Bill Text: MN HF1185 | 2011-2012 | 87th Legislature | Introduced
Bill Title: Contracting procedures between health care providers and health plan companies adjusted.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2011-04-14 - Committee report, to pass and re-refer to Commerce and Regulatory Reform [HF1185 Detail]
Download: Minnesota-2011-HF1185-Introduced.html
1.2relating to health; adjusting contracting procedures between health care providers
1.3and health plan companies;amending Minnesota Statutes 2010, sections
1.462Q.735, subdivision 5; 62Q.75, subdivision 3.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. Minnesota Statutes 2010, section 62Q.735, subdivision 5, is amended to
1.7read:
1.8 Subd. 5. Fee schedules. (a) A health plan company shall provide,upon request no
1.9later than 165 days before the next contract year's effective date, any additional fees
1.10or fee schedules relevant to the particular provider's practice beyond those provided
1.11with the renewal documents for the next contract year to all participating providers,
1.12excluding claims paid under the pharmacy benefit. Health plan companies may fulfill the
1.13requirements of this section by making the full fee schedules available through a secure
1.14Web portal for contracted providers no later than 165 days before the next contract year's
1.15effective date.
1.16(b) A dental organization may satisfy paragraph (a) by complying with section
1.1762Q.735, subdivision 1
, paragraph (c).
1.18EFFECTIVE DATE.This section is effective August 1, 2011, and applies to
1.19contracts entered into, renewed, or amended on or after that date.
1.20 Sec. 2. Minnesota Statutes 2010, section 62Q.75, subdivision 3, is amended to read:
1.21 Subd. 3. Claims filing. Unless otherwise provided by contract, for a longer period;
1.22by section16A.124, subdivision 4a ,; or by federal law, the health care providers and
1.23facilities specified in subdivision 2 must submit their charges to a health plan company or
2.1third-party administrator within six months from the date of service or the date the health
2.2care provider knew or was informed of the correct name and address of the responsible
2.3health plan company or third-party administrator, whichever is later. A health care provider
2.4or facility that does not make an initial submission of charges within the six-month period
2.5shall not be reimbursed for the charge and may not collect the charge from the recipient of
2.6the service or any other payer. The six-month submission requirement may be extended to
2.712 months in cases where a health care provider or facility specified in subdivision 2 has
2.8determined and can substantiate that it has experienced a significant disruption to normal
2.9operations that materially affects the ability to conduct business in a normal manner and to
2.10submit claims on a timely basis. Any request by a health care provider or facility specified
2.11in subdivision 2 for an exception to a contractually defined claims submission timeline
2.12must be reviewed and acted upon by the health plan company within the same time frame
2.13as the contractually agreed upon claims filing timeline. This subdivision also applies to all
2.14health care providers and facilities that submit charges to workers' compensation payers
2.15for treatment of a workers' compensation injury compensable under chapter 176, or to
2.16reparation obligors for treatment of an injury compensable under chapter 65B.
2.17EFFECTIVE DATE.This section is effective August 1, 2011, and applies to
2.18contracts entered into, renewed, or amended on or after that date.
1.3and health plan companies;amending Minnesota Statutes 2010, sections
1.462Q.735, subdivision 5; 62Q.75, subdivision 3.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. Minnesota Statutes 2010, section 62Q.735, subdivision 5, is amended to
1.7read:
1.8 Subd. 5. Fee schedules. (a) A health plan company shall provide,
1.9later than 165 days before the next contract year's effective date, any additional fees
1.10or fee schedules relevant to the particular provider's practice beyond those provided
1.11with the renewal documents for the next contract year to all participating providers,
1.12excluding claims paid under the pharmacy benefit. Health plan companies may fulfill the
1.13requirements of this section by making the full fee schedules available through a secure
1.14Web portal for contracted providers no later than 165 days before the next contract year's
1.15effective date.
1.16(b) A dental organization may satisfy paragraph (a) by complying with section
1.18EFFECTIVE DATE.This section is effective August 1, 2011, and applies to
1.19contracts entered into, renewed, or amended on or after that date.
1.20 Sec. 2. Minnesota Statutes 2010, section 62Q.75, subdivision 3, is amended to read:
1.21 Subd. 3. Claims filing. Unless otherwise provided by contract
1.22by section
1.23facilities specified in subdivision 2 must submit their charges to a health plan company or
2.1third-party administrator within six months from the date of service or the date the health
2.2care provider knew or was informed of the correct name and address of the responsible
2.3health plan company or third-party administrator, whichever is later. A health care provider
2.4or facility that does not make an initial submission of charges within the six-month period
2.5shall not be reimbursed for the charge and may not collect the charge from the recipient of
2.6the service or any other payer. The six-month submission requirement may be extended to
2.712 months in cases where a health care provider or facility specified in subdivision 2 has
2.8determined and can substantiate that it has experienced a significant disruption to normal
2.9operations that materially affects the ability to conduct business in a normal manner and to
2.10submit claims on a timely basis. Any request by a health care provider or facility specified
2.11in subdivision 2 for an exception to a contractually defined claims submission timeline
2.12must be reviewed and acted upon by the health plan company within the same time frame
2.13as the contractually agreed upon claims filing timeline. This subdivision also applies to all
2.14health care providers and facilities that submit charges to workers' compensation payers
2.15for treatment of a workers' compensation injury compensable under chapter 176, or to
2.16reparation obligors for treatment of an injury compensable under chapter 65B.
2.17EFFECTIVE DATE.This section is effective August 1, 2011, and applies to
2.18contracts entered into, renewed, or amended on or after that date.
