Providers are responsible to ask MHCP members if they are currently receiving the same health care services from another provider. 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.
TIMELY MEDICAL BILLING LAWS MANUAL
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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