The core of the HealthPartners MTM program is grounded in evidence that pharmacists integrated into patient care help achieve the triple aim: The best care at the lowest total cost with excellent patient experience. HealthPartners offers compensation to pharmacists for MTM services provided to more than 800,000 members across our Medicaid, Commercial, and Medicare populations.
Step 1: Apply for a provider NPI
Both a pharmacist and facility NPI are required to submit MTM claims. The application for an NPI may be submitted electronically on the NPPES website. Once a provider is assigned an NPI, the provider must update information within 30 days of any changes. In addition, there is no cost to the provider to obtain an NPI.
Step 2: Provider Enrollment
To be reimbursed for services provided to HealthPartners members, a pharmacist must enroll to be added to the plans provider network.
Step 3: Provider Credentialing
HealthPartners MTM program providers must be credentialed and meet a number of requirements to qualify for participation in the MTM program. Credentialing is a process to ensure a provider's qualifications to provide a given level of service. That pharmacist can fill out the MTM Initial Credentialing Application and submit through the HealthPartners online portal.
Providers must have graduated from an accredited college of pharmacy on or after January 1, 1996, or completed a structured and comprehensive education program approved by the Board of Pharmacy and the Accreditation Council for Pharmacy Education for the provision and documentation of pharmaceutical care management services that have both clinical and didactic elements. Acceptable programs are:
Delivering Medication Therapy Management Services in the in the Community/Delivering MTM Services - American Pharmacists Association or other authorized local organizations
Pharmaceutical Care Series (Level 1-3) – University of Minnesota
Step 4: Space Requirements
Provide care in a private location that meets the following requirements:
For in-person visits:
Have sufficient size and accommodations to comfortably seat at least three people (two for Interactive video) at a table
Be private, so that when a typical patient is sitting or standing in the consulting area, the patient cannot be seen by others (including other patients, customers and employees)
Be entirely devoted to enhancing patient outcomes and not used as a storage room for merchandise or other non-related items
Be accessible to the patient without having to traverse through dispensing or storage areas
Be enclosed sufficiently to prevent typical patient consultation conversation from being heard from other areas of the physical location
Be enclosed sufficiently to prevent noise from other areas of the physical location to interfere with or distract from typical conversation in the consulting area
For telehealth visits:
For visits that include video, be professional in appearance for areas of the MTM provider’s physical location that are visible to the patient
Be private, so that when a typical patient is visible via video the patient cannot be seen by others either inside or outside the MTM provider’s physical location
Be enclosed sufficiently to prevent typical patient consultation conversation from being heard from other areas of the MTM provider’s physical location
Be enclosed sufficiently to prevent noise from other areas of the MTM provider’s physical location to interfere with or distract from typical patient consultation conversation
Step 5: Understanding MTM Reimbursement
Pharmacy providers can be reimbursed for delivering two levels of MTM service codes to ForwardHealth members. These are categorized using CPT codes that describe the level of care provided and include the following:
99605 - MTM service provided by a pharmacist, individual, face-to-face with patient, with assessment and intervention if provided; initial 15 minutes, new patient ($15)
99606 - MTM service provided by a pharmacist, individual, face-to-face with patient with assessment and intervention if provided; initial 15 minutes, established patient ($40)
99607 - MTM service provided by a pharmacist, individual, face-to-face with patient with assessment and intervention if provided; additional time increments of 8 to 15 minutes as add on to 99605 and 99606 ($35)
Pharmacist billing through DocStation can earn up to $380 per member per rolling year in the HealthPartners MTM program!
It is important to note that an initial visit (CPT 99605) can only be performed once per member per rolling year, while the follow-up visit (CPT 99606) can be performed up to six times per member per rolling year. Please refer to the billing resources available on the HealthPartners provider portal for additional information.
Step 6: Enable Claims in DocStation!
Activate the DocStation Essentials or Premium subscription to start billing for your clinical services, and so much more, today!
Note: DocStation "Getting Started" assistance does not replace the requirements of the HealthPartners plans and programs. Please refer to the online HealthPartners Provider Portal for complete guidance.