HF 3396

as introduced - 86th Legislature (2009 - 2010) Posted on 03/04/2010 09:53am

A bill for an act
relating to insurance; requiring health plan companies to submit medical claims
data to health plan sponsors; proposing coding for new law in Minnesota
Statutes, chapter 62J.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

new text begin [62J.84] MEDICAL CLAIMS DATA.
new text end

new text begin Subdivision 1. new text end

new text begin Transparency. new text end

new text begin On an annual basis, health plan companies and
managers of preferred provider networks must submit to plan sponsors the comprehensive
medical claims data submitted for reimbursement under the sponsor's health plan.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin For purposes of this section, the terms in this subdivision
have the meanings given.
new text end

new text begin (a) "Comprehensive medical claims data" means participant-specific medical claims
information that is submitted to a health plan company or a preferred provider network
manager for reimbursement under a health plan. Comprehensive medical claims data
includes, but is not limited to, information related to plan participants and providers;
claims submitted for payment, including diagnostic codes; provider pricing of claims; and
reimbursement provided to the provider by the plan and the participant.
new text end

new text begin (b) "Plan sponsor" means:
new text end

new text begin (1) the employer, in the case of an employee benefit plan established or maintained
by a single employer;
new text end

new text begin (2) the employee organization, in the case of a plan established or maintained by an
employee organization; or
new text end

new text begin (3) in the case of a plan established or maintained by two or more employers
or jointly by one or more employers and one or more employee organizations, the
association, committee, joint board of trustees, or other similar group of representatives of
the parties who establish or maintain the plan.
new text end

new text begin Subd. 3. new text end

new text begin Electronic submission. new text end

new text begin Submission of the data required in subdivision 1
must be provided in an electronic format that is agreed to by the plan sponsor and the health
plan company or manager of the preferred provider network that is submitting the data.
new text end