Revised: February 19, 2025
Navigating the enrollment process for healthcare programs can be complex. This guide provides a detailed overview for providers seeking to enroll in Minnesota Health Care Programs (MHCP). Whether you are new to MHCP or need a refresher, this resource will walk you through each step to ensure a smooth and successful enrollment.
Understanding the Enrollment Process for Minnesota Health Care Programs
The Minnesota Health Care Programs (MHCP) offer essential health coverage to eligible individuals and families in Minnesota. For healthcare providers, enrolling in MHCP is crucial to serving this population and receiving reimbursement for provided services. To assist providers, MHCP conducts quarterly webinars focused on initial enrollment via the Minnesota Provider Screening and Enrollment (MPSE) portal. These sessions offer valuable insights and practical guidance, and registration is available on the MPSE training website.
To become an enrolled MHCP provider, follow these essential steps:
1. Verify Exclusion Status on Federal and State Lists
Before initiating your application to the Minnesota Health Care Program, it is imperative to check both federal and state excluded provider lists. The Office of Inspector General (OIG) within the federal Department of Health and Human Services maintains a list of individuals and entities excluded from participation in federal healthcare programs like Medicare and Medicaid. MHCP adheres to these federal exclusions and also maintains its own state exclusion list.
Minnesota Health Care Programs cannot enroll or compensate providers who, or whose employees or contractors, are on these exclusion lists. Engaging excluded individuals or entities can lead to civil monetary penalties from the OIG.
Regularly checking the List of Excluded Individuals and Entities (LEIE) is a mandatory practice for all current and prospective MHCP providers. Perform LEIE searches by name for all relevant parties:
- Prior to submitting your enrollment application.
- Before onboarding new employees or contractors.
- On a monthly basis to monitor for updates.
Any exclusions discovered should be immediately reported to MHCP Provider Eligibility and Compliance via fax at 651-431-7462.
Further information can be found on the Excluded Provider Lists page within the MHCP Provider Manual.
2. Comply with All Rules and Requirements
Eligibility for enrollment in Minnesota Health Care Programs necessitates meeting specific criteria and certifications based on the type of healthcare services you intend to provide. Prior to submitting your enrollment information to MHCP, ensure full compliance with all applicable requirements.
To determine the specific requirements for your provider type:
- Consult the “Eligible Providers” section on this page for provider-specific licensure and certification needs.
- Review the Provider Screening Requirements page in the MHCP Provider Manual.
3. Obtain a Provider Identification Number
A crucial step in enrolling with the Minnesota Health Care Program is obtaining the correct provider identification number. The National Provider Identifier (NPI) is a unique identifier required for healthcare providers for claims processing and other transactions. Providers eligible for an NPI must obtain it from the National Plan and Provider Enumeration System (NPPES) before applying to MHCP.
For certain provider types who may not be required to obtain an NPI, or are not eligible under HIPAA guidelines, Minnesota Health Care Programs will assign a Unique Minnesota Provider Identifier (UMPI). These provider types can enroll without an NPI, and MHCP will issue a UMPI upon application processing. These include:
- Home and community-based services providers
- Personal care provider organizations
- Day training and habilitation providers
- Early Intensive Developmental and Behavioral Intervention (EIDBI) Level II and III individuals
- Nonemergency medical transportation (NEMT) organizations
- Doula providers (Individual and organizational)
Providers not meeting the HIPAA definition of a health care provider may not be NPI eligible. In such cases, they can still apply for enrollment and will receive a Welcome letter with their assigned 10-digit UMPI.
The following provider types are not eligible for an NPI before enrollment:
- Approved day treatment centers
- Children’s residential services providers
- Clearinghouses and billing intermediaries (Not MCO-only eligible)
- Health care case coordinators
- Individual personal care assistants (PCAs)
- Community health workers
- Women, Infants and Children (WIC) programs
- Head Start programs
- Electronic Data Interchange (EDI) trading partners (Not MCO-only eligible)
- Clearing houses (Not MCO-only eligible)
- Billing intermediaries (Not MCO-only eligible)
- Non-emergency medical transportation (NEMT) drivers
The NPI or UMPI is mandatory for all fee-for-service claims submitted to Minnesota Health Care Programs, ensuring proper payment to providers for services delivered to MHCP members.
4. Submitting Your Enrollment Application to MHCP
Providers seeking enrollment in Minnesota Health Care Programs have two convenient submission options:
-
Online Enrollment via MPSE Portal: Register for access to the Minnesota Provider Screening and Enrollment (MPSE) portal and complete the online application. The MPSE portal offers built-in guidance, error review, and application status tracking, making it the most efficient method.
-
Fax Submission: Complete the required documents and fax them to MHCP’s Provider Eligibility and Compliance division.
