MHCP provider types

The Minnesota Health Care Programs (MHCP) fee-for-service delivery system includes several different types of providers. This page provides quick links for providers looking for information, including how to enroll with MHCP and what services are covered. If specific enrollment information is not listed for a provider type, refer to the enrollment section in the MHCP Provider Manual.

All providers: In addition to sections of the MHCP Provider Manual about the services you provide, refer to the Provider Basics section for general requirements and billing information.

Refer to the Billing Policy Overview section for information about your Remittance Advice (RA).
Refer to the MN–ITS User Manual for information about submitting claims, verifying member’s eligibility and checking claim status.

If you are an MHCP member looking for a provider, you can search our MHCP Provider Directory of fee-for-service providers. If you are enrolled in a health plan, contact your health plan to help find providers.

If you are a provider and have questions, contact the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411.

A | B | C | D | E | F | H | I | L | M | N | O | P | R | S | T

A

B

Billing intermediaries and clearinghouses

C

D

E

F

Family planning
Family planning services

MHCP Provider Manual
Additional resources
Minnesota Family Planning Program (MFPP)

MHCP offers MFPP as a separate set of family planning services. Provider, member and service delivery requirements are not the same for MFPP and non-MFPP MHCP family planning services. For complete information refer to the MFPP Provider Training Guide (DHS-7421) (PDF).

MHCP Provider Manual
- Minnesota Family Planning Program (MFPP)
- Nonemergency medical transportation (MFPP covers transportation and related ancillary services)
Eligibility and Certification

Verify eligibility in MN–ITS before determining presumptive eligibility.

Training: MFPP Provider Training Guide (DHS-7421) (PDF)

Additional resources: MFPP forms, documents and resources
Federally Qualified Health Centers (FQHCs)
MHCP Provider Manual: Federally Qualified Health Center and Rural Health Clinics

Forms and documents
Additional resources
- Direct Course

H

I

L

Laboratory services

M

Mental health providers
For mental health-specific codes and rates, see Mental Health Codes, Maximum FFS Rates, and Eligible Providers.

Intensive residential treatment services

MHCP Provider Manual: Mental Health Services

Additional resources
Licensed Independent Clinical Social Workers (LICSWs)

MHCP Provider Manual
- Mental Health Services
- Relocation Service Coordination – Targeted Case Management (RSC-TCM)
Additional resources
Licensed marriage and family therapists (LMFTs)

MHCP Provider Manual: Mental Health Services

Additional resources
Psychologists

MHCP Provider Manual
- Mental Health Services
- Relocation Service Coordination – Targeted Case Management (RSC-TCM)
Additional resources
- Drug Prior Authorization DHS-4424 (PDF)
- Authorization Form DHS-4695 (PDF)

N

Nurses
Clinical nurse specialist

MHCP Provider Manual
Additional resources
- Adult mental health: Training and conferences
Nurse midwife

MHCP Provider Manual: Reproductive health/OB-GYN

Nurse practitioner

MHCP Provider Manual
- Physician and Professional Services
- Relocation Service Coordination – Targeted Case Management (RSC-TCM)
Additional resources
- CTSS Authorization Form and Instructions (DHS-4159) (PDF)
- Authorization Form (DHS-4695) (PDF)
- Minnesota Department of Health information
Public health nursing

MHCP Provider Manual: Various sections in the Provider Manual may have information relevant to these services

Additional forms and resources
Nursing facilities
MHCP Provider Manual
Forms and Documents:
Additional resources:
Nutritionists and dieticians

