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Health Care Homes

  • Health Care Homes - Homepage
  • Patient Information
  • Sustainability Roadmap
  • Minnesota Care Coordination Effectiveness Study
  • Learning
  • Strategic Planning
  • News & Announcements
  • Background Information

Related Topics

  • DHS Behavioral Health Home Service
  • MDH Disabilities and Special Health Needs
  • MDH Health Care Facilities, Providers and Insurance
  • MDH Health Equity
Contact Info
Health Care Homes
651-201-5421
health.healthcarehomes@state.mn.us

Contact Info

Health Care Homes
651-201-5421
health.healthcarehomes@state.mn.us

Health Care Homes Incentives and Payments
HCH Care Coordination Billing

Billing and reimbursement for HCH care coordination is different depending on payers. Each clinic or organization should begin with an understanding of the payer mix of their population to determine reimbursement approaches.

Resources for HCH care coordination services reimbursement are listed below by payer.

Minnesota Health Care Programs (MHCP)

Certified HCH providers may receive per member per month reimbursement for the delivery of care coordination services to MHCP recipients who have complex and chronic medical conditions. The Minnesota Department of Human Services (DHS) administers MHCP.

The following information may guide you in the billing process:

  • MHCP Provider Manual – Physician and Professional Services – HCH [DHS website]
  • Resource for billing care coordination (PDF)
  • Tiering Tools
    1. Tier Assignment Tool (PDF)
    2. Expanded Diagnostic Clusters (PDF)
    3. Tier Assignment Tool Training (PDF)
  • Managed Care Organization Contacts for MHCP providers [DHS website]. Contact the MCO directly for MCO-enrolled patients.
  • Behavioral Health Home (BHH) Services [DHS website]. Note: only one care coordination service, HCH or BHH, can be billed for a patient at a time.
Commercial Insurance

Reimbursement for HCH care coordination depends on the contract arrangements your organization has with each payer. Each payer reimburses differently and needs to be contacted directly about billing for care coordination. Some contract arrangements may allow per member per month or up front reimbursement for care coordination. Often, commercial insurers do not automatically offer reimbursement; therefore organizations must specifically request it.

Return to main Incentives & Payments Page

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Last Updated: 04/18/2024

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