Update on MN DHS Enrollment Issues and Contract Updates
We have an update to our post “DHS Enrollment, Ucare Letters to Providers, and Contract Updates.” This applies to both WHY a provider might be showing up as not-enrolled, and how to respond if you’re told to submit a copy of your MHCP enrollment letter.
Why You’re Not “Enrolled”
First - Enrolled is actually the wrong word. The right word is “screened.”
All providers must at least be screened by MHCP in order for them to meet the requirements of the 21st Century Cures Act. That means all providers need to have gone through the enrollment process and selected one of the three following options (also mentioned in our previous post):
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 MCO clients.
In-Network Managed Care Only - Enroll with MHCP, but only see MCO member.
Out-of-Network Managed Care Only - Get screened by MHCP, but provide out-of-network care for MCO members only. (i.e. you’re not seeing Medicaid clients or PMAP clients at the MCO).
Choosing Option 3 means you are NOT enrolled with MHCP, but you will be screened.
Why is this so Confusing?
The enrolled/not enrolled confusion comes from how MHCP handled providers who submitted claims for subscribers on MCOs’ medicaid plans. If a provider was not enrolled with MHCP, but their name and credentials came through on a PMAP claim from an MCO, then that provider was ‘provisionally enrolled’ with MHCP.
For Example: Dr. Jane Smith has a contract with BlueCross BlueShield of MN. That contract includes the BluePlus (BCBS MN’s PMAP) panel. She never enrolled with MHCP to provide services to Medicaid recipients. However, she did see a client with a BluePlus plan. She submitted the claims and was paid.
BluePlus also passed that claim info to MHCP. Dr. Smith was not in the MHCP system, so MHCP added her information in their system and tagged her as “provisionally enrolled.”
If Dr. Smith called into MHCP she might be told that she’s enrolled by the rep, when really she’s provisionally enrolled. And that means she was never screened by MHCP. Boiled down, what the 21st Century Cures Act is asking it that all providers officially register with (or be screened by) their state’s Medicaid program.
This is why MCOs are asking for enrollment letters (more on that next). It’s the fastest way for an MCO to prove that a provider went through the enrollment, or really screening, process. Providers who are provisionally enrolled would not have that letter.
Don’t Send that Enrollment Letter
The enrollment letter request typically comes up when a provider is trying to apply for a contract or update their existing contract with an MCO. If a provider is calling to confirm they’re all set with the MCO, the request may also be made.
We were told that providers should not send in that letter. MHCP enrollment letters contain sensitive login information. The MCO has access to the list of enrolled providers through their own MN-ITS accounts, and it is their responsibility to check those lists. The list is called a “PECD” file (PECD stands for “Provider Enrollment Compact Disc”). It is sent to the MCOs’ MN-ITs accounts daily. If an MCO rep takes issue with your refusal, request to speak with their supervisor. If you’re still having an issue, then we’ve been told to reach out to the MHCP Provider Resource Center at 651-431-2700 and ask to be connected with that MCO’s contract manager. Please just keep in mind MHCP is still getting flooded with calls, so you’ll need to be patient and tenacious.
Not Sure if You’re Enrolled?
If you can’t find your letter, don’t have MN-ITS access or you’re not sure if you’re enrolled, you need to figure that out. The only way to do that is to call MHCP at 651-431-2700. When you connect with a representative, ask them to confirm if you’re enrolled as one of those three options from above (Fee for Service, In-Network Managed Care only, or Out of Network Managed Care only). If you are enrolled, request a copy of your letter if it’s not in hand. If you’re not enrolled, then you’ll need to go through the enrollment process with MHCP, which we’ve also outlined in our previous post on this subject.
