HF 3372
1st Unofficial Engrossment - 85th Legislature (2007 - 2008)
Posted on 12/15/2009 12:00 a.m.
KEY: stricken = removed, old language.
underscored = added, new language.
Line numbers
1.1A bill for an act
1.2relating to health; changing provisions for uniform billing forms and electronic
1.3claim filing; establishing compliance procedures for electronic transactions;
1.4amending Minnesota Statutes 2006, sections 62J.51, subdivisions 17, 18;
1.562J.52, subdivision 4; 62J.59; 72A.201, subdivision 4; Minnesota Statutes
1.62007 Supplement, sections 62J.52, subdivisions 1, 2; 62J.536, subdivision 1,
1.7by adding subdivisions; repealing Minnesota Statutes 2006, sections 62J.52,
1.8subdivision 5; 62J.58.
1.9BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.10 Section 1. Minnesota Statutes 2006, section 62J.51, subdivision 17, is amended to read:
1.11 Subd. 17. Uniform billing form CMS 1450. "Uniform billing form CMS 1450"
1.12means the new text begin most current version of the new text end uniform billing form known as the CMS 1450 or
1.13UB92, developed by the National Uniform Billing Committee in 1992 and approved for
1.14implementation in October 1993, and any subsequent amendments to the form.
1.15 Sec. 2. Minnesota Statutes 2006, section 62J.51, subdivision 18, is amended to read:
1.16 Subd. 18. Uniform billing form CMS 1500. "Uniform billing form CMS 1500"
1.17means the 1990 new text begin most current new text end version of the health insurance claim form, CMS 1500,
1.18developed by the National Uniform Claim Committee and any subsequent amendments to
1.19the form.
1.20 Sec. 3. Minnesota Statutes 2007 Supplement, section 62J.52, subdivision 1, is amended
1.21to read:
1.22 Subdivision 1. Uniform billing form CMS 1450. (a) On and after January 1,
1.231996, all institutional inpatient hospital services, ancillary services, institutionally owned
1.24or operated outpatient services rendered by providers in Minnesota, and institutional
2.1or noninstitutional home health services that are not being billed using an equivalent
2.2electronic billing format, must be billed using the uniform billing form CMS 1450, except
2.3as provided in subdivision 5.
2.4 (b) The instructions and definitions for the use of the uniform billing form CMS
2.51450 shall be in accordance with the uniform billing form manual specified by the
2.6commissioner. In promulgating these instructions, the commissioner may utilize the
2.7manual developed by the National Uniform Billing Committee, as adopted and finalized
2.8by the Minnesota Uniform Billing Committee.
2.9 (c) Services to be billed using the uniform billing form CMS 1450 include:
2.10institutional inpatient hospital services and distinct units in the hospital such as psychiatric
2.11unit services, physical therapy unit services, swing bed (SNF) services, inpatient state
2.12psychiatric hospital services, inpatient skilled nursing facility services, home health
2.13services (Medicare part A), and hospice services; ancillary services, where benefits are
2.14exhausted or patient has no Medicare part A, from hospitals, state psychiatric hospitals,
2.15skilled nursing facilities, new text begin ICF/MR's,new text end and home health (Medicare part B); institutional
2.16owned or operated outpatient services such as waivered services, hospital outpatient
2.17services, including ambulatory surgical center services, hospital referred laboratory
2.18services, hospital-based ambulance services, and other hospital outpatient services,
2.19skilled nursing facilities, home health, freestanding renal dialysis centers, comprehensive
2.20outpatient rehabilitation facilities (CORF), outpatient rehabilitation facilities (ORF), rural
2.21health clinics,new text begin federally qualified health centers,new text end and community mental health centers;
2.22home health services such as home health intravenous therapy providers, waivered
2.23services, personal care attendants, and hospice; and any other health care provider certified
2.24by the Medicare program to use this form.
2.25 (d) On and after January 1, 1996, a mother and newborn child must be billed
2.26separately, and must not be combined on one claim form.
2.27 (e) Services provided by Medicare Critical Access Hospitals electing Method
2.28II billing will be allowed an exception to this provision to allow the inclusion of the
2.29professional fees on the CMS 1450.
2.30 Sec. 4. Minnesota Statutes 2007 Supplement, section 62J.52, subdivision 2, is amended
2.31to read:
2.32 Subd. 2. Uniform billing form CMS 1500. (a) On and after January 1, 1996, all
2.33noninstitutional health care services rendered by providers in Minnesota except dental
2.34or pharmacy providers, that are not currently being billed using an equivalent electronic
3.1billing format, must be billed using the health insurance claim form CMS 1500, except as
3.2provided in subdivision 5.
3.3 (b) The instructions and definitions for the use of the uniform billing form CMS
3.41500 shall be in accordance with the manual developed by the Administrative Uniformity
3.5Committee entitled standards for the use of the CMS 1500 form, dated February 1994,
3.6as further defined by the commissioner.
3.7 (c) Services to be billed using the uniform billing form CMS 1500 include physician
3.8services and supplies, durable medical equipment, noninstitutional ambulance services,
3.9independent ancillary services including occupational therapy, physical therapy, speech
3.10therapy and audiology, home infusion therapy, podiatry services, optometry services,
3.11mental health licensed professional services, substance abuse licensed professional
3.12services, nursing practitioner professional services, certified registered nurse anesthetists,
3.13chiropractors, physician assistants, laboratories, medical suppliers, new text begin waivered services, new text end
3.14new text begin personal care attendants, new text end and other health care providers such as day activity centers and
3.15freestanding ambulatory surgical centers.
3.16 (d) Services provided by Medicare Critical Access Hospitals electing Method
3.17II billing will be allowed an exception to this provision to allow the inclusion of the
3.18professional fees on the CMS 1450.
3.19 Sec. 5. Minnesota Statutes 2006, section 62J.52, subdivision 4, is amended to read:
3.20 Subd. 4. Uniform pharmacy billing form. (a) On and after January 1, 1996,
3.21all pharmacy services provided by pharmacists in Minnesota that are not currently
3.22being billed using an equivalent electronic billing format shall be billed using the
3.23NCPDP/universal claim form, except as provided in subdivision 5.
3.24(b) The instructions and definitions for the use of the uniform claim form shall
3.25be in accordance with instructions specified by the commissioner of health, except as
3.26provided in subdivision 5.
3.27 Sec. 6. Minnesota Statutes 2007 Supplement, section 62J.536, subdivision 1, is
3.28amended to read:
3.29 Subdivision 1. Electronic claims and eligibility transactions required. (a)
3.30Beginning January 15, 2009, all group purchasers must accept from health care providers
3.31the eligibility for a health plan transaction described under Code of Federal Regulations,
3.32title 45, part 162, subpart L. Beginning July 15, 2009, all group purchasers must accept
3.33from health care providers the health care claims or equivalent encounter information
3.34transaction described under Code of Federal Regulations, title 45, part 162, subpart K.
4.1 (b) Beginning January 15, 2009, all group purchasers must transmit to providers
4.2the eligibility for a health plan transaction described under Code of Federal Regulations,
4.3title 45, part 162, subpart L. Beginning December 1new text begin 15new text end , 2009, all group purchasers must
4.4transmit to providers the health care payment and remittance advice transaction described
4.5under Code of Federal Regulations, title 45, part 162, subpart P.
4.6 (c) Beginning January 15, 2009, all health care providers must submit to group
4.7purchasers the eligibility for a health plan transaction described under Code of Federal
4.8Regulations, title 45, part 162, subpart L. Beginning July 15, 2009, all health care
4.9providers must submit to group purchasers the health care claims or equivalent encounter
4.10information transaction described under Code of Federal Regulations, title 45, part 162,
4.11subpart K.
4.12 (d) Beginning January 15, 2009, all health care providers must accept from group
4.13purchasers the eligibility for a health plan transaction described under Code of Federal
4.14Regulations, title 45, part 162, subpart L. Beginning December 15, 2009, all health care
4.15providers must accept from group purchasers the health care payment and remittance
4.16advice transaction described under Code of Federal Regulations, title 45, part 162, subpart
4.17P.
4.18 (e) Each of the transactions described in paragraphs (a) to (d) shall require the use
4.19of a single, uniform companion guide to the implementation guides described under
4.20Code of Federal Regulations, title 45, part 162. The companion guides will be developed
4.21pursuant to subdivision 2.
4.22 (f) Notwithstanding any other provisions in sections
62J.50 to
62J.61, all group
4.23purchasers and health care providers must exchange claims and eligibility information
4.24electronically using the transactions, companion guides, implementation guides, and
4.25timelines required under this subdivision. Group purchasers may not impose any fee on
4.26providers for the use of the transactions prescribed in this subdivision.
4.27 (g) Nothing in this subdivision shall prohibit group purchasers and health care
4.28providers from using a direct data entry, Web-based methodology for complying with
4.29the requirements of this subdivision. Any direct data entry method for conducting
4.30the transactions specified in this subdivision must be consistent with the data content
4.31component of the single, uniform companion guides required in paragraph (e) and the
4.32implementation guides described under Code of Federal Regulations, title 45, part 162.
4.33 Sec. 7. Minnesota Statutes 2007 Supplement, section 62J.536, is amended by adding a
4.34subdivision to read:
5.1 new text begin Subd. 4.new text end new text begin Group purchasers not covered by HIPAA.new text end new text begin (a) For transactions with new text end
5.2new text begin group purchasers defined in section 62J.03, subdivision 6, that are not covered under new text end
5.3new text begin United States Code, title 42, sections 1320d to 1320d-8, the requirements of this section new text end
5.4new text begin are modified as follows:new text end
5.5new text begin (1) The group purchasers may be exempt from one or more of the requirements new text end
5.6new text begin to exchange claims and eligibility information electronically using the transactions, new text end
5.7new text begin companion guides, implementation guides, and timelines in subdivision 1 if the new text end
5.8new text begin commissioner of health determines that:new text end
5.9new text begin (i) a transaction is incapable of exchanging data that are currently being exchanged new text end
5.10new text begin on paper and is necessary to accomplish the purpose of the transaction; ornew text end
5.11new text begin (ii) another national electronic transaction standard would be more appropriate and new text end
5.12new text begin effective to accomplish the purpose of the transaction.new text end
5.13new text begin (2) If group purchasers are exempt from one or more of the requirements to exchange new text end
5.14new text begin claims and eligibility information electronically using the transactions, companion guides, new text end
5.15new text begin implementation guides, and timelines in subdivision 1, providers shall also be exempt new text end
5.16new text begin from exchanging those transactions with the group purchaser.new text end
5.17new text begin (3) If the commissioner of health exempts a group purchaser from one or more of new text end
5.18new text begin the requirements because a transaction is incapable of exchanging data that are currently new text end
5.19new text begin being exchanged on paper and are necessary to accomplish the purpose of the transaction, new text end
5.20new text begin the commissioner shall review that exemption annually. If the commissioner determines new text end
5.21new text begin that the exemption is no longer necessary or appropriate, the commissioner of health shall new text end
5.22new text begin adopt rules pursuant to section 62J.61 establishing and requiring group purchasers and new text end
5.23new text begin health care providers to use the transactions and the uniform, standard companion guides new text end
5.24new text begin required under subdivision 1, paragraph (e). Group purchasers and providers shall have 12 new text end
5.25new text begin months to implement any rules adopted.new text end
5.26new text begin (4) If the commissioner of health exempts a group purchaser from one or more of new text end
5.27new text begin the requirements because another national electronic transaction standard would be more new text end
5.28new text begin appropriate and effective to accomplish the purpose of the transaction, the commissioner new text end
5.29new text begin shall adopt rules pursuant to section 62J.61 establishing and requiring group purchasers new text end
5.30new text begin and health care providers to use the national electronic transaction standard. Group new text end
5.31new text begin purchasers and providers shall have 12 months to implement any rules adopted.new text end
5.32new text begin (5) The requirement of paper claims attachments shall not indicate that a health new text end
5.33new text begin care claims or equivalent encounter information transaction described under Code of new text end
5.34new text begin Federal Regulations, title 45, part 162, subpart K, is incapable of exchanging data that new text end
5.35new text begin are currently being exchanged on paper provided that the electronic health care claims new text end
5.36new text begin transaction has a mechanism to link the paper attachments to the electronic claim.new text end
6.1 Sec. 8. Minnesota Statutes 2007 Supplement, section 62J.536, is amended by adding a
6.2subdivision to read:
6.3 new text begin Subd. 5.new text end new text begin Compliance and investigations.new text end new text begin (a) The commissioner of health shall, to new text end
