Certain services require prior authorization for Hennepin Health members. The prior authorization document (PDF) outlines which services require prior authorization or notification to Hennepin Health. Providers are responsible for verifying eligibility and benefits before providing services to members.
Hennepin Health follows the legislative standards outlined in Minnesota statute 62J.536. Per this statute, all claims submitted to Hennepin Health must be submitted electronically following the American National Standards Institute guidelines, Accredited Standards Committee X12 standard transactions or National Council for Prescription Drug Program (NCPDP) standards. Paper claim submissions will not be accepted.
Providers are required to adhere to State of Minnesota Uniform Companion Guide requirements and the Administrative Uniformity Committee (AUC) Best Practices for claims submissions. These documents are available on the AUC website.
Hennepin Health contracts with Payer Connectivity Services (PCS), part of Change Healthcare, to receive, test and send HIPAA-compliant mandated transactions. Services provided by PCS can be performed in batch transactions or as real-time transactions. Hennepin Health does not contract directly with providers as trading partners. PCS, on behalf of Hennepin Health, works with several clearinghouses. If you would like to become a trading partner with Hennepin Health, please contact one of the following clearinghouses:
Availity (835 only): 800-282-4548
ClaimLynx: 952-593-5969
Change Healthcare: 877-271-0054
Infotech Global, Inc. (aka MN e-Connect): 877-444-7194
Office Ally: 866-575-4120
RelayHealth: 800-778-6711
If you are unable to send electronic institutional and professional claims, and/or electronic replacement/cancel claims, Hennepin Health, along with several other large Minnesota group purchasers, has secured the services of Infotech Global, Inc. (aka MN e-Connect) to provide free Web-based services for provider data entry of ANSI X12 837 v5010 and AUC compliant claims.
Availity is not a direct submitter of 837 (claims) transactions to Hennepin Health. Providers using Availity as their claims submission clearinghouse can contact Availity directly to learn how these are routed to Hennepin Health.
Electronic Remittance Advises (ERAs) will be sent to the same clearinghouse submitting the 837 transactions on behalf of the service provider. If you would like the ERA to be sent to a different clearinghouse other than the one used for claims submissions, refer to the implementation checklist outlined in Hennepin Health’s 835 Companion Guide.
The referral requirements for accessing out-of-network providers differ between the ACO defined partnership network and in-network non-ACO partner providers. This FAQ provides tips and answers common questions.
The Rendering Provider Procedure Code List (XLS) is a reference document that contains procedure codes for when an individual rendering provider is required to be at the claim or service line levels of an 837 claim transaction. Click here to read the related bulletin for more information.
The SNIP 0-8 Error Code List (XLS) is a reference document that contains a list of the error codes and corresponding error code descriptions for SNIP Levels 0 through 8 testing on 837 claims transactions. Click here to read the related bulletin for more information.
Five health plans – Blue Plus, HealthPartners, Medica, Hennepin Health and UCare – launched the Antidepressant Medication Management project in the spring of 2015. Interventions include working with providers and partners to support efforts to improve adherence to antidepressant medication with a particular focus on reducing ethnic and racial disparities. In 2016, the health plans combined the antidepressant medication management initiative with a depression-related initiative that focused on diagnosis and treatment of depression within the senior/Medicare population.
Provider Toolkit – Resources for providers and care coordinators working with culturally diverse and senior/Medicare patients experiencing depression include best practices for depression care, mental health resources for providers and patients, cultural competency and shared decision making.
Seven Minnesota health plans – Blue Plus, HealthPartners, Hennepin Health, Medica, PrimeWest Health System, South Country Health Alliance and UCare – are collaborating on a project to reduce the rate of chronic opioid use among the State Public Programs population in Minnesota. Minnesota Department of Human Services (DHS) has identified 45 days of opioid use as a critical timeline for patients prescribed opioids, as continued use beyond 45 days can result in long-term/chronic use or addiction. The goal of this project, which began in 2018, is to decrease the number of PMAP, SNBC, MSHO, and MSC+ members who reach that 45-day threshold by providing clinician, member, and community education and resources to understand best practices in opioid prescribing, potential alternative therapies and safe disposal options.
Provider Toolkit – Resources include patient education on pain and opioid prescriptions, addressing opioid prescription practices, identifying safe and effective pain management protocols, and nonpharmacologic and non-opioid pharmacotherapy alternatives.