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