6.4new text begin the extent practicable, seek the cooperation of health care providers and group purchasers new text end
6.5new text begin in obtaining compliance with this section and may provide technical assistance to health new text end
6.6new text begin care providers and group purchasers.new text end
6.7 new text begin (b) A person who believes a health care provider or group purchaser is not complying new text end
6.8new text begin with the requirements of this section may file a complaint with the commissioner of health. new text end
6.9new text begin Complaints filed under this section must meet the following requirements:new text end
6.10 new text begin (1) A complaint must be filed in writing, either on paper or electronically.new text end
6.11 new text begin (2) A complaint must name the person that is the subject of the complaint and new text end
6.12new text begin describe the acts or omissions believed to be in violation of this section.new text end
6.13 new text begin (3) A complaint must be filed within 180 days of when the complainant knew or new text end
6.14new text begin should have known that the act or omission complained of occurred.new text end
6.15 new text begin (4) The commissioner may prescribe additional procedures for the filing of new text end
6.16new text begin complaints as required to satisfy the requirements of this section.new text end
6.17 new text begin (c) The commissioner of health may investigate complaints filed under this section. new text end
6.18new text begin The investigation may include a review of the pertinent policies, procedures, or practices new text end
6.19new text begin of the health care provider or group purchaser and of the circumstances regarding any new text end
6.20new text begin alleged violation. At the time of initial written communication with the health care new text end
6.21new text begin provider or group purchaser about the complaint, the commissioner of health shall new text end
6.22new text begin describe the acts or omissions that are the basis of the complaint. The commissioner new text end
6.23new text begin may conduct compliance reviews to determine whether health care providers and group new text end
6.24new text begin purchasers are complying with this section.new text end
6.25 new text begin (d) Health care providers and group purchasers must cooperate with the new text end
6.26new text begin commissioner of health if the commissioner undertakes an investigation or compliance new text end
6.27new text begin review of the policies, procedures, or practices of the health care provider or group new text end
6.28new text begin purchaser to determine compliance with this section. This cooperation includes, but is new text end
6.29new text begin not limited to:new text end
6.30 new text begin (1) A health care provider or group purchaser must permit access by the new text end
6.31new text begin commissioner of health during normal business hours to its facilities, books, records, new text end
6.32new text begin accounts, and other sources of information that are pertinent to ascertaining compliance new text end
6.33new text begin with this section.new text end
6.34 new text begin (2) If any information required of a health care provider or group purchaser under new text end
6.35new text begin this section is in the exclusive possession of any other agency, institution, or person and new text end
6.36new text begin the other agency, institution, or person fails or refuses to furnish the information, the new text end
7.1new text begin health care provider or group purchaser must so certify and set forth what efforts it has new text end
7.2new text begin made to obtain the information.new text end
7.3 new text begin (3) Any individually identifiable health information obtained by the commissioner new text end
7.4new text begin of health in connection with an investigation or compliance review under this section new text end
7.5new text begin may not be used or disclosed by the commissioner of health, except as necessary for new text end
7.6new text begin ascertaining or enforcing compliance with this section.new text end
7.7 new text begin (e) If an investigation of a complaint indicates noncompliance, the commissioner new text end
7.8new text begin of health shall attempt to reach a resolution of the matter by informal means. Informal new text end
7.9new text begin means may include demonstrated compliance or a completed corrective action plan or new text end
7.10new text begin other agreement. If the matter is resolved by informal means, the commissioner of health new text end
7.11new text begin shall so inform the health care provider or group purchaser and, if the matter arose from a new text end
7.12new text begin complaint, the complainant, in writing. If the matter is not resolved by informal means, new text end
7.13new text begin the commissioner of health shall:new text end
7.14 new text begin (1) inform the health care provider or group purchaser and provide an opportunity new text end
7.15new text begin for the health care provider or group purchaser to submit written evidence of any new text end
7.16new text begin mitigating factors or other considerations. The health care provider or group purchaser new text end
7.17new text begin must submit any such evidence to the commissioner of health within 30 calendar days new text end
