MN · guidance
MHCP Provider Manual, Hospice Services, Hospice Transaction Form
Hospice Transaction Form
The MHCP Hospice Transaction (DHS-2868) (PDF) is a multipurpose form for hospice providers to report hospice election, certification, revocation of hospice services, change of hospice provider, or a member’s death.
The elected hospice provider must follow the Hospice Transaction (DHS-2868) form’s instructions and complete the form to begin hospice services and report changes. The elected hospice provider must submit the completed form within two calendar days of beginning or changing services so that hospice spans can be added to a member’s profile and billing issues can be avoided.
Provenance
- Source
- www.dhs.state.mn.us
- Retrieved
- 2026-10-02
- Edition
- mhcp-hospice-2025-05-09
- Content hash
033693979da06274e10a308e2fc5899e5bf2c082acf43399e42f57b2592d7daa
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