DHS Enrollment, Ucare Letters to Providers, and Contract Updates
(Updated 10/02/2024)
Updated 10/03/2024 to clarify the three enrollment options in the “How to Get Settled with MHCP” section)
The 21st Century Cures Act went into effect in July of 2023. One of its mandates was that every healthcare provider contracted with a Managed Care Organization (MCO) must enroll with their state’s Medicaid program. For those of us in Minnesota, that’s Minnesota Health Care Programs (MHCP) which is managed by the Minnesota Department of Human Services (MN DHS or locally just ‘DHS’). Enforcement began in July 2024.
In Minnesota, our MCOs are Blue Plus, HealthPartners, Hennepin Health, Itasca Medical Care, Medica, PrimeWest, South Country Health Alliance, Ucare, and United Healthcare. If you have a contract with any of these payers, you need to be enrolled with MHCP. And if you’re enrolled with MHCP the data they have on file needs to match what’s on your contract with the MCO.
In July providers began receiving letters from Ucare. The letters state that the recipients are not properly enrolled with Minnesota Health Care Programs (MHCP), and due to the requirements of the federal 21st Century Cures Act, Ucare will soon stop making payments on claims starting on October 1st if this is not rectified.
Another effect of enforcement is that the MCOs now require proof that a provider is enrolled before approving new contract applications or modifying existing contracts. The easiest way to do this is by requiring a copy of a provider’s DHS approval letter or checking against lists supplied by DHS to the MCOs. Most are opting for the former.
MHCP: The New Gold Standard for Provider and Practice Demographics
First: If you’re not enrolled with MHCP and want contracts with MCO’s, you will need to enroll with MHCP ASAP. You risk denials, and potentially could face payment recoupments if you submit claims that are not denied further down the road. Payers can take a while to update their systems, but that doesn’t mean the rules don’t apply.
Second: If you are enrolled, consider MHCP the gold standard for your group and individual provider information. That means first and foremost, you must keep MHCP updated and accurate before all other contracts. You can do this via MHCP’s Minnesota Provider Screening and Enrollment portal (MPSE *pronounced 'mipsy'*) or by fax. More on this below.
Third: Make sure you have a copy of your DHS approval letter as an individual provider. If you can’t find it you’ll need to call DHS to request a new one. The same goes for group practices.
Why MN Providers Got ‘The Letter’ from Ucare
I reached out to Ucare about the letters and was told they were sending letters to:
Individual Providers who do not appear to be enrolled in at least one service location. The address on file at UCare does not necessarily need to match MHCP.
Group Providers whose service location addresses, including Name, Address, TIN and NPI, on file at Ucare do not match the records on file with MHCP.
So if you received the letter, that means you likely need to get your information on file with MHCP updated. If you don't update your information or get enrolled I see the following ramifications:
You can't apply for new contracts with MCOs (already happening)
You can't modify your existing contracts MCOs (already happening)
Ucare is the first to potentially stop paying (coming very soon)
Other payers will likely follow suit (coming soon)
A Little Good (?) News
In my communication with DHS, I was told the enrollment deadline has come and passed, but they are negotiating with CMS at the federal level a date where they will start enforcing cutoffs of payments for claims by non-enrolled providers. Watch for MHCP’s Provider News emails for updates. You can sign up here if you’re not on the list.
Ucare has also indicated that claim denials in October will start with provider types that had the lowest utilization first. However, the didn’t say which providers those are, and they will not stop paying on claims for any provider whose enrollment or update shows as pending at DHS.
Finally, for any providers who received Ucare letters, but were told everything was fine by MHCP, you can reach out to providerapp@ucare.org to ask for a review of what is needed from DHS to resolve the issue, but only after contacting DHS at 651-431-2700 and being told everything looks good.
How to Get Settled with MHCP
You Can Use the MPSE in MN-ITS or fax in your updates. In addition to demographic updates, you have three options when enrolling, or updating your enrollment with MHCP:
Fee For Service and In-Network Managed Care - Enroll with MHCP and accept clients with a Medicaid Plan (aka “straight Medicaid”) in addition to working with MCO clients.
In-Network Managed Care Only - Enroll with MHCP, but only see MCO members. You will not see clients with Medicaid Plans.
Out-of-Network Managed Care Only - Register with MHCP as required by the 21st Century Cures Act, but opt out of seeing Medicaid clients and PMAP clients at all MCOs.
Additionally, make sure that your NPI Registry information in the NPPES is up-to-date.
Click here to enter your NPI to see what’s publicly availabl (works for both Individual and Group NPIs)
Click here to log in to make changes, or start the password reset process.
For the MPSE
Click the "Minnesota Provider Screening and Enrollment portal (MPSE)" link to modify your enrollments.
From there what you need to do is entirely dependent on your Organization Information and your Organization to Individual Affiliations or whatever is not correct.
This link takes you to the MPSE information page, which might help you navigate the system.
Additionally, there is a standing MPSE Q&A session on Wednesdays at 1 p.m. (link). You can sign up to ask questions if you want to try to take this on yourself. Look for the "Join the MPSE Questions and Answers Session" button in the center of the page.
Faxing in Your Updates
Additionally, you may use the PDFs on DHS's "Changes to Enrollment" section of their enrollment page (LINK). You'd complete the DHS-3535 to update your individual information and the DHS-3535A for your group.
We recommend faxing it in twice since these seem to get lost quite often. Once faxed you need to wait 30 days before checking on if it was processed or even received.
Conclusion
Many, many providers were caught off guard when this started hitting in July. There is still plenty of confusion around if a provider is enrolled with MHCP and if so, what needs to be updated, and how. DHS and the MCOs are aware of the issue, and it sounds like they are working to give everyone time to get themselves organized. However, time is running out, so do not delay. Keeping your provider details up-to-date, especially with MHCP, has never been more important.
By Paul Jonas, CEO
Phoenix Credentialing & BreezyBilling
paul.jonas@phoenixcredentialing.com
paulj@breezynotes.com