To determine the specific documents required for your service type, refer to the relevant service section under Eligible Providers on this page.
Important Note: MHCP does not accept enrollment documents via email. Applications must be submitted through the MPSE portal or by fax.
Application Fees for Minnesota Health Care Programs
Certain provider types enrolling in Minnesota Health Care Programs are required to pay a nonrefundable application fee. This fee is applicable for new enrollments, re-enrollments, and revalidations. Payment must be made prior to submitting the enrollment application. For detailed information on application fee requirements, consult the Application Fees section within the Provider Screening Requirements page of the MHCP Provider Manual.
Electronic Funds Transfer (EFT) for Payments
Minnesota Health Care Programs recommends Electronic Funds Transfer (EFT) or direct deposit as the preferred payment method for all fee-for-service providers. Enrollment in EFT can be initiated during the application process and does not require prior enrollment approval. EFT offers numerous benefits:
- Faster Access to Funds: Eliminates mail delays and bank deposit trips.
- Enhanced Security: Reduces risks associated with lost, stolen, or misdirected checks.
- Simplified Cash Flow Management: Less paperwork and easier reconciliation.
To receive EFT payments from MHCP, providers need an active 10-digit supplier ID and a 3-digit supplier location code from Minnesota Management and Budget (MMB).
To establish a supplier ID for MHCP payments:
- Visit the Minnesota Supplier Portal and register as a “New Supplier” if you do not have an existing supplier ID.
- To update banking information for an existing supplier ID, refer to Update Supplier Profile or submit the MMB EFT Bank Change Request (PDF). For supplier ID inquiries, contact MMB at 651-201-8106.
- Allow 10 business days for your supplier ID to become active after adding banking details. Subsequently, enter your EFT supplier ID and location code in the MPSE portal (instructions in the MPSE user manual for Enrollment Record Information) or fax a completed EFT Supplier ID Notification (DHS-3725) (PDF) to Provider Eligibility and Compliance at 651-431-7462.
Enrollment for Managed Care Organization (MCO) Providers
Federal mandates (21st Century Cures Act) require state agencies like DHS to enroll all Medicaid providers, including those participating in both fee-for-service and Managed Care Organization (MCO) networks. Enrollment for MCO in-network only providers began on July 17, 2023. The Enrollment Process section outlines the steps for MCO provider enrollment.
For further details, refer to Enrollment process for MCO network providers and the Eligible Providers section for a list of enrollable provider types and their specific requirements within Minnesota Health Care Programs.
Existing fee-for-service providers already contracted with an MCO are exempt from re-enrollment.
Providers interested in joining an MHCP managed care organization’s network should also contact the relevant health plan for participation and contract information. Additional information is available on the MCOs page in the MHCP Provider Manual.
MCO in-network provider enrollment instructions are available on the MCO In-Network Provider Enrollment page of the MPSE User Manual.
Enrollment Approvals for Minnesota Providers
Minnesota-Based Providers
Minnesota Health Care Programs may grant retroactive enrollment approvals to Minnesota-based providers. If enrollment requirements are met, the effective enrollment date will be determined using one of the following criteria:
- The provider’s requested effective date in MPSE or the application.
- The first day of the month when the enrollment request is received.
- Up to 90 days prior to the Medicare certification effective date.
- The retroactive date of member’s MHCP eligibility confirmation.
- The date of confirmation that the provider meets all MHCP requirements.
Providers requiring additional screening, such as site visits and background checks (listed as moderate or high-risk on the Risk Levels section of the Provider Screening Requirements page), will be approved upon completion of these screenings.
Out-of-State Providers
Out-of-state providers can apply for Minnesota Health Care Program enrollment for specific dates of service to MHCP members. Payment eligibility for out-of-state providers requires:
- Compliance with licensing and certification standards of their state, except for home and community-based waiver service providers who must meet Minnesota’s waiver plan requirements.
- Submission of an enrollment request via the MPSE portal with a copy of the Provider Agreement, assurance statements, credentials, or faxing required documents to Provider Eligibility and Compliance.
Refer to Billing Policy Overview and Out-of-State Providers sections in the MHCP Provider Manual for additional requirements.
Consolidated Providers within MHCP
A consolidated provider in Minnesota Health Care Programs is defined as one with multiple enrollment records under a single National Provider Identifier (NPI). While providers may offer diverse services, not all can be billed under a single enrollment record. Multiple records may be necessary based on service types. Provider Eligibility and Compliance reviews providers with multiple active credentials to determine if record consolidation is needed.
Taxonomy Codes in MHCP (not applicable to MCO in-network only providers): A taxonomy code classifies the provider type, specialization, and classification. Codes and descriptions are available on the X12 External Codes List.
