Minnesota Payer Configuration and Requirements Tables
The payer configuration table is a valuable resource to help you understand the specific requirements for each payer contract as they relate to the integration process. By referencing this table, you can ensure the correct configuration of payer contracts, maintain compliance, and streamline workflows. Use this topic as a quick reference to verify the scope of each payer’s requirements and to facilitate a smooth integration process.
MN FMS
| Payer | MN FMS |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not in Scope |
| DX Code Provider/Payer Managed | State Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 500 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Home Health FFS
| Payer | Home Health FFS |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not in Scope |
| DX Code Provider/Payer Managed | State Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 500 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Community First Services and Support PCA
| Payer | Community First Services and Support PCA |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not in Scope |
| DX Code Provider/Payer Managed | State Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 500 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Waiver Services FFS
| Payer | Waiver Services FFS |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not in Scope |
| DX Code Provider/Payer Managed | State Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 500 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Blue Cross Blue Shield (Blue Plus)
| Payer | Blue Cross Blue Shield (Blue Plus) |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not in Scope |
| DX Code Provider/Payer Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 500 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Health Partners
| Payer | Health Partners |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not in Scope |
| DX Code Provider/Payer Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 500 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Hennepin Health
| Payer | Hennepin Health |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not in Scope |
| DX Code Provider/Payer Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 500 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
IMCare
| Payer | IMCare |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not in Scope |
| DX Code Provider/Payer Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 500 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Medica
| Payer | Medica |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not in Scope |
| DX Code Provider/Payer Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 500 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
PrimeWest
| Payer | PrimeWest |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not in Scope |
| DX Code Provider/Payer Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 500 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
PrimeWest South Country Heath Alliance
| Payer | PrimeWest South Country Heath Alliance |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not in Scope |
| DX Code Provider/Payer Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 500 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Ucare
| Payer | Ucare |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not in Scope |
| DX Code Provider/Payer Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 500 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
United Health Care
| Payer | United Health Care |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not in Scope |
| DX Code Provider/Payer Managed | Provider Managed |
| EVV Required | Required |
| Payer GPS Tolerance | 500 ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |