Subdivision 1. Uniform billing form CMS 1450. (a) On and after January 1, 1996, all institutional inpatient hospital services, ancillary services, institutionally owned or operated outpatient services rendered by providers in Minnesota, and institutional or noninstitutional home health services that are not being billed using an equivalent electronic billing format, must be billed using the most current version of the uniform billing form CMS 1450.
(b) The instructions and definitions for the use of the uniform billing form CMS 1450 shall be in accordance with the uniform billing form manual specified by the commissioner. In promulgating these instructions, the commissioner may utilize the manual developed by the National Uniform Billing Committee.
(c) Services to be billed using the uniform billing form CMS 1450 include: institutional inpatient hospital services and distinct units in the hospital such as psychiatric unit services, physical therapy unit services, swing bed (SNF) services, inpatient state psychiatric hospital services, inpatient skilled nursing facility services, home health services (Medicare part A), and hospice services; ancillary services, where benefits are exhausted or patient has no Medicare part A, from hospitals, state psychiatric hospitals, skilled nursing facilities, ICFs/DD, and home health (Medicare part B); institutional owned or operated outpatient services such as waivered services, hospital outpatient services, including ambulatory surgical center services, hospital referred laboratory services, hospital-based ambulance services, and other hospital outpatient services, skilled nursing facilities, home health, freestanding renal dialysis centers, comprehensive outpatient rehabilitation facilities (CORF), outpatient rehabilitation facilities (ORF), rural health clinics, federally qualified health centers, and community mental health centers; home health services such as home health intravenous therapy providers and hospice; and any other health care provider certified by the Medicare program to use this form.
(d) On and after January 1, 1996, a mother and newborn child must be billed separately, and must not be combined on one claim form.
(e) Services provided by Medicare Critical Access Hospitals electing Method II billing will be allowed an exception to this provision to allow the inclusion of the professional fees on the CMS 1450.
Subd. 2. Uniform billing form CMS 1500. (a) On and after January 1, 1996, all noninstitutional health care services rendered by providers in Minnesota except dental or pharmacy providers, that are not currently being billed using an equivalent electronic billing format, must be billed using the most current version of the health insurance claim form CMS 1500.
(b) The instructions and definitions for the use of the uniform billing form CMS 1500 shall be in accordance with the manual developed by the Administrative Uniformity Committee entitled standards for the use of the CMS 1500 form, dated February 1994, as further defined by the commissioner.
(c) Services to be billed using the uniform billing form CMS 1500 include physician services and supplies, durable medical equipment, noninstitutional ambulance services, independent ancillary services including occupational therapy, physical therapy, speech therapy and audiology, home infusion therapy, podiatry services, optometry services, mental health licensed professional services, substance abuse licensed professional services, advanced practice registered nurse services, chiropractors, physician assistants, laboratories, medical suppliers, waivered services, personal care attendants, and other health care providers such as day activity centers and freestanding ambulatory surgical centers.
(d) Services provided by Medicare Critical Access Hospitals electing Method II billing will be allowed an exception to this provision to allow the inclusion of the professional fees on the CMS 1450.
Subd. 3. Uniform dental billing form. (a) On and after January 1, 1996, all dental services provided by dental care providers in Minnesota, that are not currently being billed using an equivalent electronic billing format, shall be billed using the most current version of the American Dental Association uniform dental billing form.
(b) The instructions and definitions for the use of the uniform dental billing form shall be in accordance with the manual developed by the Administrative Uniformity Committee dated February 1994, and as amended or further defined by the commissioner.
Subd. 4. Uniform pharmacy billing form. (a) On and after January 1, 1996, all pharmacy services provided by pharmacists in Minnesota that are not currently being billed using an equivalent electronic billing format shall be billed using the most current version of the NCPDP/universal claim form.
(b) The instructions and definitions for the use of the uniform claim form shall be in accordance with instructions specified by the commissioner of health.
Subd. 5. [Repealed, 2008 c 305 s 11]
1994 c 625 art 9 s 3; 2000 c 460 s 4-6; 1Sp2003 c 14 art 7 s 14,15; 2005 c 106 s 3-5; 2007 c 147 art 9 s 6,7; 2008 c 305 s 3-5; 2013 c 125 art 1 s 107; 2014 c 192 art 1 s 4; 2020 c 115 art 4 s 6
Structure Minnesota Statutes
Chapters 59A - 79A — Insurance
Chapter 62J — Health Care Cost Containment
Section 62J.016 — Goals Of Restructuring.
Section 62J.017 — Implementation Timetable.
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.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.692 — Medical Education.
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.76 — Nonpreemption.
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.