2000 Minnesota Statutes

     62J.52 Establishment of uniform billing forms. 

    Subdivision 1.    Uniform billing form HCFA 1450.  (a) 
 On and after January 1, 1996, all institutional inpatient 
 hospital services, ancillary services, institutionally owned or 
 operated outpatient services rendered by providers in Minnesota, 
 and institutional or noninstitutional home health services that 
 are not being billed using an equivalent electronic billing 
 format, must be billed using the uniform billing form HCFA 1450, 
 except as provided in subdivision 5. 

    (b) The instructions and definitions for the use of the 
 uniform billing form HCFA 1450 shall be in accordance with the 
 uniform billing form manual specified by the commissioner.  In 
 promulgating these instructions, the commissioner may utilize 
 the manual developed by the National Uniform Billing Committee, 
 as adopted and finalized by the Minnesota uniform billing 
 committee.  

    (c) Services to be billed using the uniform billing form 
 HCFA 1450 include:  institutional inpatient hospital services 
 and distinct units in the hospital such as psychiatric unit 
 services, physical therapy unit services, swing bed (SNF)  
 services, inpatient state psychiatric hospital services, 
 inpatient skilled nursing facility services, home health 
 services (Medicare part A), and hospice services; ancillary 
 services, where benefits are exhausted or patient has no 
 Medicare part A, from hospitals, state psychiatric hospitals, 
 skilled nursing facilities, and home health (Medicare part B); 
 institutional owned or operated outpatient services such as 
 waivered services, hospital outpatient services, including 
 ambulatory surgical center services, hospital referred 
 laboratory services, hospital-based ambulance services, and 
 other hospital outpatient services, skilled nursing facilities, 
 home health, including infusion therapy, freestanding renal 
 dialysis centers, comprehensive outpatient rehabilitation 
 facilities (CORF), outpatient rehabilitation facilities (ORF), 
 rural health clinics, and community mental health centers; home 
 health services such as home health intravenous therapy 
 providers, waivered services, personal care attendants, and 
 hospice; and any other health care provider certified by the 
 Medicare program to use this form. 

    (d) On and after January 1, 1996, a mother and newborn 
 child must be billed separately, and must not be combined on one 
 claim form. 

    Subd. 2.    Uniform billing form HCFA 1500.  (a) On and 
 after January 1, 1996, all noninstitutional health care services 
 rendered by providers in Minnesota except dental or pharmacy 
 providers, that are not currently being billed using an 
 equivalent electronic billing format, must be billed using the 
 health insurance claim form HCFA 1500, except as provided in 
 subdivision 5. 

    (b) The instructions and definitions for the use of the 
 uniform billing form HCFA 1500 shall be in accordance with the 
 manual developed by the administrative uniformity committee 
 entitled standards for the use of the HCFA 1500 form, dated 
 February 1994, as further defined by the commissioner. 

    (c) Services to be billed using the uniform billing form 
 HCFA 1500 include physician services and supplies, durable 
 medical equipment, noninstitutional ambulance services, 
 independent ancillary services including occupational therapy, 
 physical therapy, speech therapy and audiology, podiatry 
 services, optometry services, mental health licensed 
 professional services, substance abuse licensed professional 
 services, nursing practitioner professional services, certified 
 registered nurse anesthetists, chiropractors, physician 
 assistants, laboratories, medical suppliers, and other health 
 care providers such as day activity centers and freestanding 
 ambulatory surgical centers. 

    Subd. 3.    Uniform dental billing form.  (a) On and 
 after January 1, 1996, all dental services provided by dental 
 care providers in Minnesota, that are not currently being billed 
 using an equivalent electronic billing format, shall be billed 
 using the American Dental Association uniform dental billing 
 form. 

    (b) The instructions and definitions for the use of the 
 uniform dental billing form shall be in accordance with the 
 manual developed by the administrative uniformity committee 
 dated February 1994, and as amended or further defined by the 
 commissioner. 

    Subd. 4.    Uniform pharmacy billing form.  (a) On and 
 after January 1, 1996, all pharmacy services provided by 
 pharmacists in Minnesota that are not currently being billed 
 using an equivalent electronic billing format shall be billed 
 using the NCPDP/universal claim form, except as provided in 
 subdivision 5. 

    (b) The instructions and definitions for the use of the 
 uniform claim form shall be in accordance with instructions 
 specified by the commissioner of health, except as provided in 
 subdivision 5. 

    Subd. 5.    State and federal health care programs.  (a) 
 Skilled nursing facilities and ICF/MR services billed to state 
 and federal health care programs administered by the department 
 of human services shall use the form designated by the 
 department of human services. 

    (b) On and after July 1, 1996, state and federal health 
 care programs administered by the department of human services 
 shall accept the HCFA 1450 for community mental health center 
 services and shall accept the HCFA 1500 for freestanding 
 ambulatory surgical center services. 

    (c) State and federal health care programs administered by 
 the department of human services shall be authorized to use the 
 forms designated by the department of human services for 
 pharmacy services. 

    (d) State and federal health care programs administered by 
 the department of human services shall accept the form 
 designated by the department of human services, and the HCFA 
 1500 for supplies, medical supplies, or durable medical 
 equipment.  Health care providers may choose which form to 
 submit. 

    (e) Personal care attendant and waivered services billed on 
 a fee-for-service basis directly to state and federal health 
 care programs administered by the department of human services 
 shall use either the HCFA 1450 or the HCFA 1500 form, as 
 designated by the department of human services. 

    HIST: 1994 c 625 art 9 s 3; 2000 c 460 s 4-6