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HF 2627

as introduced - 87th Legislature (2011 - 2012) Posted on 03/01/2012 11:22am

KEY: stricken = removed, old language.
underscored = added, new language.
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A bill for an act
relating to health; changing a requirement for electronic claims and electronic
transactions; amending Minnesota Statutes 2010, section 62J.536, subdivision 1.

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

Section 1.

Minnesota Statutes 2010, section 62J.536, subdivision 1, is amended to read:


Subdivision 1.

Electronic claims and eligibility transactions required.

(a)
Beginning January 15, 2009, all group purchasers must accept from health care providers
the eligibility for a health plan transaction described under Code of Federal Regulations,
title 45, part 162, subpart L. Beginning July 15, 2009, all group purchasers must accept
from health care providers the health care claims or equivalent encounter information
transaction described under Code of Federal Regulations, title 45, part 162, subpart K.

(b) Beginning January 15, 2009, all group purchasers must transmit to providers the
eligibility for a health plan transaction described under Code of Federal Regulations, title
45, part 162, subpart L. Beginning December 15, 2009, all group purchasers must transmit
to providers the health care payment and remittance advice transaction described under
Code of Federal Regulations, title 45, part 162, subpart P.

(c) Beginning January 15, 2009, all health care providers must submit to group
purchasers the eligibility for a health plan transaction described under Code of Federal
Regulations, title 45, part 162, subpart L. Beginning July 15, 2009, all health care
providers must submit to group purchasers the health care claims or equivalent encounter
information transaction described under Code of Federal Regulations, title 45, part 162,
subpart K.

(d) Beginning January 15, 2009, all health care providers must accept from group
purchasers the eligibility for a health plan transaction described under Code of Federal
Regulations, title 45, part 162, subpart L. Beginning December 15, 2009, all health care
providers must accept from group purchasers the health care payment and remittance
advice transaction described under Code of Federal Regulations, title 45, part 162, subpart
P.

(e) Beginning January 1, 2012, all health care providers, health care clearinghouses,
and group purchasers must provide an appropriate, standard, electronic acknowledgment
when receiving the health care claims or equivalent encounter information transaction
or the health care payment and remittance advice transactionnew text begin, unless those claims were
submitted electronically by an entity licensed as a pharmacy or as a resident or nonresident
durable medical equipment supplier in Minnesota
new text end. The acknowledgment provided must be
based on one or more of the following American National Standards Institute, Accredited
Standards Committee X12 standard transactions:

(1) TA1;

(2) 997;

(3) 999; or

(4) 277CA.

Health care providers, health care clearinghouses, and group purchasers may send and
receive more than one type of standard acknowledgment as mutually agreed upon. The
mutually agreed upon acknowledgments must be exchanged electronically. Electronic
exchanges of acknowledgments do not include e-mail or facsimile.

(f) Each of the transactions described in paragraphs (a) to (e) shall require the use
of a single, uniform companion guide to the implementation guides described under
Code of Federal Regulations, title 45, part 162. The companion guides will be developed
pursuant to subdivision 2.

(g) Notwithstanding any other provisions in sections 62J.50 to 62J.61, all group
purchasers and health care providers must exchange claims and eligibility information
electronically using the transactions, companion guides, implementation guides, and
timelines required under this subdivision. Group purchasers may not impose any fee on
providers or providers' clearinghouses for the use of the transactions prescribed in this
subdivision. Health care providers may not impose a fee on group purchasers or group
purchasers' clearinghouses for the use of the transactions prescribed in this subdivision.
A clearinghouse may not charge a fee solely to receive a standard transaction from a
health care provider, a health care provider's clearinghouse, a group purchaser, or a group
purchaser's clearinghouse when it is not an agent of the sending entity. A clearinghouse
may not charge a fee solely to send a standard transaction to a health care provider, a health
care provider's clearinghouse, a group purchaser, or a group purchaser's clearinghouse
when it is not an agent of the receiving entity.

(h) Nothing in this subdivision shall prohibit group purchasers and health care
providers from using a direct data entry, Web-based methodology for complying with
the requirements of this subdivision. Any direct data entry method for conducting
the transactions specified in this subdivision must be consistent with the data content
component of the single, uniform companion guides required in paragraph (f) and the
implementation guides described under Code of Federal Regulations, title 45, part 162.