When a provider uses one NPI for billing across multiple records (due to locations or service types), MHCP consolidates these under provider type (PT) 33, while maintaining the linked active records.
- If records under one NPI share a physical address or zip code, taxonomy codes for each record are required post-enrollment and MN–ITS registration. Custom taxonomy codes are permissible for records with identical codes. MHCP uses these for billing purposes only.
- Taxonomy or custom codes must be submitted via MN–ITS. A tutorial is available: Adding Taxonomy Codes video.
- For NPIs representing records with unique physical addresses, the service facility location must be submitted on claims.
MN–ITS Registration for Fee-for-Service Providers
MN–ITS is a free, HIPAA-compliant, web-based system required for all Minnesota Health Care Programs fee-for-service providers. Upon application approval, Provider Eligibility and Compliance sends a Welcome letter with initial MN–ITS User ID and Password. Fax enrollees must register for MN–ITS using registration instructions. MPSE enrollees can use the login details in their Welcome letter.
Minnesota law mandates electronic claim submission for MHCP reimbursement. All providers and billing services must register for MN–ITS as paper claims are not processed.
MN–ITS allows registered users to:
- Verify program eligibility for MHCP members.
- Retrieve enrollment letters and notices.
- Submit authorization requests for services or supplies.
- Submit service agreement (SA) requests for home care.
- Retrieve authorization and service agreement letters and other items via the MN–ITS Mailbox.
- Submit claims, including those with third-party insurance or Medicare.
- Copy previous claims or replace incorrect paid claims.
- Check claim status.
- Access MPSE for enrollment record management.
MN-ITS Registration for MCO In-Network Only Providers
MN–ITS is also mandatory for MCO in-network only providers within Minnesota Health Care Programs. Upon MHCP approval, a Welcome letter with MN–ITS login credentials and registration instructions is sent. MCO providers use MN–ITS to access the MPSE portal for managing enrollment information and retrieving enrollment-related notices.
Managing Changes to Your MHCP Enrollment
Providers are responsible for maintaining up-to-date enrollment information with Minnesota Health Care Programs. The most efficient way to report changes is through MPSE. MHCP offers quarterly webinars on managing enrollment changes via MPSE, with registration details on the MPSE Training site.
Alternatively, providers can fax forms relevant to their practice:
- Individual Practitioner MHCP Provider Profile Change Form (DHS-3535) (PDF): For individual enrollment changes or affiliation updates.
- Organization MHCP Provider Profile Change Form (DHS-3535A) (PDF): For organizational contact or enrollment changes.
- Disclosure of Ownership and Control Interest of an Entity (DHS-5259) (PDF): For changes in management, board, or ownership.
- Electronic Remittance Advice (RA) Request Form (DHS-4087) (PDF) (not for MCO-only providers): To manage electronic RA on MN–ITS. See remittance advice page.
- EFT bank change form (PDF): For direct deposit changes (submitted to MMB).
- EFT Supplier ID Notification (DHS-3725) (PDF) (not for MCO-only providers): For MMB-issued EFT Vendor Number or Location Code changes.
- Provider Entity Sale or Transfer Addendum (DHS-5550) (PDF): For ownership changes due to sale or transfer. Submit with new enrollment documents 30 days prior to sale to avoid billing interruptions. Note: Credentialing is required, and processing time is similar to new enrollments. Ownership changes may lead to payment reversals for terminated providers.
Provider Eligibility and Compliance will process change requests and contact providers if further documentation is needed. Enrollment status letters are sent to providers for participation changes.
Processing Timelines and Actions for MHCP Enrollment
Provider Eligibility and Compliance processes complete Minnesota Health Care Programs enrollment requests within 30 days of receipt, regardless of submission method (MPSE or fax). This 30-day timeline applies to new, corrected, and resubmitted requests.
Complete Requests
A complete request includes all required fields and documents. MPSE users can refer to the Request Submitted and Next Steps section of the user manual for status updates and outcomes.
For incomplete new enrollment requests, Provider Eligibility and Compliance issues a request for more information (RFMI) via MN–ITS mailbox or U.S. mail. Providers have 60 days to respond using the original application method (MPSE or fax – methods should not be mixed). Partial submissions may result in a further 30-day RFMI. Non-response will lead to request denial.
If enrollment documents are incomplete or incorrect, processing may take up to 30 days from the most recent submission date after corrections or additional information is provided.
Inactive Enrollment Records
Inactive enrollment records require providers to re-enroll with Minnesota Health Care Programs via the MPSE portal or by faxing a new application to Provider Eligibility and Compliance.
Billing Organizations for MHCP Claims
Minnesota Health Care Programs enrolled providers can utilize clearinghouses or billing intermediaries as billing agents for electronic claim submissions and transactions.
