The Minnesota Health Care Programs (MHCP) enrollment process can be complex, but understanding the system and utilizing available resources is key to a smooth experience. This guide provides a comprehensive overview of MHCP enrollment, focusing on how advanced system care portal programs streamline the process for healthcare providers. Whether you are a new provider or managing an existing enrollment, this information will help you navigate each step effectively.
Understanding the MHCP Enrollment Process
Enrolling as an MHCP provider involves several critical steps, all designed to ensure the integrity and efficiency of Minnesota’s healthcare system. The state offers resources and online portals to assist providers through each stage.
Step 1: Verifying Excluded Provider Lists
Before initiating your MHCP enrollment, it is crucial to check both federal and state excluded provider lists. This preventative measure ensures compliance and avoids potential enrollment issues down the line.
The Office of Inspector General (OIG) maintains a List of Excluded Individuals and Entities (LEIE). Being on this list can disqualify you from participating in Medicare, Medicaid, and other federal health care programs, including MHCP. Regularly checking this list is not just a preliminary step but an ongoing responsibility for enrolled providers.
Why is this important? MHCP is obligated to exclude any provider listed on either the federal or state exclusion lists. Engaging with excluded individuals or entities can lead to penalties.
Best Practices:
- Pre-Enrollment Check: Always verify the LEIE before beginning the enrollment process.
- Regular Monitoring: Conduct monthly checks of the LEIE to stay informed of any updates.
- Employee and Contractor Screening: Extend these checks to all employees and contractors to ensure full compliance.
- Reporting Exclusions: Promptly report any discovered exclusions to MHCP Provider Eligibility and Compliance.
Step 2: Meeting MHCP Rules and Requirements
Eligibility for MHCP enrollment hinges on meeting specific rules and requirements tailored to the type of service you intend to provide. These regulations ensure that all enrolled providers maintain a standard of quality and compliance.
Key Actions:
- Service-Specific Requirements: Identify the precise licensure and certification needed for your provider type. Refer to the “Eligible Providers” section within this guide for detailed information.
- Provider Screening Requirements: Familiarize yourself with the comprehensive Provider Screening Requirements outlined in the MHCP Provider Manual.
Step 3: Obtaining a Provider Identification Number (NPI or UMPI)
A crucial step in the MHCP enrollment process is securing the correct provider identification number. For most providers, this is the National Provider Identifier (NPI). However, some provider types may be assigned a Unique Minnesota Provider Identifier (UMPI) instead.
NPI – National Provider Identifier:
- Most healthcare providers who are HIPAA-covered entities are required to obtain an NPI.
- Apply for your NPI through the National Plan and Provider Enumeration System (NPPES) before starting your MHCP enrollment.
UMPI – Unique Minnesota Provider Identifier:
- Certain provider types, particularly those not meeting the federal HIPAA definition of a health care provider, may not be eligible for an NPI.
- If an NPI is not applicable, MHCP will assign a UMPI upon successful enrollment.
- Providers who may receive a UMPI include Home and Community-Based Services providers, Personal Care Provider Organizations, and others listed in the original article.
Important Note: Whether you use an NPI or UMPI, this identification number is mandatory for all fee-for-service claims submitted to MHCP.
Step 4: Submitting Enrollment Documents via the Advanced MPSE Portal
MHCP offers a streamlined approach to enrollment through the Minnesota Provider Screening and Enrollment (MPSE) portal. This advanced system care portal program is designed to simplify and expedite the enrollment process.
Two Enrollment Methods:
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Online Enrollment via MPSE Portal (Recommended):
- Register for MPSE to begin your online application.
- The MPSE portal offers built-in guidance, error detection, and real-time application status tracking, making it the most efficient method.
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Fax Submission:
- Alternatively, you can complete the required documents and fax them to MHCP’s Provider Eligibility and Compliance division.
- Refer to the “Eligible Providers” section to identify the specific forms required for your service type.
Why Use the MPSE Portal?
- Efficiency: Faster processing and reduced errors.
- Guidance: Step-by-step instructions and help tips throughout the application.
- Transparency: Track your application progress and status online.
- Error Reduction: Built-in validation to catch common mistakes before submission.
Application Fees and Electronic Funds Transfer (EFT)
Navigating payment processes is a crucial part of MHCP enrollment. Understanding application fees and setting up Electronic Funds Transfer (EFT) are essential for efficient financial operations.
Application Fees
Certain MHCP provider types are required to pay a nonrefundable application fee during enrollment, re-enrollment, or revalidation.
Key Points:
- Fee Requirement: Check the Application Fees section of the Provider Screening Requirements for fee applicability to your provider type.
- Payment Timing: Fees must be paid before submitting your enrollment application.
Electronic Funds Transfer (EFT)
MHCP strongly encourages all fee-for-service providers to enroll in EFT for direct deposit payments. This modern payment method offers numerous benefits over traditional paper checks.
Advantages of EFT:
- Speed: Faster access to funds.
- Security: Reduced risk of lost or stolen checks.
- Convenience: Simplified cash flow management and less paperwork.
Setting up EFT:
- Supplier ID: You need an active 10-digit supplier ID and a 3-digit supplier location code from Minnesota Management and Budget (MMB).
