This online MHCP Provider Manual is your primary information source for MHCP coverage policies, rates and billing procedures and is updated on an ongoing basis. MHCP may not receive notification that a member is incarcerated until after the person’s eligibility was determined. Be sure to enter the UMPI number assigned to you Refer also to HCBS Waiver Services section of the MHCP Provider Manual for additional provider information about waiver and AC programs. Institution for Mental Disease (IMD) Revised: March 3, 2020 Removed American Dental Association (ADA) Request for Authorization Claim Form Instructions under Dental Services. Review the SMRT web page for information about the determination process, how SMRT coordinates services between the applicant and providers, and how providers are able to receive payment for services that SMRT requests for the disability determination. The information provided in this FAQ related to eligibility of additional benefits or services or waiving of copays is specific to Minnesota Health Care Programs (MHCP), including: Blue Advantage Families and Children (F&C), MinnesotaCare (MNCare), SecureBlue (MSHO), and Minnesota Senior Care Plus (MSC+). ), • Appropriate and effective for the medical needs of the of the patient, • Able to meet quality and timeliness standards, • Able to represent an effective and appropriate use of program funds, • Able to meet specific limits outlined in rules adopted by DHS and explained in the service-specific, • Personally rendered by a provider, except as specifically authorized in the MHCP Provider Manual. MinnesotaCare Covered Services. DHS has reprocessed claims that were already submitted and denied due to Minnesota’s Medicaid program with more than a million Minnesotans eligible, most enrolled in managed care organizations (MCOs). St Paul MN 55164-0838 Updates cited below do not include minor grammatical or formatting changes that otherwise do not have bearing on the meaning of the policy contained herein. MinnesotaCare Use this directory to find health care providers that serve fee-for-service MHCP members. Program (MHCP) dental providers dipped to 38.5 percent during 2002, the first … are enrolled in the Medical Assistance (MA) program, monthly averages of ….. 6 American Academy of Pediatric Dentistry Reference Manual, 07-08:29(7): 22-23. COVID -19 vaccine billing instructions can be found under Billing in the Coronavirus (COVID-19) section of the MHCP Provider Manual. Medicare Savings Program that covers Medicare Part B premiums. Minnesota Statute 256B.03, subd. Medicare Savings Program that covers Medicare Part A & B copays, coinsurance, premiums and deductibles only. The online MHCP Provider Manual is your primary information source for MHCP coverage policies, rates and billing procedures and is updated on an ongoing basis.. HCBS Waiver Services. • City, county, state and federal correctional and detention facilities for adults, including, inmates who are: • In a work release program that requires they return to the facility during non-work hours, • Admitted to an acute care medical hospital for medical treatment or to give birth, but required to return to the facility when treatment or convalescence is completed, • Sent by the court or penal institution to a chemical dependency residential treatment program while serving a sentence and are required to return to the correctional facility after completing treatment, • Secure juvenile facilities licensed by the Department of Corrections (DOC) that are for holding, evaluation, and detention purposes, • State-owned and operated juvenile correctional facility, • Publicly owned and operated juvenile residential treatment and group foster care facilities licensed by the DOC with more than 25 non-secure beds, • The information on the form is incorrect, • The spenddown is not applied to claims appropriately, • The provider stops rendering services to the named recipient, • The provider no longer renders services that equal or exceed the spenddown amount reported on the monthly designated provider notice, • The provider continues to receive the designated provider notices after it has stopped providing services, • MHCP ID numbers do not change, regardless of changes in program, eligibility or address, • MHCP ID cards do not include eligibility information. Alternative Care Program In those cases, MHCP will retroactively close out the member’s eligibility and recoup any reimbursements made to the provider for services performed during the member’s dates of incarceration. To make HPE determinations, a hospital must be an enrolled MHCP provider and agree to comply with the DHS HPE policy and procedures. See Qualified Medicare Beneficiary (QMB) (DHS-2087e) (PDF). In general, adults who are incarcerated in detention or correctional facilities are not eligible for MHCP. Minnesota Statute 256B.0625 Covered Services Contact MinnesotaCare at: MinnesotaCare Each member approved for MHCP is assigned an 8-digit member number that is printed on his or her ID card. The requirements for authorization are different for each of the three se rvice types. For MA applicants who indicate they may have a disability, the State Medical Review Team (SMRT) determines if they meet the criteria for disability status. 