Minnesota Health Care Programs (MHCP)
MHCP Providers

Reminder: Service Agreement and Screening Document (SASD) support team discontinues fax option to submit documents

This is a reminder that the SASD support team will no longer have an active fax number beginning May 1, 2024. Several provider groups will now have to use online forms to submit materials that previously were faxed to the SASD support team. Refer to the following guidance.

• Personal care assistance (PCA) – Use the following online form to request a technical change:
  • Personal Care Assistance (PCA) Technical Change Request (DHS-4074A)
• Skilled nursing visits, home health services, and home care nursing providers – Use the following online form to request a technical change:
  • MA Home Care Technical Change Request (DHS-4074)
• County public health agencies, tribal nations and PCA assessors contracted by a lead agency – Use the following online form to request a technical change:
  • PCA Request Form (for lead agency use) (DHS-4292)
• County and managed care organization staff – Use the following online form to request the deletion of a screening document from MMIS:
  • Screening Deletion Request (DHS-4689A)

Helpful reminders:

• When submitting forms, double-check that you have correctly entered your name and contact information, such as email address and phone number. This ensures you receive an auto-generated response that the form was successfully submitted and that the SASD support team can contact you about your request.
• Only submit forms to the location and fax number as listed on the form or within the form instructions since the SASD support team fax number will be discontinued.