Minnesota Statutes
Chapter 62J — Health Care Cost Containment
Section 62J.51 — Definitions.

Subdivision 1. Scope. For purposes of sections 62J.50 to 62J.61, the following definitions apply.
Subd. 2. ANSI. "ANSI" means the American National Standards Institute.
Subd. 3. ASC X12. "ASC X12" means the American National Standards Institute committee X12.
Subd. 3a. Card issuer. "Card issuer" means the group purchaser who is responsible for printing and distributing identification cards to members or insureds.
Subd. 4. [Repealed by amendment, 2014 c 192 art 1 s 3]
Subd. 5. [Repealed by amendment, 2014 c 192 art 1 s 3]
Subd. 6. Claim payment/advice transaction set (ANSI ASC X12 835). "Claim payment/advice transaction set (ANSI ASC X12 835)" means the electronic transaction format used for electronic remittance advice and electronic funds transfer as adopted under Code of Federal Regulations, title 45, part 162, subpart P, and any future revisions of the subpart.
Subd. 6a. Claim status transaction set (ANSI ASC X12 276/277). "Claim status transaction set (ANSI ASC X12 276/277)" means the electronic transaction format used by providers to request and receive information on the status of a health care claim or encounter that has been submitted to a group purchaser as adopted under Code of Federal Regulations, title 45, part 162, subpart N, and any future revisions of the subpart.
Subd. 6b. Claim submission address. "Claim submission address" means the address to which the group purchaser requires health care providers, members, or insureds to send health care claims for processing.
Subd. 6c. Claim submission number. "Claim submission number" means the unique identification number to identify group purchasers as described in section 62J.54, with its suffix identifying the claim submission address.
Subd. 7. Claim submission transaction set (ANSI ASC X12 837). "Claim submission transaction set (ANSI ASC X12 837)" means the electronic transaction format used to submit all health care claims information as adopted under Code of Federal Regulations, title 45, part 162, subpart K, and any future revisions of the subpart.
Subd. 8. EDI or electronic data interchange. "EDI" or "electronic data interchange" means the computer application to computer application exchange of information using nationally accepted standard formats.
Subd. 9. Eligibility transaction set (ANSI ASC X12 270/271). "Eligibility transaction set (ANSI ASC X12 270/271)" means the electronic transaction format used by providers to request and receive coverage information on the member or insured as adopted under Code of Federal Regulations, title 45, part 162, subpart L, and any future revisions of the subpart.
Subd. 10. Enrollment transaction set (ANSI ASC X12 834). "Enrollment transaction set (ANSI ASC X12 834)" means the electronic transaction format used to transmit enrollment and benefit information from the employer to the payer for the purpose of enrolling in a benefit plan as adopted under Code of Federal Regulations, title 45, part 162, subpart O, and any future revisions of the subpart.
Subd. 11. Group purchaser. "Group purchaser" has the meaning given in section 62J.03, subdivision 6.
Subd. 11a. Health care clearinghouse. "Health care clearinghouse" means a public or private entity, including a billing service, repricing company, community health management information system or community health information system, and "value-added" networks and switches that does any of the following functions:
(1) processes or facilitates the processing of health information received from another entity in a nonstandard format or containing nonstandard data content into standard data elements or a standard transaction;
(2) receives a standard transaction from another entity and processes or facilitates the processing of health information into nonstandard format or nonstandard data content for the receiving entity;
(3) acts on behalf of a group purchaser in sending and receiving standard transactions to assist the group purchaser in fulfilling its responsibilities under section 62J.536;
(4) acts on behalf of a health care provider in sending and receiving standard transactions to assist the health care provider in fulfilling its responsibilities under section 62J.536; and
(5) other activities including but not limited to training, testing, editing, formatting, or consolidation transactions.
A health care clearinghouse acts as an agent of a health care provider or group purchaser only if it enters into an explicit, mutually agreed upon arrangement or contract with the provider or group purchaser to perform specific clearinghouse functions.
Subd. 12. ISO. "ISO" means the International Standardization Organization.
Subd. 13. NCPDP. "NCPDP" means the National Council for Prescription Drug Programs, Inc.
Subd. 14. [Repealed by amendment, 2014 c 192 art 1 s 3]
Subd. 15. [Repealed by amendment, 2014 c 192 art 1 s 3]
Subd. 16. Provider; health care provider. "Provider" or "health care provider" has the meaning given in section 62J.03, subdivision 8.
Subd. 16a. Standard transaction. "Standard transaction" means a transaction that is defined in Code of Federal Regulations, title 45, part 162.103, and that meets the requirements of the single, uniform companion guides described in section 62J.536.
Subd. 17. Uniform billing form CMS 1450. "Uniform billing form CMS 1450" means the most current version of the uniform billing form known as the CMS 1450 developed by the National Uniform Billing Committee.
Subd. 18. Uniform billing form CMS 1500. "Uniform billing form CMS 1500" means the most current version of the health insurance claim form, CMS 1500, developed by the National Uniform Claim Committee.
Subd. 19. Uniform dental billing form. "Uniform dental billing form" means the most current version of the uniform dental claim form developed by the American Dental Association.
Subd. 19a. Uniform explanation of benefits document. "Uniform explanation of benefits document" means the document associated with and explaining the details of a group purchaser's claim adjudication for services rendered, which is sent to a patient.
Subd. 19b. [Repealed by amendment, 2014 c 192 art 1 s 3]
Subd. 20. Uniform pharmacy billing form. "Uniform pharmacy billing form" means the National Council for Prescription Drug Programs/universal claim form (NCPDP/UCF).
Subd. 21. WEDI. "WEDI" means the national Workgroup for Electronic Data Interchange.
1994 c 625 art 9 s 2; 1996 c 440 art 1 s 22-25; 2000 c 460 s 2,3; 2002 c 307 art 2 s 3; 2002 c 330 s 19; 2005 c 106 s 1,2; 2008 c 305 s 1,2; 2010 c 243 s 1,2; 2014 c 192 art 1 s 3

