Health Care Homes

Medicare Demonstration/Payment

Requirements Overview

The following requirements must be met when submitting claims for reimbursement.
  • Certified HCH in demo area
  • On MDH Provider File
  • Medicare Beneficiary who:
    • Lives in demo area
    • Has Medicare Parts A & B
    • Medicare is primary insurer
    • No Medicare Advantage (i.e. eligible for Medicare FFS)
    • Chronic, severe condition(s) requiring care team
  • Correctly submitted Claim

Information Needed by MDH:

The following items must be submitted to MDH for each participating certified clinic;

  • Group PTAN (aka Group PIN, Medicare Part B Group Number)

  • Group PTAN Palmetto, if applicable (RRB Beneficiaries)

  • Clinic NPI

  • Clinic Tax ID

For each participating certified provider;

  • Individual NPI

  • Individual PIN (aka Medicare Provider Number, Rendering PTAN)

  • Individual PIN Palmetto, if applicable (RRB Beneficiaries)

Update Medicare Provider Numbers in the HCH Portal;

  • The rendering provider must be HCH certified on the Date of Service

    • Note: Remember to add/edit/remove(end) when provider list changes.

    Use the online HCH portal

More information on:

Quick Facts
MAPCP Quarterly Reports
MAPCP Billing Instructions and Webinars
MAPCP Steering Committee

Updated Monday, April 20, 2015 at 02:11PM