![]() ěill only one calendar month of service per claimįollow these requirements for timely billing:.ěill the provider's usual and customary charge.Payments for EW or AC environmental accessibility adapations must be prorated over several months due to EW or AC budgets and this is specified on the service authorization ěill only for dates of service when services were provided except in the case of Elderly Waiver (EW) or Alternative Care (AC) for environmental accessibility adaptations.Submit claims only after you provide one or more MHCP-covered service.MHCP providers who render or supervise services are responsible for claims submitted to MHCP: Services must still meet all other MHCP coverage criteria to be eligible for reimbursement. MHCP pays for covered services even when the provider offers the same service for free to any other patient. The pharmacy will be contacted with payment information after the claims unit reprocesses the claim.Ĝontact the MHCP Provider Call Center to create a case to be sent to the claims unit.The claim will deny with NCPDP reject code of AF Ğnter in the coordination of benefits (COB) information on the claim.Ĝomplete the coordination of benefits (COB) information on claim.Ěttach MCO explanation of benefits (EOB).Send cover sheet that states the member has overlapping coverage for dates of service.See the following for billing instructions. If the member has overlapping coverage for the dates of service provided, bill the MCO as primary and MHCP fee for service as secondary for cost sharing. Prepaid Health Plan: this subscriber receives (product code) - MinnesotaCare delivered through (name of MCO.) Major Programs: this subscriber has eligibility for MA: Medical Assistance The following is an example of verifying eligibility when programs overlap: See Minnesota Health Care Programs (MHCP) chart on the Health Care Programs and Services webpage for more information on the programs. Overlapping MHCP and managed care organization (M CO) covera geĪ member could have both Medical Assistance and MinnesotaCare programs overlap for a short span in certain circumstances. MHCP will not inform providers of services the member is receiving from other providers. If the member is receiving the same services from another provider, the providers must coordinate the services and document in the member's record how the services were coordinated. Providers are responsible to ask MHCP members if they are currently receiving the same health care services from another provider. Please also review the following billing policies for all providers: Reconsideration of a Claim (Appeals vs.Overlapping MHCP and managed care organization (MCO) coverage.This section outlines the following for all MHCP providers: Minnesota’s Uniform Electronic Transactions and Implementation Guide Standards (PDF) require all Minnesota-based health care claims to be submitted electronically. The federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires all health care providers and payers to use universal standards for electronic billing and administrative transactions (health care claims, remittance advice, eligibility verification requests, referral authorizations and coordination of benefits). Contact the appropriate MCO to learn about the billing policies for services provided to MCO-enrolled MHCP members. MHCP members enrolled in a managed care organization (MCO) contracted with MHCP receive their health care services through the MCO. Minnesota Health Care Programs (MHCP) providers and their billing organizations must follow MHCP billing policies as outlined in this section and provider type specific sections of the MHCP Provider Manual for billing services provided to FFS members. ![]() In a fee-for-service (FFS) delivery system, providers (including billing organizations) bill for each service they provide and receive reimbursement for each covered service based on a predetermined rate.
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