O-11-212 Request to Add Out of State Provider

🎯 PURPOSE

Outlines the process to confirm if an out-of-state provider can sign home health orders or the Face to Face Encounter for a home health patient. If it is identified that an out-of-state provider must sign home health orders or the Face to Face Encounter, the specific case must first be reviewed by the Parent Clinical Compliance Specialist to determine if the provider is eligible to be used in that specific case and needing to be added to HCHB.

🔄 PROCESS

1. When a provider is needing to be added to HCHB, the branch will initiate the request by completing a REQUEST TO ADD NEW PHYSICIAN coordination note.

• REFERENCE

  Refer to process “O-11-203 Request to add New Physician” for additional details.

2. If the Medical Records Specialist discovers or is notified that the provider may be an out-of-state provider (not licensed in Minnesota), they will follow this process.
3. Medical Records Specialist will complete the following verification steps:
   1. Ensure provider is not licensed in the state of Minnesota
   2. Verify out-of-state licensure for the provider
   3. Manually verify PECOS
   4. Check Medicaid eligibility
4. Update Follow-Up section of the Coordination Note, stating they have initiated the process to evaluate the out of state provider.
5. If the provider is ONLY licensed out of state, Medical Records Specialist will initiate e-mail communication to the requestor, Branch Intake, Clinical Supervisor and the Parent Clinical Compliance Specialist :

6. Branch location will obtain all necessary information and reply back to the Request to Add Out of State Provider e-mail with responses to the above items for approval. Ensure that Parent Clinical Compliance Specialist is included on the response.
7. Parent Clinical Compliance Specialist will determine whether the out-of-state provider can be used in this case, which is specific to the client.
8. Parent Clinical Compliance Specialist will respond back to the Branch location and Medical Records Specialist with the final determination and guidance moving forward.
9. If approved, Medical Records Specialist will complete the process "Review Request to Add New Physician” and enter provider into HCHB.
   1. The Medical Records Specialist must also identify the provider as being licensed out-of-state in HCHB by adding the physician group "Out of State License" to the provider's information, overriding the physician group specific to the clinic group (e.g. Allina).
10. After completion of all previous steps, the Medical Records Specialist will notify the following individuals:
    1. Compliance Manager, who will add the specific provider and client information into a tracking system
    2. Medical Records Specialist who is assigned to adding provider group tags in Forcura, who will identify the provider as being licensed out-of-state in Forcura by adding the directory tag "Out of State License" to the directory.

📅 Effective: 3.25.24  |  🔍 Reviewed:   |  🛠️ Revised: 10.31.25 |  ✅ Approved by: JFJ, BL