Subdivision 1. Minnesota uniform remittance advice. All group purchasers shall provide a uniform claim payment/advice transaction to health care providers when a claim is adjudicated. The uniform claim payment/advice transaction shall comply with section 62J.536, subdivision 1b, and rules adopted under section 62J.536, subdivision 2.
Subd. 2. Minnesota uniform explanation of benefits document. (a) All group purchasers shall provide a uniform explanation of benefits document to health care patients when an explanation of benefits document is provided as otherwise required or permitted by law. The uniform explanation of benefits document shall comply with the standards prescribed in this section.
(b) Notwithstanding paragraph (a), this section does not apply to group purchasers not included as covered entities under United States Code, title 42, sections 1320d to 1320d-8, as amended from time to time, and the regulations promulgated under those sections.
Subd. 3. Scope. For purposes of sections 62J.50 to 62J.61, the uniform claim payment/advice transaction and uniform explanation of benefits document format specified in subdivision 4 shall apply to all health care services delivered by a health care provider or health care provider organization in Minnesota, regardless of the location of the payer. Health care services not paid on an individual claims basis, such as capitated payments, are not included in this section. A health plan company is excluded from the requirements in subdivisions 1 and 2 if they comply with section 62A.01, subdivisions 2 and 3.
Subd. 4. Specifications. The uniform explanation of benefits document shall be provided by use of a paper document conforming to the specifications in this section. The commissioner, after consulting with the Administrative Uniformity Committee, shall specify the data elements and definitions for the uniform explanation of benefits document. The commissioner and the Administrative Uniformity Committee must consult with the Minnesota Dental Association and Delta Dental Plan of Minnesota before requiring under this section the use of a paper document for the uniform explanation of benefits document or the uniform claim payment/advice transaction for dental care services.
Subd. 5. Effective date. The requirements in subdivisions 1 and 2 are effective June 30, 2007. The requirements in subdivisions 1 and 2 apply regardless of when the health care service was provided to the patient.
2000 c 460 s 7; 2002 c 307 art 2 s 7; 2002 c 330 s 23; 2005 c 106 s 8; 2014 c 192 art 1 s 14-16
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.