7.18new text begin of receipt of the notification; andnew text end
7.19 new text begin (2) inform the health care provider or group purchaser, through a notice of proposed new text end
7.20new text begin determination according to paragraph (i), that the commissioner of health finds that a new text end
7.21new text begin civil money penalty should be imposed.new text end
7.22 new text begin (f) If, after an investigation or a compliance review, the commissioner of health new text end
7.23new text begin determines that further action is not warranted, the commissioner of health shall so inform new text end
7.24new text begin the health care provider or group purchaser and, if the matter arose from a complaint, the new text end
7.25new text begin complainant, in writing.new text end
7.26 new text begin (g) A health care provider or group purchaser may not threaten, intimidate, coerce, new text end
7.27new text begin harass, discriminate against, or take any other retaliatory action against any individual new text end
7.28new text begin or other person for:new text end
7.29 new text begin (1) filing of a complaint under this section;new text end
7.30 new text begin (2) testifying, assisting, or participating in an investigation, compliance review, new text end
7.31new text begin proceeding, or contested case proceeding under this section; ornew text end
7.32 new text begin (3) opposing any act or practice made unlawful by this section, provided the new text end
7.33new text begin individual or person has a good faith belief that the practice opposed is unlawful, and new text end
7.34new text begin the manner of opposition is reasonable and does not involve an unauthorized disclosure new text end
7.35new text begin of a patient's health information.new text end
8.1 new text begin (h) The commissioner of health may impose a civil money penalty on a health care new text end
8.2new text begin provider or group purchaser if the commissioner of health determines that the health new text end
8.3new text begin care provider or group purchaser has violated this section. If the commissioner of health new text end
8.4new text begin determines that more than one health care provider or group purchaser was responsible new text end
8.5new text begin for a violation, the commissioner of health may impose a civil money penalty against new text end
8.6new text begin each health care provider or group purchaser. The amount of a civil money penalty shall new text end
8.7new text begin be determined as follows:new text end
8.8 new text begin (1) The amount of a civil money penalty shall be up to $100 for each violation, but new text end
8.9new text begin not exceed $25,000 for identical violations during a calendar year.new text end
8.10 new text begin (2) In the case of continuing violation of this section, a separate violation occurs each new text end
8.11new text begin business day that the health care provider or group purchaser is in violation of this section.new text end
8.12 new text begin (3) In determining the amount of any civil money penalty, the commissioner of health new text end
8.13new text begin may consider as aggravating or mitigating factors, as appropriate, any of the following:new text end
8.14 new text begin (i) the nature of the violation, in light of the purpose of the goals of this section;new text end
8.15 new text begin (ii) the time period during which the violation occurred;new text end
8.16 new text begin (iii) whether the violation hindered or facilitated an individual's ability to obtain new text end
8.17new text begin health care;new text end
8.18 new text begin (iv) whether the violation resulted in financial harm;new text end
8.19 new text begin (v) whether the violation was intentional;new text end
8.20 new text begin (vi) whether the violation was beyond the direct control of the health care provider new text end
8.21new text begin or group purchaser;new text end
8.22 new text begin (vii) any history of prior compliance with the provisions of this section, including new text end
8.23new text begin violations;new text end
8.24 new text begin (viii) whether and to what extent the provider or group purchaser has attempted to new text end
8.25new text begin correct previous violations;new text end
8.26 new text begin (ix) how the health care provider or group purchaser has responded to technical new text end
8.27new text begin assistance from the commissioner of health provided in the context of a compliance new text end
8.28new text begin effort; ornew text end
8.29 new text begin (x) the financial condition of the health care provider or group purchaser including, new text end
8.30new text begin but not limited to, whether the healthcare provider or group purchaser had financial new text end
8.31new text begin difficulties that affected its ability to comply or whether the imposition of a civil money new text end
8.32new text begin penalty would jeopardize the ability of the health care provider or group purchaser to new text end
8.33new text begin continue to provide, or to pay for, health care.new text end
8.34 new text begin (i) If a penalty is proposed according to this section, the commissioner of health new text end
8.35new text begin must deliver, or send by certified mail with return receipt requested, to the respondent new text end
