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MHCP provider news and updates

This page includes news and resources for providers enrolled to serve Minnesota Health Care Programs (MHCP) members. News articles are retained on the Minnesota Department of Human Services (DHS) website for one year. Current messages are linked below. Sign up to receive provider news and other MHCP notices through our free provider email lists.

Systems announcements

We will update this section with information about MN–ITS availability, technical information and other systems announcements when necessary.

Revised: Pharmacy billing and support changes for outpatient fee-for-service functions effective Nov. 4

We revised this message to state the new pharmacy billing and support changes for outpatient fee-for-service functions are now in effect. We also added hyperlinks to the related Minnesota Health Care Programs Provider Manual sections and Minnesota Medical Assistance Portal (hosted by Prime Therapeutics).

Outpatient pharmacy services claims processing and related pharmacy benefit functions transitioned from the Minnesota Department of Human Services (DHS) to Prime Therapeutics (formerly known as Magellan Health) on Nov. 4, 2024. This impacts only the fee-for-service outpatient pharmacy benefit. Managed care organizations will continue to provide outpatient pharmacy benefits for members enrolled in their plans.

DHS has contracted with Prime Therapeutics to provide the following services:

  • outpatient pharmacy claims processing (point-of-sale claims)
  • outpatient pharmacy member and provider call center (24 hours a day, 7 days a week)
  • drug rebate system and administrative support
  • prior authorization determinations for outpatient pharmacy and provider-administered drugs
  • retrospective drug utilization review
  • state maximum allowable cost and 340B ceiling price file 
  • preferred drug list 

Refer to Pharmacy Services, 340B Drug Pricing Program and Drug Authorizations in the Minnesota Health Care Programs Provider Manual for more information.

Also, refer to the Minnesota Medical Assistance Portal (hosted by Prime Therapeutics) for additional information, forms and other resources. (pub. 8/27/24, rev. 11/4/24)

MHCP wants your feedback

MHCP wants feedback from enrolled providers and invites you to take the MHCP Provider Survey. We want to hear from you about what works well, what needs improvement, and what else we should be considering when we work with you to accomplish our shared goals. 

Current news and updates

Training

Minnesota Health Care Programs (MHCP) offers free training for MHCP enrolled providers.

Additional information

Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 if you have questions about this information.

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