Medicare Part D: The Medicare prescription drug benefit program. We call this program “Part D” for short. Medicare Part D covers outpatient prescription drugs, vaccines, and some supplies not covered by Medicare Part A or Medicare Part B or Medical Assistance. Our plan includes Medicare Part D.Medicare Part A: The Medicare program that covers most medically necessary hospital, skilled nursing facility, home health, and hospice care.
Medicare Part B: The Medicare program that covers services (such as lab tests, surgeries, and doctor visits) and supplies (such as wheelchairs and walkers) that are medically necessary to treat a disease or condition. Medicare Part B also covers many preventive and screening services.
Medical Assistance: This is the name of Minnesota’s Medicaid program. Medical Assistance is run by the state and is paid for by the state and the federal government. It helps people with limited incomes and resources pay for long-term services and supports and medical costs.
It covers extra services and some drugs not covered by Medicare. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.

Provider Manual

Provider Manual Chapters

  1. Introduction (pdf)
  2. Rights and Responsibilities of Physicians and Providers (pdf)
  3. Provider Network Resources (pdf)
  4. Provider Billing (pdf)
  5. Credentialing and Organizational Assessment (pdf)
  6. Service Authorizations & Notification Standards (pdf)
  7. Clinical Practice Guidelines (pdf)
  8. Fraud and Abuse (pdf)
  9. Clinic Complaint Reporting Process (pdf)
  10. Model of Care (pdf)
  11. Sample Member ID Cards (pdf)
  12. Member Enrollment (pdf)
  13. Member Grievances and Appeals Process for Dual-Eligible Special Needs Programs (pdf)
  14. Member Grievances and Appeals Process for Minnesota HealthCare (Medicaid) Programs (pdf)
  15. Restricted Recipient Program (pdf)
  16. Wellness Programs (pdf)
  17. Child and Teen Checkups (C&TC) Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program (pdf)
  18. Durable Medical Equipment and Supplies (pdf)
  19. Chiropractic and Acupuncture Services (pdf)
  20. Dental Services (pdf)
  21. Pharmacy Services (pdf)
  22. Mental Health & Substance Use Disorders Services (pdf)
  23. Personal Care Assistant (PCA) Services (pdf)
  24. Home Health Care/Hospice Services (pdf)
  25. Optical Services (pdf)
  26. Interpreter Services (pdf)
  27. Transportation Services (pdf)
  28. Critical Access Hospital (CAH) (pdf)
  29. Rural Health Clinic (RHC) and Federally Qualified Health Centers (FQHC) (pdf)
  30. Long-Term Care (LTC) (pdf)
  31. Immunizations and Vaccinations (pdf)
  32. Home and Community Based Services - Elderly Waiver (pdf)
  33. Telehealth (pdf)
  34. Housing Stabilization Services (pdf)
  35. School-based Community Services (pdf)
  36. Early Intensive Developmental and Behavioral Intervention (EIDBI) Services
  37. Minnesota Provider Screening and Enrollment
  38. Physician and Professional Services
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