- Minnesota Supplier Portal: Register as a “New Supplier” on the Minnesota Supplier Portal if you don’t have a supplier ID.
- Banking Information: Add or update your banking details in the Supplier Portal or submit the MMB EFT Bank Change Request form.
- Activation Time: Allow 10 business days for your supplier ID to become active after adding banking information.
- MPSE Portal Integration: Enter your EFT supplier ID and location code in the MPSE portal or submit the EFT Supplier ID Notification form.
Enrollment for Managed Care Organization (MCO) Providers
The landscape of healthcare enrollment is evolving, and federal mandates now require enrollment for providers participating in Managed Care Organization (MCO) networks. This ensures comprehensive oversight across all Medicaid providers.
MCO Enrollment Process:
- Universal Enrollment: Enrollment is required for both fee-for-service and MCO in-network providers.
- Follow Standard Steps: MCO providers should follow the same enrollment steps outlined earlier in this guide, utilizing the MPSE portal.
- MCO Network Participation: Contact the relevant health plan for specific participation and contract details within the MCO network.
- Existing Fee-for-Service Providers: If you are already enrolled as a fee-for-service provider and also contract with an MCO, re-enrollment is not necessary.
Enrollment Approvals and Timelines
Understanding the approval process and timelines helps manage expectations and plan accordingly. MHCP has specific protocols for both Minnesota-based and out-of-state providers.
Minnesota Providers
Minnesota providers may be eligible for retroactive enrollment approvals, depending on various factors.
Effective Date Determination: The effective date of your enrollment can be determined by:
- Your requested effective date in MPSE.
- The first day of the month MHCP receives your application.
- Up to 90 days before your Medicare certification date.
- The date the member’s MHCP eligibility is confirmed.
- The date you meet all MHCP provider requirements.
Screening Processes: Providers requiring additional screening, such as site visits or background checks, will be approved upon completion of these screenings.
Out-of-State Providers
Out-of-state providers can enroll with MHCP for services provided to MHCP members.
Requirements for Out-of-State Enrollment:
- State Compliance: Comply with licensing and certification requirements of your state (or Minnesota’s waiver plan requirements for home and community-based services).
- MPSE Submission: Submit your enrollment request via the MPSE portal with required documentation.
Navigating Changes and Maintaining Active Enrollment
Maintaining up-to-date enrollment information is a continuous responsibility for MHCP providers. The MPSE portal serves as your primary tool for managing and updating your enrollment details.
Changes to Enrollment Information
Providers are responsible for promptly reporting any changes to their enrollment information.
Reporting Methods:
- MPSE Portal (Recommended): Submit change requests directly through the MPSE portal for the most efficient updates.
- Fax Forms: Alternatively, utilize specific forms for different types of changes, such as:
- Individual Practitioner Change Form (DHS-3535)
- Organization Provider Profile Change Form (DHS-3535A)
- Disclosure of Ownership Form (DHS-5259)
- EFT forms for banking changes (MMB forms)
- Provider Entity Sale or Transfer Addendum (DHS-5550) for ownership changes.
Processing Timelines: Allow up to 30 days for processing of change requests, whether submitted via MPSE or fax.
Processing Timelines and Actions
MHCP strives to process complete enrollment requests efficiently.
Standard Processing Time:
- Complete requests are typically processed within 30 days of receipt.
- This timeline applies to new, corrected, and resubmitted requests.
Incomplete Requests:
- Request for More Information (RFMI): If your application is incomplete, MHCP will send an RFMI via MN–ITS mailbox or U.S. mail.
- Response Time: You have 60 days to respond to the initial RFMI, with an additional 30 days for subsequent requests.
- Denial for Incomplete Information: Failure to provide complete information within the allotted time may result in denial of your enrollment request.
Inactive Enrollment Records: If your enrollment record becomes inactive, re-enrollment is required through the MPSE portal or by faxing a new application.
Billing Organizations and Eligible Provider Types
For providers utilizing billing agents and understanding the scope of eligible provider types, MHCP provides clear guidelines.
Billing Organizations
Enrolled MHCP providers can use clearinghouses or billing intermediaries to submit claims electronically.
Enrollment Requirement: Billing organizations must enroll separately as billing organizations with MHCP.
Eligible Providers
MHCP enrollment is open to a wide range of provider types, both organizations and individuals, contingent upon meeting specific certification and licensure requirements.
Provider Categories:
- Organization Providers: Include hospitals, clinics, treatment centers, and various healthcare facilities.
- Individual Providers: Encompass physicians, therapists, nurses, and other healthcare practitioners.
Comprehensive Lists: Refer to the detailed tables in the original article for a complete list of eligible organization and individual provider types and their corresponding provider type numbers.
Conclusion: Leveraging Advanced Systems for MHCP Enrollment
Navigating MHCP enrollment successfully relies on understanding the process, utilizing the right tools, and maintaining diligent compliance. The Minnesota Provider Screening and Enrollment (MPSE) portal represents an advanced system care portal program designed to streamline this process, offering efficiency, guidance, and transparency. By leveraging resources like the MPSE portal and staying informed about requirements and updates, healthcare providers can confidently manage their MHCP enrollment and focus on delivering quality care to Minnesota communities. Embrace these advanced systems to simplify your administrative tasks and ensure seamless participation in Minnesota Health Care Programs.
