HF 3372

1st Unofficial Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

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 most current version of the 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 most current 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, ICF/MR's, 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, federally qualified health centers, 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, waivered services,
3.14personal care attendants, 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 1 15, 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    Subd. 4. Group purchasers not covered by HIPAA. (a) For transactions with
5.2group purchasers defined in section 62J.03, subdivision 6, that are not covered under
5.3United States Code, title 42, sections 1320d to 1320d-8, the requirements of this section
5.4are modified as follows:
5.5(1) The group purchasers may be exempt from one or more of the requirements
5.6to exchange claims and eligibility information electronically using the transactions,
5.7companion guides, implementation guides, and timelines in subdivision 1 if the
5.8commissioner of health determines that:
5.9(i) a transaction is incapable of exchanging data that are currently being exchanged
5.10on paper and is necessary to accomplish the purpose of the transaction; or
5.11(ii) another national electronic transaction standard would be more appropriate and
5.12effective to accomplish the purpose of the transaction.
5.13(2) If group purchasers are exempt from one or more of the requirements to exchange
5.14claims and eligibility information electronically using the transactions, companion guides,
5.15implementation guides, and timelines in subdivision 1, providers shall also be exempt
5.16from exchanging those transactions with the group purchaser.
5.17(3) If the commissioner of health exempts a group purchaser from one or more of
5.18the requirements because a transaction is incapable of exchanging data that are currently
5.19being exchanged on paper and are necessary to accomplish the purpose of the transaction,
5.20the commissioner shall review that exemption annually. If the commissioner determines
5.21that the exemption is no longer necessary or appropriate, the commissioner of health shall
5.22adopt rules pursuant to section 62J.61 establishing and requiring group purchasers and
5.23health care providers to use the transactions and the uniform, standard companion guides
5.24required under subdivision 1, paragraph (e). Group purchasers and providers shall have 12
5.25months to implement any rules adopted.
5.26(4) If the commissioner of health exempts a group purchaser from one or more of
5.27the requirements because another national electronic transaction standard would be more
5.28appropriate and effective to accomplish the purpose of the transaction, the commissioner
5.29shall adopt rules pursuant to section 62J.61 establishing and requiring group purchasers
5.30and health care providers to use the national electronic transaction standard. Group
5.31purchasers and providers shall have 12 months to implement any rules adopted.
5.32(5) The requirement of paper claims attachments shall not indicate that a health
5.33care claims or equivalent encounter information transaction described under Code of
5.34Federal Regulations, title 45, part 162, subpart K, is incapable of exchanging data that
5.35are currently being exchanged on paper provided that the electronic health care claims
5.36transaction has a mechanism to link the paper attachments to the electronic claim.

