If you need help with the medical assistance enrollment process, we’ve got you covered! Here are details on how to go about it. After an individual or a group provider qualifies by meeting professional, certification, and licensure requirements, they can apply to be an enrolled MHCP provider through the Minnesota Provider Screening and Enrollment (MPSE) portal. Alternatively, they can submit the application materials needed for your service(s) by fax.

Medical Assistance Enrollment Process

Federal health care programsYou can follow these steps to apply to be an enrolled MHCP provider.

Check Federal and State Excluded Providers’ Lists

Typically, the federal Health and Human Services Office of Inspector General (OIG) is constitutionally mandated to exclude individuals and entities from participation in Medicare, Medicaid, and other forms of federal health care programs. Moreover, MHCP excludes individuals and institutions from participation in MHCP if they are on either the federal or state excluded provider list.

Meet all Rules and Requirements

Provider types eligible for MHCP enrollment should meet all of the requirements and certifications for the type of service they want to offer before submitting enrollment information to MHCP. To establish what those requirements and are, one can:

  • Review the MHCP Provider Screening Requirements section of the MHCP Provider Manual.
  • Check the appropriate service section listed under Eligible Providers

Get a Provider Identification Number

National Provider Identifiers (NPIs) are the standard unique identifiers commonly used to submit and process health care claims and other crucial transactions. You must obtain your NPI number(s) from the National Plan and Provider Enumeration System (NPPES) before enrolling with MHCP if you are a provider eligible for an NPI.

Notably, the following providers are not required to obtain an NPI. However, one may have the option of using an NPI registered to the provider:

  • Home and community-based services
  • Personal care provider organizations
  • Day training and habilitation

Submitting Enrollment Documents to MHCP

Enrolling with MHCP Medicare providers who wish to enroll with MHCP or make enrollment requests can do so through one of the following two ways.

  • Register to access the Minnesota Provider Screening and Enrollment (MPSE) portal and finish the enrollment online using the MPSE portal 
  • Complete the needed documents and fax the materials to Provider Eligibility and Compliance

Check on the manual section specific to the service(s) you wish to offer to see the MHCP requirements and the forms required if submitting by fax.

Changes to MHCP Enrollment

It is the responsibility of the coverage provider to keep all enrollment information updated. You can report any changes and updated information to your enrollment application by submitting a change request via MPSE or fax the filled forms appropriate to your practice. MHCP sends enrollment status letters to providers, including when changes in provider participation occur.

MHCP Processing Timelines and Actions

After submitting your materials using MPSE or by fax, MHCP processes complete requests within 30 days of receiving the request. Each request, including corrected and resubmitted requests, is deemed a new request and subject to the same processing timelines (30 days) as an initial request.

MHCP Incomplete Requests

Complete requests imply that all required fields are completed and all needed documents have been received. If a new enrollment request is incomplete, MHCP will send you a request for more information (RFMI) letter through your MN–Its mailbox and U.S. mail to tell you the information we still require to process your request. You have 60 days to respond and return the missing information. Note that you can submit the missing information by MPSE or fax.

If we receive part of your information and there happens to be some missing information, we will send an additional RFMI to tell you the information that is still missing and give you an additional 30 days to return the missing information. Note that we will deny the request if information is still missing or incomplete after that.

If enrollment documents submitted are not comprehensive and correct and we requested additional information or corrections, you must allow up to 30 days from the date you sent the most recent paperwork for processing. For more information, contact health insurance today!

References and Resources 

Eligibility to MCHP

Enrolling with MHCP