9.1new text begin written notice of the commissioner of health's intent to impose a penalty. This notice new text end
9.2new text begin of proposed determination must include:new text end
9.3 new text begin (1) a reference to the statutory basis for the penalty;new text end
9.4 new text begin (2) a description of the findings of fact regarding the violations with respect to new text end
9.5new text begin which the penalty is proposed;new text end
9.6 new text begin (3) the amount of the proposed penalty;new text end
9.7 new text begin (4) any circumstances described in paragraph (i) that were considered in determining new text end
9.8new text begin the amount of the proposed penalty;new text end
9.9 new text begin (5) instructions for responding to the notice, including a statement of the respondent's new text end
9.10new text begin right to a contested case proceeding and a statement that failure to request a contested case new text end
9.11new text begin proceeding within 30 calendar days permits the imposition of the proposed penalty; and new text end
9.12 new text begin (6) the address to which the contested case proceeding request must be sent.new text end
9.13 new text begin (j) A health care provider or group purchaser may contest whether the finding of new text end
9.14new text begin facts constitute a violation of this section, according to a contested case proceeding as set new text end
9.15new text begin forth in sections 14.57 to 14.62, subject to appeal according to sections 14.63 to 14.68.new text end
9.16 new text begin (k) Any data collected by the commissioner of health as part of an active new text end
9.17new text begin investigation or active compliance review under this section are classified as protected new text end
9.18new text begin nonpublic data pursuant to section 13.02, subdivision 13, in the case of data not on new text end
9.19new text begin individuals and confidential pursuant to section 13.02, subdivision 3, in the case of data new text end
9.20new text begin on individuals. Data describing the final disposition of an investigation or compliance new text end
9.21new text begin review are classified as public.new text end
9.22 new text begin (l) Civil money penalties imposed and collected under this subdivision shall be new text end
9.23new text begin deposited into a revolving fund and are appropriated to the commissioner of health for the new text end
9.24new text begin purposes of this subdivision, including the provision of technical assistance.new text end
9.25 Sec. 9. Minnesota Statutes 2006, section 62J.59, is amended to read:
9.2662J.59 IMPLEMENTATION OF NCPDP TELECOMMUNICATIONS
9.27STANDARD FOR PHARMACY CLAIMS.
9.28 (a) Beginning January 1, 1996, All category I and II pharmacists new text begin pharmacies new text end licensed
9.29in this state shall accept new text begin use new text end the new text begin most recent HIPAA-mandated version of the new text end NCPDP
9.30telecommunication standard format 3.2 or the NCPDP tape billing and payment format 2.0
9.31new text begin batch standard new text end for the electronic submission of claims new text begin to group purchasers new text end as appropriate.
9.32 (b) Beginning January 1, 1996, All category I and category II group purchasers
9.33in this state shall use the new text begin most recent HIPAA-mandated version of the new text end NCPDP
9.34telecommunication standard format 3.2 or NCPDP tape billing and payment format 2.0
10.1new text begin batch standard new text end for new text begin the new text end electronic submission of payment information new text begin NCPDP response new text end
10.2new text begin transaction new text end to pharmacistsnew text begin pharmacies as appropriatenew text end .
10.3 Sec. 10. Minnesota Statutes 2006, section 72A.201, subdivision 4, is amended to read:
10.4 Subd. 4. Standards for claim filing and handling. The following acts by an
10.5insurer, an adjuster, a self-insured, or a self-insurance administrator constitute unfair
10.6settlement practices:
10.7 (1) except for claims made under a health insurance policy, after receiving
10.8notification of claim from an insured or a claimant, failing to acknowledge receipt of the
10.9notification of the claim within ten business days, and failing to promptly provide all
10.10necessary claim forms and instructions to process the claim, unless the claim is settled
10.11within ten business days. The acknowledgment must include the telephone number of the
10.12company representative who can assist the insured or the claimant in providing information
10.13and assistance that is reasonable so that the insured or claimant can comply with the policy
10.14conditions and the insurer's reasonable requirements. If an acknowledgment is made by
10.15means other than writing, an appropriate notation of the acknowledgment must be made in
10.16the claim file of the insurer and dated. An appropriate notation must include at least the
10.17following information where the acknowledgment is by telephone or oral contact:
10.18 (i) the telephone number called, if any;
10.19 (ii) the name of the person making the telephone call or oral contact;
10.20 (iii) the name of the person who actually received the telephone call or oral contact;
10.21 (iv) the time of the telephone call or oral contact; and
10.22 (v) the date of the telephone call or oral contact;
