Past timely filing
If the member has overlapping coverage for the dates of service provided, bill the MCO as primary and MHCP fee for service as secondary for cost sharing. Prepaid Health Plan: this subscriber receives (product code) - MinnesotaCare delivered through (name of MCO.) Major Programs: this subscriber has eligibility for MA: Medical Assistance The following is an example of verifying eligibility when programs overlap: See Minnesota Health Care Programs (MHCP) chart on the Health Care Programs and Services webpage for more information on the programs. Overlapping MHCP and managed care organization (MCO) coverageĪ member could have both Medical Assistance and MinnesotaCare programs overlap for a short span in certain circumstances. MHCP will not inform providers of services the member is receiving from other providers. If the member is receiving the same services from another provider, the providers must coordinate the services and document in the member's record how the services were coordinated. 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.
PAST TIMELY FILING VERIFICATION
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.
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PAST TIMELY FILING 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.