6.1    Sec. 8. Minnesota Statutes 2007 Supplement, section 62J.536, is amended by adding a
6.2subdivision to read:
6.3    Subd. 5. Compliance and investigations. (a) The commissioner of health shall, to
6.4the extent practicable, seek the cooperation of health care providers and group purchasers
6.5in obtaining compliance with this section and may provide technical assistance to health
6.6care providers and group purchasers.
6.7    (b) A person who believes a health care provider or group purchaser is not complying
6.8with the requirements of this section may file a complaint with the commissioner of health.
6.9Complaints filed under this section must meet the following requirements:
6.10    (1) A complaint must be filed in writing, either on paper or electronically.
6.11    (2) A complaint must name the person that is the subject of the complaint and
6.12describe the acts or omissions believed to be in violation of this section.
6.13    (3) A complaint must be filed within 180 days of when the complainant knew or
6.14should have known that the act or omission complained of occurred.
6.15    (4) The commissioner may prescribe additional procedures for the filing of
6.16complaints as required to satisfy the requirements of this section.
6.17    (c) The commissioner of health may investigate complaints filed under this section.
6.18The investigation may include a review of the pertinent policies, procedures, or practices
6.19of the health care provider or group purchaser and of the circumstances regarding any
6.20alleged violation. At the time of initial written communication with the health care
6.21provider or group purchaser about the complaint, the commissioner of health shall
6.22describe the acts or omissions that are the basis of the complaint. The commissioner
6.23may conduct compliance reviews to determine whether health care providers and group
6.24purchasers are complying with this section.
6.25    (d) Health care providers and group purchasers must cooperate with the
6.26commissioner of health if the commissioner undertakes an investigation or compliance
6.27review of the policies, procedures, or practices of the health care provider or group
6.28purchaser to determine compliance with this section. This cooperation includes, but is
6.29not limited to:
6.30    (1) A health care provider or group purchaser must permit access by the
6.31commissioner of health during normal business hours to its facilities, books, records,
6.32accounts, and other sources of information that are pertinent to ascertaining compliance
6.33with this section.
6.34    (2) If any information required of a health care provider or group purchaser under
6.35this section is in the exclusive possession of any other agency, institution, or person and
6.36the other agency, institution, or person fails or refuses to furnish the information, the
7.1health care provider or group purchaser must so certify and set forth what efforts it has
7.2made to obtain the information.
7.3    (3) Any individually identifiable health information obtained by the commissioner
7.4of health in connection with an investigation or compliance review under this section
7.5may not be used or disclosed by the commissioner of health, except as necessary for
7.6ascertaining or enforcing compliance with this section.
7.7    (e) If an investigation of a complaint indicates noncompliance, the commissioner
7.8of health shall attempt to reach a resolution of the matter by informal means. Informal
7.9means may include demonstrated compliance or a completed corrective action plan or
7.10other agreement. If the matter is resolved by informal means, the commissioner of health
7.11shall so inform the health care provider or group purchaser and, if the matter arose from a
7.12complaint, the complainant, in writing. If the matter is not resolved by informal means,
7.13the commissioner of health shall:
7.14    (1) inform the health care provider or group purchaser and provide an opportunity
7.15for the health care provider or group purchaser to submit written evidence of any
7.16mitigating factors or other considerations. The health care provider or group purchaser
7.17must submit any such evidence to the commissioner of health within 30 calendar days
7.18of receipt of the notification; and
7.19    (2) inform the health care provider or group purchaser, through a notice of proposed
7.20determination according to paragraph (i), that the commissioner of health finds that a
7.21civil money penalty should be imposed.
7.22    (f) If, after an investigation or a compliance review, the commissioner of health
7.23determines that further action is not warranted, the commissioner of health shall so inform
7.24the health care provider or group purchaser and, if the matter arose from a complaint, the
7.25complainant, in writing.
7.26    (g) A health care provider or group purchaser may not threaten, intimidate, coerce,
7.27harass, discriminate against, or take any other retaliatory action against any individual
7.28or other person for:
7.29    (1) filing of a complaint under this section;
7.30    (2) testifying, assisting, or participating in an investigation, compliance review,
7.31proceeding, or contested case proceeding under this section; or
7.32    (3) opposing any act or practice made unlawful by this section, provided the
7.33individual or person has a good faith belief that the practice opposed is unlawful, and
7.34the manner of opposition is reasonable and does not involve an unauthorized disclosure
7.35of a patient's health information.
8.1    (h) The commissioner of health may impose a civil money penalty on a health care