10.23 (2) failing to reply, within ten business days of receipt, to all other communications
10.24about a claim from an insured or a claimant that reasonably indicate a response is
10.25requested or needed;
10.26 (3)(i) unless provided otherwise by clause (ii) or (iii), other law, or in the policy,
10.27failing to complete its investigation and inform the insured or claimant of acceptance or
10.28denial of a claim within 30 business days after receipt of notification of claim unless
10.29the investigation cannot be reasonably completed within that time. In the event that the
10.30investigation cannot reasonably be completed within that time, the insurer shall notify
10.31the insured or claimant within the time period of the reasons why the investigation is not
10.32complete and the expected date the investigation will be complete. For claims made under
10.33a health policy the notification of claim must be in writing;
10.34 (ii) for claims submitted under a health policy, the insurer must comply with all of
10.35the requirements of section
62Q.75;
11.1 (iii) for claims submitted under a health policy that are accepted, the insurer must
11.2notify the insured or claimant no less than semiannually of the disposition of claims of the
11.3insured or claimant. new text begin Notwithstanding the requirements of section 72A.20, subdivision new text end
11.4new text begin 37, this notification requirement is satisfied if the information related to the acceptance of new text end
11.5new text begin the claim is made accessible to the insured or claimant on a secured Web site maintained new text end
11.6new text begin by the insurer. new text end For purposes of this clause, acceptance of a claim means that there is no
11.7additional financial liability for the insured or claimant, either because there is a flat
11.8co-payment amount specified in the health plan or because there is no co-payment,
11.9deductible, or coinsurance owed;
11.10 (4) where evidence of suspected fraud is present, the requirement to disclose their
11.11reasons for failure to complete the investigation within the time period set forth in clause
11.12(3) need not be specific. The insurer must make this evidence available to the Department
11.13of Commerce if requested;
11.14 (5) failing to notify an insured who has made a notification of claim of all available
11.15benefits or coverages which the insured may be eligible to receive under the terms of a
11.16policy and of the documentation which the insured must supply in order to ascertain
11.17eligibility;
11.18 (6) unless otherwise provided by law or in the policy, requiring an insured to give
11.19written notice of loss or proof of loss within a specified time, and thereafter seeking to
11.20relieve the insurer of its obligations if the time limit is not complied with, unless the
11.21failure to comply with the time limit prejudices the insurer's rights and then only if the
11.22insurer gave prior notice to the insured of the potential prejudice;
11.23 (7) advising an insured or a claimant not to obtain the services of an attorney or
11.24an adjuster, or representing that payment will be delayed if an attorney or an adjuster
11.25is retained by the insured or the claimant;
11.26 (8) failing to advise in writing an insured or claimant who has filed a notification of
11.27claim known to be unresolved, and who has not retained an attorney, of the expiration of
11.28a statute of limitations at least 60 days prior to that expiration. For the purposes of this
11.29clause, any claim on which the insurer has received no communication from the insured
11.30or claimant for a period of two years preceding the expiration of the applicable statute
11.31of limitations shall not be considered to be known to be unresolved and notice need not
11.32be sent pursuant to this clause;
11.33 (9) demanding information which would not affect the settlement of the claim;
11.34 (10) unless expressly permitted by law or the policy, refusing to settle a claim of an
11.35insured on the basis that the responsibility should be assumed by others;
12.1 (11) failing, within 60 business days after receipt of a properly executed proof of loss,
12.2to advise the insured of the acceptance or denial of the claim by the insurer. No insurer
12.3shall deny a claim on the grounds of a specific policy provision, condition, or exclusion
12.4unless reference to the provision, condition, or exclusion is included in the denial. The
12.5denial must be given to the insured in writing with a copy filed in the claim file;
12.6 (12) denying or reducing a claim on the basis of an application which was altered or
12.7falsified by the agent or insurer without the knowledge of the insured;
12.8 (13) failing to notify the insured of the existence of the additional living expense
12.9coverage when an insured under a homeowners policy sustains a loss by reason of a
12.10covered occurrence and the damage to the dwelling is such that it is not habitable;
12.11 (14) failing to inform an insured or a claimant that the insurer will pay for an
12.12estimate of repair if the insurer requested the estimate and the insured or claimant had
12.13previously submitted two estimates of repair.
12.14 Sec. 11. new text begin REPEALER.new text end
12.15new text begin Minnesota Statutes 2006, sections 62J.52, subdivision 5; and 62J.58,new text end new text begin are repealed.new text end