Minnesota Legislature
HF 1185
as introduced - 87th Legislature (2011 - 2012) Posted on 03/17/2011 09:42am
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A bill for an act
relating to health; adjusting contracting procedures between health care providers
and health plan companies; amending Minnesota Statutes 2010, sections
62Q.735, subdivision 5; 62Q.75, subdivision 3.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2010, section 62Q.735, subdivision 5, is amended to
read:
Subd. 5.
Fee schedules.
(a) A health plan company shall provide, deleted text begin upon requestdeleted text end new text begin no
later than 165 days before the next contract year's effective datenew text end , any additional fees
or fee schedules relevant to the particular provider's practice beyond those provided
with the renewal documents for the next contract year to all participating providers,
excluding claims paid under the pharmacy benefit. Health plan companies may fulfill the
requirements of this section by making the full fee schedules available through a secure
Web portal for contracted providersnew text begin no later than 165 days before the next contract year's
effective datenew text end .
(b) A dental organization may satisfy paragraph (a) by complying with section
62Q.735, subdivision 1, paragraph (c).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2011, and applies to
contracts entered into, renewed, or amended on or after that date.
new text end
Sec. 2.
Minnesota Statutes 2010, section 62Q.75, subdivision 3, is amended to read:
Subd. 3.
Claims filing.
Unless otherwise provided by contractdeleted text begin ,deleted text end new text begin for a longer period;new text end
by section 16A.124, subdivision 4adeleted text begin ,deleted text end new text begin ;new text end or by federal law, the health care providers and
facilities specified in subdivision 2 must submit their charges to a health plan company or
third-party administrator within six months from the date of service or the date the health
care provider knew or was informed of the correct name and address of the responsible
health plan company or third-party administrator, whichever is later. A health care provider
or facility that does not make an initial submission of charges within the six-month period
shall not be reimbursed for the charge and may not collect the charge from the recipient of
the service or any other payer. The six-month submission requirement may be extended to
12 months in cases where a health care provider or facility specified in subdivision 2 has
determined and can substantiate that it has experienced a significant disruption to normal
operations that materially affects the ability to conduct business in a normal manner and to
submit claims on a timely basis. Any request by a health care provider or facility specified
in subdivision 2 for an exception to a contractually defined claims submission timeline
must be reviewed and acted upon by the health plan company within the same time frame
as the contractually agreed upon claims filing timeline. This subdivision also applies to all
health care providers and facilities that submit charges to workers' compensation payers
for treatment of a workers' compensation injury compensable under chapter 176, or to
reparation obligors for treatment of an injury compensable under chapter 65B.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2011, and applies to
contracts entered into, renewed, or amended on or after that date.
new text end