skip to content
Primary navigation

Navigator Case Association Form Policy

Scope

This policy applies to navigators.

Terms and Definitions

  • IAP: Insurance Affordability Programs (IAPs) include Medical Assistance, MinnesotaCare and Advanced Premium Tax Credit (APTC).
  • MAXIS: A legacy computer system used by Minnesota state and county workers to determine eligibility for public assistance and health care.
  • METS: Minnesota Eligibility Technology System.
  • Navigator Case Association Form: Form used to associate a navigator with a consumer application or enrollment to facilitate per enrollee payments.

Policy Details

In order to facilitate the processing of payments to navigator organizations, navigators may use the online or paper Navigator Case Association Form to associate with a consumer when other methods of association are not possible. Refer to the Assister Case Association policy for procedures for using other methods of association.

Allowable situations for using the online or paper Navigator Case Association Form include:

  • Assisted with submitting a pre-populated Renewal Form for a consumer in “Need to Renew” status in METS (Consumers in “Auto Renew” status and MAXIS renewals are not eligible for payment)
  • Assisted a consumer with an application for coverage that is not processed through METS (check one):
    • Minnesota Health Care Programs Application for Certain Populations (DHS-3876)
    • DACA Application (Deferred Action for Childhood Arrivals)
    • Medicare Savings Program
  • Assisted an inmate with completing a Minnesota Health Care Programs Application
  • Assisted a consumer who submitted a paper Application for Health Coverage (DHS-6696 or DHS-6741, including EMA)
  • Assisted a consumer who submitted an online application and the navigator and consumer were not associated at the time the application was submitted
  • Assisted with reporting a life event that resulted in newly adding IAP coverage for a household member
  • Assisted a renewing consumer with actively selecting a qualified health plan during open enrollment or a special enrollment period and the navigator and consumer were not associated through the assister portal at the time the enrollment was completed

Online Form Procedure

  1. Go to the Online Case Association Form
  2. Fill out all required fields (*) on the form. All required fields must be completed or the form will not be accepted.
  3. An electronic signature is required from both the navigator and the primary applicant.
  4. Once the navigator clicks “submit” on the online form, the data will be automatically submitted to the ARC for processing. If there are any issues with the data, the ARC will contact the navigator directly.
  5. The online form must be submitted within 30 days of the application. Online forms submitted 30 days after the application date will not be processed.

Paper Form Procedure

Please use the online form whenever possible

  1. All required fields (*) on the paper form must be completed or the form will not be processed.
  2. Enter information about the navigator in the “From:” section.
  3. Enter information about the primary applicant in the “Re:” section.
    • The name, date of birth and address are all required fields.
    • If a paper application was submitted, the date of application is also a required field.
  4. Enter the name and date of birth for any additional household members applying for coverage or enrolling in a qualified health plan.
  5. Select the reason for using the form. If no reason is selected, the form will not be processed.
  6. A signature is required from both the navigator and the primary applicant. While the Navigator Case Association Form is fillable, it will need to be printed to be signed by the navigator and the applicant. Electronic signatures are not acceptable.
  7. Submit the form to the ARC by fax or secure email within 30 days. Incomplete forms received by the ARC will not be processed. A new and complete form will need to be submitted to process the association.

References and Related Documents

back to top