42 CFR 456 MA Utilization Control, © 2021 Minnesota Department of Human Services, Minnesota Provider Screening and Enrollment Manual (MPSE), Certified Community Behavioral Health Clinic (CCBHC), Community Emergency Medical Technician (CEMT) Services, Allied Oral Health Professional (Overview), Early Intensive Development and Behavioral Intervention (EIDBI), Inpatient Hospitalization for Detoxification Guidelines, Lab/Pathology, Radiology & Diagnostic Services, Adult Residential Crisis Stabilization Services (RCS), Clinical Supervision of Outpatient Mental Health Services, Health Behavioral Assessment/Intervention, Physician Consultation, Evaluation and Management, Psychiatric Consultations to Primary Care Providers, Psychiatric Residential Treatment Facility (PRTF), Moving Home Minnesota (MHM) Provider Enrollment, MHM Supported Employment Services (MHM SES), Breast and Cervical Cancer (BRCA) Genetic Testing and Presumptive Eligibility Services, Access Services Ancillary to Transportation, Local County or Tribal Agency Administered NEMT, Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information, State-Administered Transportation Procedure Codes, Modifiers and Payment Rates, Tribal and Federal Indian Health Services, Minnesota Restricted Recipient Program (MRRP), Minnesota Children with Special Health Needs (MCSHN) Program, Community Access for Disability Inclusion (CADI). 14 Persons detained by law Providers who are owed spenddown amounts see group and reason code PR142 on their remittance advices with a dollar amount that indicates the member’s spenddown amount. CTSS establishes policies and practices for certification and coverage of mental health services for children who require varying therapeutic and … This section outlines eligibility and coverage for these programs. Refer to the policy and procedures shown here for changes that have been made to the Medical Assistance and MinnesotaCare programs in relation to COVID-19. Contact the appropriate county jail or correctional facility about how to bill for the services that were provided. Coronavirus (COVID-19) Minnesota Health Care Programs (MHCP) Provider Manual section posted . IMCare Provider Manual Chapter 21 – Transportation Services – Revised 02/16/2016 1 Chapter 21 Transportation Services Transportation is a covered service if provided as follows: 1. The remaining nine digits are your legacy Provider #. To and/or from the site of a IMCare-covered medical service 2. Consult the appropriate section(s) of this manual for more specific information about other noncovered services. Adult Prophylaxis Criteria (PDF) • Advanced Dental Therapist (ADT) • Allied Dental Health Professional (Overview) • Authorization Requirement Tables for Children and Pregnant Women • Authorization Requirement Tables for Non Pregnant Adults • Collaborative Practice Dental Hygienists (was Limited Authorization Dental Hygienists) The current public health emergency declared by Governor Walz necessitates the temporary modifications listed in this manual section. Program SL reimburses a person’s Medicare premium and does not include coverage for health care services. Minnesota Rules 9505.0170 to 9505.0475 Health Care Programs, Medical Assistance Payments State and federally funded program for people age 21 years and older. Staff from this program are available to help families of children with special health care needs throughout Minnesota to identify services and supports (including financial support) that might be available. MHCP member eligibility is generally approved on a monthly basis. Minnesota Rules 9505.0010 to 9505.0140 Health Care Programs, Medical Assistance Eligibility Refer to the Dental Services Overview for Minnesota Health Care Programs (MHCP) Eligible Providers and Eligible Recipients.. A person who is approved for HPE is eligible to receive full MA benefits under the adults and families with children benefit set. Member Evidence of Coverage (EOC) Latest revisions to this Manual, Certified Community Behavioral