Provider_Manual_TOC_DHS16_157386



Provider Manual Table of Contents

Revised: March 2, 2022

Added Allergen-Reducing Products for Children under Equipment and Supplies.

|Member Evidence of Coverage (EOC) |

|Latest revisions to this Manual |

|Coronavirus (COVID-19) |

|Provider Basics |

|Provider Requirements |

|Access Services |

|Billing Organizations/Responsibilities |

|Enroll with MHCP |

|Excluded Provider Lists |

|Provider Participation Requirements - Rule 101 |

|Provider Screening Requirements |

|Risk Levels and Enrollment Verification Requirements |

|Health Care Programs and Services |

|Emergency Medical Assistance (EMA) |

|EMA Sample Scenarios |

|End Stage Renal Disease (ESRD) |

|Kidney Transplant Services |

|MHCP Benefits at-a-glance |

|Program HH (HIV/AIDS) Covered Services |

|Program HH Dental Authorization Requirement Chart |

|Managed Care Organizations (MCOs) |

|Billing Policy (Overview) |

|Billing the Member (Recipient) |

|Medicare and Other Insurance |

|Minnesota-defined U Modifiers |

|Out of State Providers |

|Paper Claim Submission Policies |

|Payment Methodology - Hospital |

|Payment Methodology - Non-Hospital |

|Supplemental Payments – Non-Hospital and Hospital |

|Authorization |

|Drug Authorizations |

|MHCP Pharmacy Quick Reference |

|Acupuncture Services |

|Ambulatory Surgical Services |

|Anesthesia Services |

|Behavioral Health Home Services |

|Certified Community Behavioral Health Clinic (CCBHC) |

|Child and Teen Checkups (C&TC) |

|Abbreviations and Acronyms |

|C&TC Health Insurance Portability and Accountability Act (HIPAA) Referral Coding Information |

|Helpful Website Links |

|Chiropractic Services |

|Clinic Services |

|Federally Qualified Health Center and Rural Health Clinics |

|FQHC and RHC Global Encounters for MCO Enrollees – Examples |

|Community Emergency Medical Technician (CEMT) Services |

|Community Health Worker |

|Community Paramedic Services |

|CW-TCM |

|Day Training & Habilitation (DT&H) |

|Dental Services |

|Adult Prophylaxis Criteria (PDF) |

|Advanced Dental Therapist (ADT) |

|Allied Oral 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) |

|Critical Access Dental Payment Program |

|Dental Benefits for Children and Pregnant Women |

|Dental Benefits for Non-Pregnant Adults |

|Dental Therapist (DT) |

|Non-Dental Health Providers |

|Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit |

|Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit Billing Grid (PDF) |

|EIDBI) Managed Care Organization (MCO) Contact Information Grid (PDF) |

|Elderly Waiver and Alternative Care Program (EW and AC) |

|Specialized Supplies & Equipment Authorization & Billing Responsibilities |

|Equipment and Supplies |Equipment and Supplies (continued) |

|Airway Clearance Devices |Orthopedic and Therapeutic Footwear |

|Allergen-Reducing Products for Children |Orthotics |

|Ambulatory Assist Equipment |Oximeters |

|Apnea Monitors |Oxygen Contract Regions and Price Schedule (PDF) |

|Bath and Toilet Equipment |Oxygen Equipment |

|Bone Growth Stimulators |Patient Lifts and Seat Lift Mechanisms |

|Diabetic Equipment and Supplies |Pneumatic Compression Devices |

|Electrical Stimulation Devices |Positioning Equipment |

|External Defibrillators |Positive Airway Pressure for Treatment of Obstructive Sleep Apnea |

|Gloves |Pressure Reducing Support Surfaces |

|Hospital Beds |Respiratory Equipment |

|Humanitarian Use Devices |Seasonal Affective Disorder (SAD) Lights |

|Incontinence Products |Specialized Wound Treatment Technology |

|Lower Limb Prosthetics |Spirometers |

|Mobility Devices |Standers |

|Nebulizers |Transcutaneous Electrical Nerve Stimulator (TENS) |

|Non-Mobility Equipment Repairs |Transfer and Mobility Device (TRAM) |

|Nutritional Products and Related Supplies |Ultraviolet Light Therapy Systems |

| |Urological and Bowel Supplies |

|Essential Community Supports (ECS) |

|HCBS Waiver Services |

|Billing for Waiver and Alternative Care (AC) Program |

|Training Requirements |

|Void (“Take-Back”) Waiver and Alternative Care (AC) Service Claims |

|Health Care Homes (HCH) |

|Hearing Aid Services |

|Cochlear Implants |

|Hearing Aid Services Codes Table |

|Health Care Homes (HCH) |

|Home Care Services |

|Home Care Nursing (HCN) Services |

|Home Health Aide Services |

|Rehabilitation Therapy Services |

|Skilled Nurse Visits (SNV) Services |

|Hospice Services |

|Hospital Services |

|Critical Access Hospital (CAH) Services |

|Hospital In-reach Service Coordination (IRSC) |

|Inpatient Hospital Authorization |

|Inpatient Hospitalization for Detoxification Guidelines |

|Inpatient Hospital Services |

|Outpatient Hospital Services |

|Housing Stabilization Services |

|Housing Support Supplemental Services |

|Immunizations & Vaccinations |

|Immunization and Vaccine Benefits Codes for Children |

|Immunization and Vaccine Benefits Codes for Adults |

|Individualized Education Program (IEP) Services |

|Inpatient Hospital Authorization |

|Intermediate Care Facilities (ICF/DDs) |

|Lab/Pathology, Radiology & Diagnostic Services |

|Authorization Criteria: Cardiac Magnetic Resonance Imaging of the Coronary Arteries |

|Coverage Criteria: Computed Tomography Colonography |

|Laboratory/Pathology Services |

|Laboratory Authorization Code List |

|Radiology/Diagnostic Services |

|Medication Management Therapy Services |

|Mental Health Services |

|Adult Crisis Response Services |

|Adult Day Treatment |

|Adult Mental Health Targeted Case Management (AMH-TCM) and Children’s Mental Health Targeted Case Management (CMH-TCM) |

|Adult Rehabilitative Mental Health Services (ARMHS) |

|Adult Residential Crisis Stabilization Services (RCS) |

|Assertive Community Treatment (ACT) |

|Certified Family Peer Specialist |

|Certified Peer Specialist Services |

|Children’s Mental Health Clinical Care Consultation |

|Children's Mental Health Crisis Response Services |

|Children’s Mental Health Residential Treatment |

|Children’s Therapeutic Services and Supports (CTSS) |

|Clinical Supervision of Outpatient Mental Health Services |

|CTSS Children's Day Treatment |

|Diagnostic Assessment |

|Diagnostic Assessment (DA) Report Components |

|Dialectical Behavior Therapy Intensive Outpatient Program (DBT IOP) |

|Explanation of Findings |

|Family Psychoeducation |

|Functional Assessments |

|General MHCP Non-Enrollable Mental Health Provider Requirements |

|Health Behavior Assessment/Intervention |

|Inpatient Visits |

|Intensive Residential Treatment Services (IRTS) |

|Intensive Treatment in Foster Care |

|LOCUS |

|Mental Health Diagnostic Code Ranges |

|Mental Health Provider Travel Time |

|MHCP Professional Certification & Enrollment Requirements |

|Neuropsychological Services |

|Partial Hospitalization Program |

|Physician Consultation, Evaluation and Management |

|Psychiatric Consultations to Primary Care Providers |

|Psychiatric Residential Treatment Facility (PRTF) |

|Psychological Testing |

|Psychotherapy |

|Psychotherapy for Crisis |

|Telemedicine Delivery of Mental Health Services |

|Youth Assertive Community Treatment (Youth ACT)/Intensive Rehabilitative Mental Health Services (IRMHS) |

|MHCP Member Evidence of Coverage |

|Moving Home Minnesota |

|Moving Home Minnesota Demonstration and Supplemental Services Table (PDF) |

|Moving Home Minnesota Supported Employment Services (MHM SES) |

|Nursing Facilities |

|Officer-Involved Community-Based Care Coordination Services |

|Optical Services |

|PCA Services |

|Individual PCA Enrollment Criteria |

|Pharmacy Services |

|340B Drug Pricing Program |

|Compound Drugs |

|Drug Categories with Limited Coverage |

|Home Infusion Therapy |

|Long Term Care (LTC) |

|Medicare |

|Minnesota Covered Active Pharmaceutical Ingredient (API) and Excipient List |

|NCPDP Payer Sheets Guidelines |

|Pharmacy Early-Refill Overrides |

|Point of Sale Diabetic Testing Supply Program |

|Pro-DUR Conflict Codes |

|Quantity Dispensing Limits Table |

|Physician and Professional Services |

|Gender-Confirming Surgery |

|Transplant Authorization Code List |

|Rehabilitation Services |

|Audiology Services Procedure Codes |

|Augmentative Communication Devices |

|Casting & Strapping Services/Supplies |

|Orthotic Procedures |

|Rehabilitative and Therapeutic Services Authorization Criteria |

|Rehabilitative Services Procedure Codes |

|Renal Dialysis |

|Renal Dialysis Billing |

|Reproductive Health/OB-GYN |

|Abortion Services |

|Breast and Cervical Cancer (BRCA) Genetic Testing and Presumptive Eligibility Services |

|Doula Services |

|Family Planning |

|Family Planning Codes with Increased Rates |

|Free-Standing Birth Center Services |

|Hysterectomy |

|ICD-9 to ICD-10 Diagnosis Conversion Table |

|MFPP Contraceptive and Medication Supplies Table |

|Minnesota Family Planning Program (MFPP) |

|Minnesota Family Planning Program (MFPP) Procedure Codes |

|Obstetrics Services and HIV Counseling |

|Sterilization |

|Relocation Service Coordination—Targeted Case Management (RSC—TCM) |

|School-Based Community Services (SBCS) |

|Substance Use Disorder Services (SUD) |

|Rule 25 Process |

|Substance Use Disorder (SUD) Withdrawal Management Services |

|Telemedicine |

|Transportation Services |

|Nonemergency Medical Transportation (NEMT) Services (Overview) |

|Access Services Ancillary to Transportation |

|Ambulance Transportation Services |

|Ancillary Services Claim and Rate Information for Counties and Tribes |

|Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Transportation Services |

|Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information |

|Protected Transportation Services |

|State-Administered NEMT |

|State-Administered Transportation Procedure Codes, Modifiers and Payment Rates |

|Tribal and Federal Indian Health Services |

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