Clearinghouses and billing intermediaries submitting claims for enrolled providers must enroll as a billing organization with MHCP.
Eligible Providers for Minnesota Health Care Programs
Providers participating in Minnesota Health Care Programs must meet professional certification and licensure requirements as per state and federal regulations for their service type. Upon meeting these requirements, providers can apply for MHCP enrollment via the Minnesota Provider Screening and Enrollment (MPSE) portal or by faxing the required application materials.
Contact your contracted Managed Care Organizations (MCOs) for their specific enrollment requirements.
Fee-for-service providers marked with ¹ do not receive direct payment and must bill through an organization. Providers marked with ² are not eligible for MCO-only enrollment.
The following tables list eligible provider types for MHCP enrollment:
| ### Organization Providers | ### Individual Providers |
|---|---|
| Adult Day Treatment – 46 | Acupuncturist – AP |
| Allied Oral HealthProfessional Group – 31 | Alcohol and Drug Counselor – DC |
| Ambulatory Surgical Center – 22 | Allied Oral HealthProfessional– 31 |
| Birthing Center – B1 (Contact the MHCP Provider Resource Center for enrollment information) | Audiologist – 43 |
| Certified Registered Nurse Anesthetist Organization – 67 | Certified Mental Health Rehabilitation Professional¹- 26 |
| Child and Teen Checkup Clinic – 16 | Certified Nurse Midwife – 66 |
| Children’s Residential Treatment Facility¹- 06 | Certified Professional Midwife – C1 |
| Community First Services and Supports (CFSS) – CFSS | Certified Registered Nurse Anesthetist – 67 |
| Community Health Clinic – 58 | Chiropractor – 37 |
| Community Mental Health Center – 10 | Clinical Nurse Specialist – 68 |
| County Case Manager²- 23 | Community Health Worker¹ – 55 |
| County Human Services Agency² – 45 | Dentist – 30 |
| Day Training and Habilitation for ICF/DD– 19 | Direct Support Worker, Individual¹, ² – 38 |
| Dental Group – 30 | Doula – DA |
| Doula Entity – DA | Early Intensive Developmental and Behavioral Intervention² – EI |
| Durable Medical Equipment – 76 | Health Care Case Coordinator – 27 |
| Early Intensive Developmental and Behavioral Intervention² – EI | Hearing Aid Dispenser – 77 |
| Electronic Data Interchange (EDI) Trading Partner² – 28, 95, 98 | Home Care Nurse – 64 |
| Family Planning Agency – 54 | Licensed Independent Clinical Social Worker – 14 |
| Federally Qualified Health Center – 52 | Licensed Marriage and Family Therapist – 25 |
| Home and Community-Based Services (HCBS) – 18 | Licensed Professional Clinical Counselor- 63 |
| Moving Home Minnesota – 18 | Licensed Psychologist – 42 |
| Housing Stabilization Services – 18-HSS | Nurse Practitioner – 65 |
| Housing Support Supplemental Services – 18 | Occupational Therapist – 29 |
| Home Care Nursing Agency Group – 64 | Optometrist – 35 |
| Home Health – 60 | Pharmacist¹ – 70 |
| Hospice – 02 | Physical Therapist – 39 |
| Hospital – 01 | Physician – 20 |
| Independent Diagnostic Testing Facility – 32 | Physician Assistant – 69 |
| Independent Laboratory – 80 | Podiatrist – 36 |
| Independent X-ray – 81 | Registered Dietician or Licensed Nutritionist – 15 |
| Indian Health Services – 51 | Speech-Language Pathologist – 40 |
| Individualized Education Program – 09 | Transportation Driver¹ – DR |
| Institution for Mental Disease¹ – 03 | |
| Intensive Residential Treatment Services – 50 | |
| Intermediate Care Facilities – 05 | |
| Medical Services Group – 49 | |
| Medical Transportation – 82 | |
| Mental Health Group – 34 | |
| Non-Profit Dental Organization | |
| Nursing Facility – 00 | |
| Optical Company – 75 | |
| Personal Care Provider Organization² – 38 | |
| Pharmacy¹ – 70 | |
| Psychiatric Residential Treatment Facility – PR | |
| Physician Clinic – 20 | |
| Public Health Clinic – 57 | |
| Public Health Nursing Organization – 61 | |
| Recovery Community Organization – RC | |
| Recuperative Care Services – RE | |
| Regional Treatment Center – 17 | |
| Rehabilitation Agency – 11 | |
| Rehabilitation Group – 48 | |
| Renal Dialysis Center – 04 | |
| Rural Health Clinic – 53 | |
| Substance Use Disorder – 62 | |
| Targeted Case Management – 44 or 18 | |
| Transportation Coordinator² – 72 (Contact the MHCP Provider Resource Center for enrollment information) |
