Minnesota

To calculate a Minnesota Medicaid claim at 100% of the state regulation rates, use the default settings. The required fields are identified on the image below. Optional fields are either applied or not applied based on the specific contract language.

Note: Refer to the contract to determine the options to select and the values to enter.

The following settings are required for Minnesota Medicaid managed care contracts.

  • Override Provider Number – Type the preferred provider number.
  • State Code – Defaults to MN (this value cannot be changed).
  • Percent of Reimbursement – This should be set to 100% unless specified otherwise.

The following table describes the fields on the MN tab of the Medicaid - Facility reimbursement tool.

Field

Description

Do not consume charges

Provides the option not to consume charges. This is used for contract carve outs.

Do not consume units

Provides the option not to consume units. This is used for contract carve outs.

Override Provider Number

Preferred provider number. Up to ten alphanumeric digits.

Override Service Date

Preferred service date. Use MM/DD/YYYY format. Overrides the service date on the claim with the date you enter. You may use the anchor date instead of this option.

Percent Reimbursement

Three digit percentage amount.

State Code

This field defaults to MN, and it cannot be changed.

Cap line items at lesser of billed charges or Medicaid reimbursement

Select this check box to allow line items to price the lesser of billed charges or Medicaid reimbursement.

Use APR-DRG

This field allows users to select APR-DRG pricing for a claim.