Health Clinic (CCBHC) Federal Demonstration Project, Community Emergency Medical Technician (CEMT) Services, Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit, Lab/Pathology, Radiology & Diagnostic Services, Relocation Service Coordination—Targeted Case Management (RSC—TCM), Tribal and Federal Indian Health Services, © 2021 Minnesota Department of Human Services, Minnesota Provider Screening and Enrollment Manual (MPSE), Certified Community Behavioral Health Clinic (CCBHC), Allied Oral Health Professional (Overview), Early Intensive Development and Behavioral Intervention (EIDBI), Inpatient Hospitalization for Detoxification Guidelines, Lab/Pathology, Radiology & Diagnostic Services, Adult Residential Crisis Stabilization Services (RCS), Clinical Supervision of Outpatient Mental Health Services, Health Behavioral Assessment/Intervention, Physician Consultation, Evaluation and Management, Psychiatric Consultations to Primary Care Providers, Psychiatric Residential Treatment Facility (PRTF), Moving Home Minnesota (MHM) Provider Enrollment, MHM Supported Employment Services (MHM SES), Breast and Cervical Cancer (BRCA) Genetic Testing and Presumptive Eligibility Services, Access Services Ancillary to Transportation, Local County or Tribal Agency Administered NEMT, Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information, State-Administered Transportation Procedure Codes, Modifiers and Payment Rates, Provider Participation Requirements - Rule 101, Risk Levels and Enrollment Verification Requirements, Program HH Dental Authorization Requirement Chart, Supplemental Payments – Non-Hospital and Hospital, C&TC Health Insurance Portability and Accountability Act (HIPAA) Referral Coding Information, Federally Qualified Health Center and Rural Health Clinics, FQHC and RHC Global Encounters for MCO Enrollees – Examples, Allied Dental Health Professional (Overview), Authorization Requirement Tables for Children and Pregnant Women, Authorization Requirement Tables for Non Pregnant Adults, Dental Benefits for Children and Pregnant Women, Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit Billing Grid (PDF), EIDBI) Managed Care Organization (MCO) Contact Information Grid (PDF), Specialized Supplies & Equipment Authorization & Billing Responsibilities, Nutritional Products and Related Supplies, Oxygen Contract Regions and Price Schedule (PDF), Positive Airway Pressure for Treatment of Obstructive Sleep Apnea, Billing for Waiver and Alternative Care (AC) Program, Void (“Take-Back”) Waiver and Alternative Care (AC) Service Claims, Hospital In-reach Service Coordination (IRSC), Authorization Criteria: Cardiac Magnetic Resonance Imaging of the Coronary Arteries, Coverage Criteria: Computed Tomography Colonography, Adult Mental Health Targeted Case Management (AMH-TCM), Adult Rehabilitative Mental Health Services (ARMHS), Residential Crisis Stabilization Services (RCS), Children’s Mental Health Clinical Care Consultation, Children’s Mental Health Residential Treatment, Children’s Therapeutic Services and Supports (CTSS), Diagnostic Assessment (DA) Report Components, Dialectical Behavior Therapy Intensive Outpatient Program (DBT IOP), General MHCP Non-Enrollable Mental Health Provider Requirements, Health and Behavioral Assessment/Intervention, Intensive Residential Treatment Services (IRTS), Mental Health Certified Family Peer Specialist, MHCP Professional Certification & Enrollment Requirements, Physician Consultation, Evaluation and Management, Telemedicine Delivery of Mental Health Services, Youth Assertive Community Treatment (Youth ACT), Moving Home Minnesota Demonstration and Supplemental Services Table (PDF), Moving Home Minnesota Supported Employment Services (MHM SES), Minnesota Covered Active Pharmaceutical Ingredient (API) and Excipient List, Point of Sale Diabetic Testing Supply Program, Rehabilitative and Therapeutic Services Authorization Criteria, Family Planning Codes with Increased Rates, ICD-9 to ICD-10 Diagnosis Conversion Table, MFPP Contraceptive and Medication Supplies Table, Minnesota Family Planning Program (MFPP) Procedure Codes, Nonemergency Medical Transportation (NEMT) Services (Overview), Ancillary Services Claim and Rate Information for Counties and Tribes, Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Transportation Services. Minnesota Statute 256B.02 Definitions Minnesota Family Planning Program (MFPP) A qualified HPE hospital must help people it approves for HPE complete and submit the full MA application. 651-297-3862 or 800-657-3672. Once identified, these people are placed under the care of a designated primary care physician or other providers who coordinate their care for a 24-month period. Hospitals must sign and submit the Hospital Presumptive Eligibility Applicant Assurance Statement (DHS-3887) (PDF). It will include a list of temporary modifications to policies and procedures that have been made to Medical Assistance and MinnesotaCare programs. Waiver services are programs that have received federal approval for expanded coverage to MHCP members of services not usually covered by MA. MHCP will deny claims if the referral is not received within 90 days of the referred-to provider’s date of service. People pending a long-term care assessment are listed as unknown until the assessment has been completed. The Minnesota Department of Human Services (DHS) ensures basic health care coverage for low-income Minnesotans through Minnesota Health Care Programs (MHCP). You must follow the MHCP copay policy found in the MHCP Provider Manual; see Copays and Family Deductible in Billing the Recipient under Billing Policy. Provider Manual UPDATED APRIL 30, 2018 Your guide to providing service to UCare Members . MinnesotaCare State-funded program for children under age 21. Unless expressly listed, all other program requirements continue to apply.All provisions shown here are time limited. MHCP will cover the person’s Medicare coinsurance and deductible based on QM coverage. Hospitals can provide direct assistance to complete the application, or help people connect with a navigator organization or certified application counselor. Minnesota Statute 256L MinnesotaCare It allows participating hospitals to determine eligibility for temporary Medical Assistance (MA) using preliminary information from applicants. See Service Limited Medicare Beneficiaries (DHS-2087G) (PDF). Refer to the manual section for each type of service listed in the following links to be aware of all of the MHCP requirements for that provider type. Members in programs MA, IM or EH may be eligible with a spenddown or waiver obligation. Eligibility; Enrollment; Billing/MNITS System; Training requirements Children born to mothers covered by MA during the month of birth are given automatic MA newborn coverage. Staff is also available to problem-solve with providers and county workers who are trying to locate resources for families. HIV/AIDS NM also covers a small number of adults age 21 and over who are not covered by CHIP. • Health services for any of the following: • For which a physician’s order is required but not obtained, • Not documented in the member’s health or medical record, • Not in the member’s plan of care, individual treatment plan, IEP, or individual service plan, • Not provided directly to the member unless the service is identified as a covered service in MHCP Provider Manual, • Of a lower standard of quality than the prevailing community standard of the provider’s professional peers (providers of services that are determined to be of low quality must bear the cost of these services), • Other than an emergency health service, provided to a member in a long-term care facility that are not in the member’s plan of care and have not been ordered, in writing, by a physician when an order is required, • Other than emergency health services, provided without the full knowledge and consent of the member or the member’s legal guardian, • Paid for directly by the member or other source, except when the member made the payment for services incurred during the member’s retroactive eligibility period. The manual is designed to serve as a reference tool for providers and facilities. Provider Manual Table of Contents. We are pleased to make MHN's Practitioner Manuals available to you online. Providers who choose to participate in MHCP must meet professional, certification and licensure requirements according to applicable state and federal laws and regulations specific to the service(s) you wish to provide. Emergency Medical Assistance For help, call 651-215-8956 or 800-728-5420. This will eliminate the need for providers to submit paper enrollment requests. Scheduled Maintenance Downtime from 6 Mar 2021 10pm to 7 Mar 2021 7am Please note that there is a scheduled maintenance downtime from 6 Mar 2021 10pm to 7 Mar 2021 7am. Also contact the managed care organization with which you contract for their enrollment requirements. It will include a list of temporary modifications to policies and procedures that have been made to Medical Assistance and MinnesotaCare programs. A hospital qualified to determine eligibility for HPE must comply with all policies and procedures and meet the HPE performance metrics established. If these children continue to live in Minnesota (regardless with whom), the automatic MA eligibility continues through the last day of the month in which the child turns one year of age. Some people who have more income than the MA income limit allows may become eligible by spending down to the income limit. However, because the person also has MA coverage, MHCP will cover services that are not covered by QM, but are covered by MA. Use the MN–ITS Interactive Eligibility Request (PDF) or 270 transaction to determine eligibility and determine when the recipient’s last pair of MHCP eyeglasses was dispensed. For example, a person has QM and MA coverage. Provider Resource Manual. Revised: 02-11-2016. Limited program for specified benefits that do not require MA basis of eligibility. A state-funded cost-sharing program that provides home and community-based services to prevent and delay transitions to nursing facility level of care for eligible Minnesotans age 65 and over. MN–ITS home page; MN–ITS functions and general information in the MN–ITS User Manual; Submitting claims through MN–ITS When mentioned, MinnesotaCare is the program for Minnesota residents without access to affordable health care coverage. MHCP-enrolled providers who are not health care providers under the federal definition were issued a 10-character ID that begins with either alpha character “A” or “M”. These programs include: Refer also to HCBS Waiver Services section of the MHCP Provider Manual for additional provider information about waiver and AC programs. 4 Prohibition on payments to providers outside of the United States Unless listed in this manual section, all other program requirements continue to apply. 42 CFR 435 MA Eligibility There is no coverage for services or Medicare copays and deductibles. The manuals contains important information about MHN's policies and procedures, as well as instructions and guidelines about authorizations, claims, care management and the MHN departments you will interact with as … State and federally funded program that provides only pre-pregnancy family planning and related health care services for people of any age. MHCP members, regardless of age, are ineligible for coverage while they reside in the following correctional facilities: Children who are placed by a juvenile court in certain juvenile programs may be eligible depending on the type of facility. Minnesota Rules 9505.2160 to 9505.2245 Health Care Programs, Surveillance and Integrity Review Program All MHCP covered services must be medically necessary, appropriate, and the most cost-effective for the medical needs of the MHCP member. Provider manual. See Billing the Recipient. MVP’s Provider Resource Manual (PRM) includes revisions on operational procedures, plan type offerings, and clinical programs. Minnesota Statues 256B.055, subd. The HPP Provider Manual reflects current policies, procedures and applicable changes to our Medicaid (Health Partners), CHIP (KidzPartners), and Health Partners Medicare product lines, and is considered an extension of your participating provider agreement. We have posted a new . Minnesota Statute 256B.055 to 26B.061 MA; Eligibility categories & requirements The MRRP office may require documentation of the emergency situation to determine payment of the claim. Provider types marked with an a… Members of an eligible household receive their own ID cards, and may have different versions of the card, depending on when they became eligible. Group Residential Housing (GRH) Supplemental Services. Welcome to the Minnesota Health Care Programs (MHCP) Provider Directory. A current list of all MHCP covered codes can be found using the MHCP Fee Schedule. MN–ITS. For these people, MHCP will pay services at the highest level of coverage. This allows MHCP to process the referred-to provider’s claim. manual section of the MHCP Provider Manual. Overview . Refugee Medical Assistance State-funded and federally funded emergency assistance for some people with a medical emergency; includes only services provided in an emergency department or inpatient hospital when the admission is the result of an emergency admission and some limited services under a certified care plan. MHCP may collect any overpayments if the provider does not take appropriate steps. MHCP Provider Manual Latest Manual Revisions. Refer to the Inpatient Hospital Services section for more information. The Hospital Presumptive Eligibility (HPE) program was established by the Affordable Care Act. Federally funded MA program available for the first eight months after a refugee arrives in the United States; covered services are the same as MA.
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