O

P

Pharmacy
MHCP Provider Manual
Prescription drug information
Uniform Preferred Drug List
- Uniform Preferred Drug List (PDF) (Fee-for-Service and Managed Care Medicaid effective 01/01/2020)
- Uniform Preferred Drug List (PDF) (Fee-for-Service and Managed Care Medicaid effective 01/15/2020)
- Uniform Preferred Drug List (PDF) (Fee-for-Service and Managed Care Medicaid effective 03/26/2020)
- Uniform Preferred Drug List (PDF) (Fee-for-Service and Managed Care Medicaid effective 04/01/2020)
- Uniform Preferred Drug List (PDF) (Fee-for-Service and Managed Care Medicaid effective 07/01/2020)
- Uniform Preferred Drug List (PDF) (Fee-for-Service and Managed Care Medicaid effective 10/01/2020)
- Uniform Preferred Drug List (PDF) (Fee-for-Service and Managed Care Medicaid effective 01/01/2021)
- Uniform Preferred Drug List (PDF) (Fee-for-Service and Managed Care Medicaid effective 06/01/2021)
- Uniform Preferred Drug List (PDF) (Fee-for-Service and Managed Care Medicaid effective 07/01/2021)
- Uniform Preferred Drug List (PDF) (Fee-for-Service and Managed Care Medicaid effective 10/01/2021)
- Uniform Preferred Drug List (PDF) (Fee-for-Service and Managed Care Medicaid effective 09/01/2022)
- Uniform Preferred Drug List (PDF) (Fee-for-Service and Managed Care Medicaid effective 10/03/2022)
- Uniform Preferred Drug List (PDF) (Fee-for-Service and Managed Care Medicaid effective 03/01/2023)
- Uniform Preferred Drug List (PDF) (Fee-for-Service and Managed Care Medicaid effective 06/15/2023)
- Uniform Preferred Drug List (PDF) (Fee-for-Service and Managed Care Medicaid effective 09/15/2023)
- Uniform Preferred Drug List (PDF) (Fee-for-Service and Managed Care Medicaid effective 01/01/2024)
- Uniform Preferred Drug List (PDF) (Fee-for-Service and Managed Care Medicaid effective 03/15/2024)
- Uniform Preferred Drug List (PDF) (Fee-for-Service and Managed Care Medicaid effective 08/01/2024)
- Uniform Preferred Drug List (PDF) (Fee-for-Service and Managed Care Medicaid effective 12/01/2024)
- Frequently Asked Questions for Members
- Frequently Asked Questions for Providers
- Preferred Drug List Flow Diagram for Providers
- Frequently Asked Questions for Drug Manufacturers
- Continuation of Therapy Prior Authorization Criteria (PDF)
- Nonpreferred Drug Prior Authorization Criteria (PDF)
Prior authorization and other resources
Physicians and clinics
MHCP Provider Manual: Various sections in the Provider Manual may have relevant information on these services

Additional resources and forms for physicians and clinics
Physicians assistants

MHCP Provider Manual
- Physician and Professional Services
- Relocation Service Coordination – Targeted Case Management (RSC-TCM)
Additional resources
- Enteral/Nutritional Authorization Form (DHS-3971) (PDF)
- Authorization Form (DHS-4695) (PDF)
Public health clinics (PHCs)

MHCP Provider Manual
- Clinic Services
- Physician and Professional Services
Additional resources
- Authorization Form (DHS-4695) (PDF)
- Direct Course
Rural Health Clinics (RHCs)

MHCP Provider Manual: Various sections in the Provider Manual may have information relevant to these services

Additional resources
Podiatrists

MHCP Provider Manual: Physician and Professional Services

R

S

T

Transportation
MHCP Provider Manual: NEMT Transportation Services

Additional resources
- Refer to the CMS NEMT Toolkit for education and training resource materials that promote best practices and awareness of Medicaid fraud, waste, and abuse.
- Air Ambulance Billing Checklist (DHS-5208) (PDF)
- Ground Ambulance Billing Checklist (DHS-5208A) (PDF)
- Protected transportation under Medical Assistance fee-for–service
Tribal and Federal Indian Health
MHCP Provider Manual: Tribal and Federal Indian Health Services

Additional resources
- Indian Health Services