Please follow the Enrollment Instructions below to become an electronic submitter to Minnesota Medicaid.

The following documents are required enrollment documents that must be completed, signed and returned to the DHSoffice prior to initiation of electronic claims submission or inquiry.

Billing Agents Only:

• MHCP Clearinghouse or Billing Intermediary Enrollment Form

• Update Form for Clearinghouses and Billing Intermediaries

• Electronic Remittance Advice Request Form

To obtain the forms above, please download them from:

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&Redirected=true&dDocName=id_017533

Providers: 

To enroll for a submitter ID and password for Medicaid-DHS’ electronic billing system, please call the DHSEDI Technology Support Center at 651-431-2700 or 1-800-366-5411, option 6 and ask to Register for their MN-ITS billing system.  Once you receive your MN-ITS log in ID please call the ClaimShuttle Support Team at 602-439-2525.

If you have any questions regarding any of the documents in this package, please call the DHSEDI Technology Support Center at 651-431-2700 or 1-800-366-5411, option 5.

We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.

Provider Enrollment Application for Billing Intermediaries, Clearinghouses and EDI Trading Partners

Section 1

·        Please select “Billing Intermediary

Section 2

·        Enter your Business Name and Demographic information

Section 3

·        The main billing contact for your office should complete this section

Provider Setup Form

Section 1

·        Please complete the Billing Intermediary section with your information

Section 2

·        Complete this section and state the necessary information for the providers you bill for.

o   For “Begin Date” enter the date you started billing for the said provider

o   Choose “Both”

o   Have each provider you bill for fill sign the Pay to Provider Signature field.

Electronic Remittance Advice Request Form

If you would like to receive the Electronic EOBs for your provider please have each provider that you bill for sign one of this form.

Section 1

·        Enter your provider’s information and the main contact for his or her office

Section 2

·        Enter your business information and the main contact for your office

Section 3

·        Please mark the ADD “835X12” option and enter today’s date

Section 4

·        Have your provider complete this section

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records.  Mail or Fax the enrollment forms reflecting original signatures to:

Minnesota Department of Human Services

Provider Enrollment

PO Box 64987

Saint Paul, MN 55164-0987

Fax 651-431-7462

It is very important that you complete and return the entire enrollment packet as described above.  Incomplete packets will not be processed and will be returned to the submitter.

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed.  Processing will take approximately 4-6 weeks from the date of receipt.

(Remember that mailing time can take as much as five days.)

After processing, a confirmation will be sent to you as notification to begin filing claims electronically. When you receive this letter it will contain instructions for registration of the MN-ITS website, if you have any difficulty with the registration process please call: MHCP Provider Call Center at (651) 431-2700 or (800) 366-5411 (option 6)

If neither confirmation nor a returned packet is received after four to six weeks, contact the DHSEDI Technology Support Center at 651-431-2700 or 1-800-366-5411, option 5.

Testing

Once you have received your MN-ITS Submitter ID and password from DHS please call the ClaimShuttle Support Team and set an appointment for a Mailbox setup and Test Transmission to DHS. 

Please have 25 test claims ready for testing.  Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved.  Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.