AC Training Requirements 4. · Void (“Take-Back”) Waiver and AC Service Claims for Fee-for-Service |
| Hearing Aid Services 2. · Bone-Anchored Hearing Aids (BAHA) 3. · Cochlear Implants 4. · Hearing Aid Services Codes Table |
| Home Care Services 2. · Home Care Nursing (HCN) Services 3. · Home Health Aide Services 4. · Rehabilitation Therapy Services 5. · Skilled Nurse Visits (SNV) Services |
| Hospice Services |
| Hospital Services 2. · Critical Access Hospital (CAH) Services 3. · Hospital In-reach Service Coordination (IRSC) 4. · Inpatient Hospital Authorization 5. · Inpatient Hospitalization for Detoxification Guidelines 6. · Inpatient Hospital Services 7. · Outpatient Hospital Services |
| Housing Stabilization Services Housing SupportSupplemental Services |
| Immunizations and Vaccinations 2. · Immunization and Vaccine Benefits Codes for Children 3. · Immunization and Vaccine Benefits Codes for Adults |
| Individualized Education Program (IEP) Services |
| Intermediate Care Facilities (ICF/DDs) |
| Laboratory and Pathology Services |
| Medication Management Therapy Services |
| Mental Health Services 2. · Adult and Children’s Crisis Response Services 3. · Adult Day Treatment 4. · Adult Mental Health Targeted Case Management (AMH-TCM) and Children’s Mental Health Targeted Case Management (CMH-TCM) 5. · Adult Rehabilitative Mental Health Services (ARMHS) 6. · Adult Residential Crisis Stabilization Services (RCS) 7. · Assertive Community Treatment (ACT) 8. · Certified Family Peer Specialist 9. · Certified Peer Specialist Services 10. · Children’s Mental Health Clinical Care Consultation 11. · Children’s Mental Health Residential Treatment 12. · Children’s Therapeutic Services and Supports (CTSS) 13. · Clinical Supervision of Outpatient Mental Health Services 14. · CTSS Children’s Day Treatment 15. · Diagnostic Assessment 16. · Dialectical Behavior Therapy Intensive Outpatient Program (DBT IOP) 17. · Explanation of Findings 18. · Family Psychoeducation 19. · Functional Assessments 20. · General MHCP Non-Enrollable Mental Health Provider Requirements 21. · Health Behavior Assessment/Intervention 22. · Inpatient Visits 23. · Intensive Residential Treatment Services (IRTS) 24. · Children’s Intensive Behavioral Health Services 25. · Level of Care Assessment 26. · Mental Health Diagnostic Code Ranges 27. · Mental Health Provider Travel Time 28. · MHCP Professional Certification and Enrollment Requirements 29. · Neuropsychological Services 30. · Partial Hospitalization Program 31. · Physician Consultation, Evaluation and Management 32. · Psychiatric Consultations to Primary Care Providers 33. · Psychiatric Residential Treatment Facility (PRTF) 34. · Psychological Testing 35. · Psychotherapy 36. · Psychotherapy for Crisis 37. · Telehealth Delivery of Mental Health Services 38. · Youth Assertive Community Treatment (Youth ACT)/Intensive Rehabilitative Mental Health Services (IRMHS) |
| Moving Home Minnesota 2. · Moving Home Minnesota Demonstration and Supplemental Services Table (PDF) 3. · Moving Home Minnesota Supported Employment Services (MHM SES) |
| Nursing Facilities |
| Officer-Involved Community-Based Care Coordination Services |
| Optical Services |
| PCA Services |
| Pharmacy Services 2. · 340B Drug Pricing Program 3. · Compound Drugs 4. · Drug Categories with Limited Coverage 5. · Home Infusion Therapy 6. · LongTermCare (LTC) 7. · Medicare 8. · Minnesota Covered Active Pharmaceutical Ingredient (API) and Excipient List 9. · NCPDP Payer Sheets Guidelines 10. · Pharmacy Early-Refill Overrides 11. · Point of Sale Diabetic Testing Supply Program 12. · Pro-DUR Conflict Codes 13. · Quantity Dispensing Limits Table |
| Physician and Professional Services 2. · Gender-Affirming Surgery 3. · Transplant Authorization Code List 4. · Health Care Homes (HCH) |
| Program HH (HIV/AIDS) Services 2. · Program HH Dental Authorization Requirement Chart |
| Radiology/Diagnostic Services 2. · Authorization Criteria: Cardiac Magnetic Resonance Imaging of the Coronary Arteries 3. · Coverage Criteria: Computed Tomography Colonography RehabilitationServices 5. · Audiology Services Procedure Codes 6. · Augmentative Communication Devices 7. · Casting & Strapping Services/Supplies 8. · Orthotic Procedures 9. · Rehabilitative and Therapeutic Services Authorization Criteria 10. · Rehabilitative Services Procedure Codes |
| Renal Dialysis Overview 2. · Renal Dialysis Billing |
| Reproductive Health/OB-GYN 2. · Abortion Services 3. · Breast and Cervical Cancer (BRCA) Genetic Testing and Presumptive Eligibility Services 4. · Doula Services 5. · Family Planning 6. · Family Planning Codes with Increased Rates 7. · Free-Standing Birth Center Services 8. · Hysterectomy 9. · ICD-9 to ICD-10 Diagnosis Conversion Table 10. · MinnesotaFamily Planning Program (MFPP) 11. · Minnesota Family Planning Program (MFPP) Procedure Codes 12. · Obstetrics Services and HIV Counseling 13. · Sterilization |
| School-Based Community Services (SBCS) |
| Screening, Brief Intervention, and Referral to Treatment (SBIRT) |
| Substance Use Disorder Services (SUD) 2. · Substance Use Disorder (SUD) Withdrawal Management Services 3. · Telehealth Delivery of Substance Use Disorder Services |
| Targeted Case Management |
| Transportation Services 2. · Nonemergency Medical Transportation (NEMT) Services (Overview) 3. · Access Services Ancillary to Transportation 4. · AmbulanceTransportationServices 5. · Ancillary Services Claim and Rate Information for Counties and Tribes 6. · Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Transportation Services 7. · Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information 8. · Protected Transportation Services 9. · State-Administered NEMT 10. · State-Administered Transportation Procedure Codes, Modifiers and Payment Rates |
| Tribal and Federal Indian Health Services |
CPT codes, descriptions and other data only are copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/HHSAR apply.
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