8.2provider or group purchaser if the commissioner of health determines that the health
8.3care provider or group purchaser has violated this section. If the commissioner of health
8.4determines that more than one health care provider or group purchaser was responsible
8.5for a violation, the commissioner of health may impose a civil money penalty against
8.6each health care provider or group purchaser. The amount of a civil money penalty shall
8.7be determined as follows:
8.8    (1) The amount of a civil money penalty shall be up to $100 for each violation, but
8.9not exceed $25,000 for identical violations during a calendar year.
8.10    (2) In the case of continuing violation of this section, a separate violation occurs each
8.11business day that the health care provider or group purchaser is in violation of this section.
8.12    (3) In determining the amount of any civil money penalty, the commissioner of health
8.13may consider as aggravating or mitigating factors, as appropriate, any of the following:
8.14    (i) the nature of the violation, in light of the purpose of the goals of this section;
8.15    (ii) the time period during which the violation occurred;
8.16    (iii) whether the violation hindered or facilitated an individual's ability to obtain
8.17health care;
8.18    (iv) whether the violation resulted in financial harm;
8.19    (v) whether the violation was intentional;
8.20    (vi) whether the violation was beyond the direct control of the health care provider
8.21or group purchaser;
8.22    (vii) any history of prior compliance with the provisions of this section, including
8.23violations;
8.24    (viii) whether and to what extent the provider or group purchaser has attempted to
8.25correct previous violations;
8.26    (ix) how the health care provider or group purchaser has responded to technical
8.27assistance from the commissioner of health provided in the context of a compliance
8.28effort; or
8.29    (x) the financial condition of the health care provider or group purchaser including,
8.30but not limited to, whether the healthcare provider or group purchaser had financial
8.31difficulties that affected its ability to comply or whether the imposition of a civil money
8.32penalty would jeopardize the ability of the health care provider or group purchaser to
8.33continue to provide, or to pay for, health care.
8.34    (i) If a penalty is proposed according to this section, the commissioner of health
8.35must deliver, or send by certified mail with return receipt requested, to the respondent
9.1written notice of the commissioner of health's intent to impose a penalty. This notice
9.2of proposed determination must include:
9.3    (1) a reference to the statutory basis for the penalty;
9.4    (2) a description of the findings of fact regarding the violations with respect to
9.5which the penalty is proposed;
9.6    (3) the amount of the proposed penalty;
9.7    (4) any circumstances described in paragraph (i) that were considered in determining
9.8the amount of the proposed penalty;
9.9    (5) instructions for responding to the notice, including a statement of the respondent's
9.10right to a contested case proceeding and a statement that failure to request a contested case
9.11proceeding within 30 calendar days permits the imposition of the proposed penalty; and
9.12    (6) the address to which the contested case proceeding request must be sent.
9.13    (j) A health care provider or group purchaser may contest whether the finding of
9.14facts constitute a violation of this section, according to a contested case proceeding as set
9.15forth in sections 14.57 to 14.62, subject to appeal according to sections 14.63 to 14.68.
9.16    (k) Any data collected by the commissioner of health as part of an active
9.17investigation or active compliance review under this section are classified as protected
9.18nonpublic data pursuant to section 13.02, subdivision 13, in the case of data not on
9.19individuals and confidential pursuant to section 13.02, subdivision 3, in the case of data
9.20on individuals. Data describing the final disposition of an investigation or compliance
9.21review are classified as public.
9.22    (l) Civil money penalties imposed and collected under this subdivision shall be
9.23deposited into a revolving fund and are appropriated to the commissioner of health for the
9.24purposes of this subdivision, including the provision of technical assistance.

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 pharmacies licensed
9.29in this state shall accept use the most recent HIPAA-mandated version of the NCPDP
9.30telecommunication standard format 3.2 or the NCPDP tape billing and payment format 2.0
9.31batch standard for the electronic submission of claims to group purchasers as appropriate.
9.32    (b) Beginning January 1, 1996, All category I and category II group purchasers
9.33in this state shall use the most recent HIPAA-mandated version of the NCPDP
9.34telecommunication standard format 3.2 or NCPDP tape billing and payment format 2.0
10.1batch standard for the electronic submission of payment information NCPDP response
10.2transaction to pharmacists pharmacies as appropriate.

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. Notwithstanding the requirements of section 72A.20, subdivision
11.437, this notification requirement is satisfied if the information related to the acceptance of
11.5the claim is made accessible to the insured or claimant on a secured Web site maintained
11.6by the insurer. 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. REPEALER.
12.15Minnesota Statutes 2006, sections 62J.52, subdivision 5; and 62J.58, are repealed.