Structure Minnesota Statutes

Minnesota Statutes

Chapters 59A - 79A — Insurance

Chapter 62J — Health Care Cost Containment

Section 62J.01 — Findings.

Section 62J.015 — Purpose.

Section 62J.016 — Goals Of Restructuring.

Section 62J.017 — Implementation Timetable.

Section 62J.03 — Definitions.

Section 62J.04 — Monitoring The Rate Of Growth Of Health Care Spending.

Section 62J.041 — Interim Health Plan Company Cost Containment Goals.

Section 62J.052 — Provider Cost Disclosure.

Section 62J.06 — Immunity From Liability.

Section 62J.156 — Closed Committee Hearings.

Section 62J.17 — Expenditure Reporting.

Section 62J.212 — Public Health Goals.

Section 62J.22 — Participation Of Federal Programs.

Section 62J.23 — Provider Conflicts Of Interest.

Section 62J.25 — Mandatory Medicare Assignment.

Section 62J.26 — Evaluation Of Proposed Health Coverage Mandates.

Section 62J.2930 — Information Clearinghouse.

Section 62J.301 — Research And Data Initiatives.

Section 62J.311 — Analysis And Use Of Data.

Section 62J.321 — Data Collection And Processing Procedures.

Section 62J.38 — Cost Containment Data From Group Purchasers.

Section 62J.40 — Cost Containment Data From State Agencies And Other Governmental Units.

Section 62J.42 — Quality, Utilization, And Outcome Data.

Section 62J.431 — Evidence-based Health Care Guidelines.

Section 62J.46 — Monitoring And Reports.

Section 62J.48 — Criteria For Ambulance Services Reimbursement.

Section 62J.49 — Ambulance Services Financial Data.

Section 62J.495 — Electronic Health Record Technology.

Section 62J.496 — Electronic Health Record System Revolving Account And Loan Program.

Section 62J.497 — Electronic Prescription Drug Program.

Section 62J.498 — Health Information Exchange.

Section 62J.4981 — Certificate Of Authority To Provide Health Information Exchange Services.

Section 62J.4982 — Enforcement Authority; Compliance.

Section 62J.50 — Citation And Purpose.

Section 62J.51 — Definitions.

Section 62J.52 — Establishment Of Uniform Billing Forms.

Section 62J.53 — Acceptance Of Uniform Billing Forms By Group Purchasers.

Section 62J.535 — Uniform Billing Requirements For Claim Transactions.

Section 62J.536 — Uniform Electronic Transactions And Implementation Guide Standards.

Section 62J.54 — Identification And Implementation Of Unique Identifiers.

Section 62J.55 — Privacy Of Unique Identifiers.

Section 62J.56 — Implementation Of Electronic Data Interchange Standards.

Section 62J.57 — Minnesota Center For Health Care Electronic Data Interchange.

Section 62J.581 — Standards For Minnesota Uniform Health Care Reimbursement Documents.

Section 62J.60 — Minnesota Uniform Health Care Identification Card.

Section 62J.61 — Rulemaking; Implementation.

Section 62J.62 — Electronic Billing Assistance.

Section 62J.63 — Center For Health Care Purchasing Improvement.

Section 62J.691 — Purpose.

Section 62J.692 — Medical Education.

Section 62J.695 — Citation.

Section 62J.70 — Definitions.

Section 62J.701 — Governmental Programs.

Section 62J.71 — Prohibited Provider Contracts.

Section 62J.72 — Disclosure Of Health Care Provider Information.

Section 62J.73 — Prohibition On Exclusive Arrangements.

Section 62J.74 — Enforcement.

Section 62J.76 — Nonpreemption.

Section 62J.80 — Retaliation.

Section 62J.81 — Disclosure Of Payments For Health Care Services.

Section 62J.812 — Primary Care Price Transparency.

Section 62J.82 — Hospital Information Reporting Disclosure.

Section 62J.823 — Hospital Pricing Transparency.

Section 62J.824 — Facility Fee Disclosure.

Section 62J.83 — Reduced Payment Amounts Permitted.

Section 62J.84 — Prescription Drug Price Transparency.