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MI Enter the recipient s middle initial if known. ID Number Enter the recipient s 8-digit MHCP ID number. Clear Form DHS-4695-ENG 9-14 Page Minnesota Health Care Programs MHCP of DOCUMENT CONTROL NUMBER FOR INTERNAL USE ONLY Authorization Form For physician administered drugs J-codes send all supporting documentation by fax or mail to Send to Medical Review Agent 7900 International Plaza Drive Suite 988 Bloomington MN 55425 Fax 1-866-889-6512 MHCP Prescription Drug Prior Authorization Review Ag ...

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is DHS sir?

The DHS Systems Information Resource (SIR) provides system availability information, announcements, and targeted links and content. DHS SIR is a secure system and can only be accessed by county, tribal and state MAXIS, MMIS, MEC2, and PRISM users. Report this page. Issue: [select]

What is the difference between Umpi and NPI?

Your provider identifier is your National Provider Identifier (NPI) or a Unique Minnesota Provider Identifier (UMPI). An NPI is a standard national unique identifier that is used to submit and process health care claims and other transactions.

What is MN Medicaid called?

Medical Assistance (MA) is Minnesota's Medicaid program for people with low income. Most people who have MA get health care through health plans.

How do I apply for welfare in Minnesota?

You can apply: Online at MNbenefits.mn.gov. On paper using the Combined Application Form (PDF). Mail or bring the completed form to your local county or tribal office.

What is the difference between Medical Assistance and Minnesota Care?

Medical Assistance (MA) is Minnesota's Medicaid program for people with low income. MA does not require you to pay a monthly premium. MA members have small co-pays for some services, usually $1 - $3. MinnesotaCare is a program for Minnesotans with low incomes who do not have access to affordable health care coverage.

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How do I upload documents to Hennepin County?

The best option for submitting documents and information is online through your InfoKeep account or MNBenefits. You can also send your documents to our virtual drop box, or fax or mail them. If you don't have access to these options, there are document drop boxes available at any Human Service Center.

Who is in charge of MN DHS?

Governor's administration Commissioner Jodi Harpstead leads one of the state's largest agencies. The department provides health care, economic assistance, child welfare services, services for the elderly and people with disabilities and other services for people who do not have the resources to meet their basic needs.

What is the combined application form mn?

The Combined Application Form (CAF) (DHS-5223) (PDF) allows people to apply for multiple assistance programs on 1 form. Minnesota Family Investment Program (MFIP). Refugee Cash Assistance (RCA). Diversionary Work Program (DWP).

Where do I send my combined application form Ramsey County?

Clients can send applications and verifications via email to FAS.Forms@ramseycounty.us, fax to 651-266-3942 or drop them off in a form drop box at sites throughout the county.

How do I contact Minnesota Medical Assistance?

Request an application by calling MinnesotaCare at (651) 297-3862 (Twin Cities Metro) or 1-800-657-3672 (toll-free). For TTY call 711 or 1-800-627-3529.