Avoid claim denials if you're contracted with a Medicaid MCO or have recently billed as an MCO network provider

Starting Oct. 1, 2024, Optum Behavioral Health will deny claims submitted by providers who are not enrolled with Minnesota Medicaid, as determined by the provider’s NPI.

These denials are required to comply with recent Minnesota Health Care Programs (MHCP) Guidance.  MHCP has instructed all managed care organizations (MCOs) – in this case, Optum Behavioral Health – to deny claims filed by providers who are not enrolled in the Medicaid program but are contracted with the MCO or have recently billed as an MCO network provider. This includes all rendering, ordering, referring and prescribing providers of services to managed care members, depending on their specialty.

How to enroll

All Medicaid providers must enroll through the Minnesota Department of Human Services (DHS). For information on the certification and licensure requirements and the enrollment process, go to the Enrollment with Minnesota Health Care Programs (MHCP) page on the Minnesota DHS site.

Note: 

To ensure compliance with the federal mandate, providers must submit their enrollment application as soon as possible.

Providers contracted with multiple MCO plans need only to submit a single MHCP enrollment request.

Enrolling with MHCP does not mean you are required to deliver services to fee-for-service Medicaid members.

Questions?

Visit the MHCP Provider Resource Center contact Optum Behavioral Health Provider Relations at ohbs.centralregion@optum.com.