Bill Text: MN SF2208 | 2011-2012 | 87th Legislature | Engrossed
Bill Title: Health insurers electronic prescription drug claims and transactions requirement modification
Sponsorship: Bipartisan Bill
Status: (Introduced - Dead) 2012-04-18 - HF substituted on General Orders HF2627 [SF2208 Detail]
Download: Minnesota-2011-SF2208-Engrossed.html
1.2relating to health; changing a requirement for electronic claims and electronic
1.3transactions;amending Minnesota Statutes 2010, section 62J.536, subdivision 1.
1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.5 Section 1. Minnesota Statutes 2010, section 62J.536, subdivision 1, is amended to read:
1.6 Subdivision 1. Electronic claims and eligibility transactions required. (a)
1.7Beginning January 15, 2009, all group purchasers must accept from health care providers
1.8the eligibility for a health plan transaction described under Code of Federal Regulations,
1.9title 45, part 162, subpart L. Beginning July 15, 2009, all group purchasers must accept
1.10from health care providers the health care claims or equivalent encounter information
1.11transaction described under Code of Federal Regulations, title 45, part 162, subpart K.
1.12 (b) Beginning January 15, 2009, all group purchasers must transmit to providers the
1.13eligibility for a health plan transaction described under Code of Federal Regulations, title
1.1445, part 162, subpart L. Beginning December 15, 2009, all group purchasers must transmit
1.15to providers the health care payment and remittance advice transaction described under
1.16Code of Federal Regulations, title 45, part 162, subpart P.
1.17 (c) Beginning January 15, 2009, all health care providers must submit to group
1.18purchasers the eligibility for a health plan transaction described under Code of Federal
1.19Regulations, title 45, part 162, subpart L. Beginning July 15, 2009, all health care
1.20providers must submit to group purchasers the health care claims or equivalent encounter
1.21information transaction described under Code of Federal Regulations, title 45, part 162,
1.22subpart K.
1.23 (d) Beginning January 15, 2009, all health care providers must accept from group
1.24purchasers the eligibility for a health plan transaction described under Code of Federal
2.1Regulations, title 45, part 162, subpart L. Beginning December 15, 2009, all health care
2.2providers must accept from group purchasers the health care payment and remittance
2.3advice transaction described under Code of Federal Regulations, title 45, part 162, subpart
2.4P.
2.5(e) Beginning January 1, 2012, all health care providers, health care clearinghouses,
2.6and group purchasers must provide an appropriate, standard, electronic acknowledgment
2.7when receiving the health care claims or equivalent encounter information transaction
2.8or the health care payment and remittance advice transaction, unless those claims were
2.9prescription drug claims submitted electronically by an entity licensed as a pharmacy. The
2.10acknowledgment provided must be based on one or more of the following American
2.11National Standards Institute, Accredited Standards Committee X12 standard transactions:
2.12(1) TA1;
2.13(2) 997;
2.14(3) 999; or
2.15(4) 277CA.
2.16Health care providers, health care clearinghouses, and group purchasers may send and
2.17receive more than one type of standard acknowledgment as mutually agreed upon. The
2.18mutually agreed upon acknowledgments must be exchanged electronically. Electronic
2.19exchanges of acknowledgments do not include e-mail or facsimile.
2.20 (f) Each of the transactions described in paragraphs (a) to (e) shall require the use
2.21of a single, uniform companion guide to the implementation guides described under
2.22Code of Federal Regulations, title 45, part 162. The companion guides will be developed
2.23pursuant to subdivision 2.
2.24 (g) Notwithstanding any other provisions in sections62J.50 to
62J.61 , all group
2.25purchasers and health care providers must exchange claims and eligibility information
2.26electronically using the transactions, companion guides, implementation guides, and
2.27timelines required under this subdivision. Group purchasers may not impose any fee on
2.28providers or providers' clearinghouses for the use of the transactions prescribed in this
2.29subdivision. Health care providers may not impose a fee on group purchasers or group
2.30purchasers' clearinghouses for the use of the transactions prescribed in this subdivision.
2.31A clearinghouse may not charge a fee solely to receive a standard transaction from a
2.32health care provider, a health care provider's clearinghouse, a group purchaser, or a group
2.33purchaser's clearinghouse when it is not an agent of the sending entity. A clearinghouse
2.34may not charge a fee solely to send a standard transaction to a health care provider, a health
2.35care provider's clearinghouse, a group purchaser, or a group purchaser's clearinghouse
2.36when it is not an agent of the receiving entity.
3.1 (h) Nothing in this subdivision shall prohibit group purchasers and health care
3.2providers from using a direct data entry, Web-based methodology for complying with
3.3the requirements of this subdivision. Any direct data entry method for conducting
3.4the transactions specified in this subdivision must be consistent with the data content
3.5component of the single, uniform companion guides required in paragraph (f) and the
3.6implementation guides described under Code of Federal Regulations, title 45, part 162.
1.3transactions;amending Minnesota Statutes 2010, section 62J.536, subdivision 1.
1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.5 Section 1. Minnesota Statutes 2010, section 62J.536, subdivision 1, is amended to read:
1.6 Subdivision 1. Electronic claims and eligibility transactions required. (a)
1.7Beginning January 15, 2009, all group purchasers must accept from health care providers
1.8the eligibility for a health plan transaction described under Code of Federal Regulations,
1.9title 45, part 162, subpart L. Beginning July 15, 2009, all group purchasers must accept
1.10from health care providers the health care claims or equivalent encounter information
1.11transaction described under Code of Federal Regulations, title 45, part 162, subpart K.
1.12 (b) Beginning January 15, 2009, all group purchasers must transmit to providers the
1.13eligibility for a health plan transaction described under Code of Federal Regulations, title
1.1445, part 162, subpart L. Beginning December 15, 2009, all group purchasers must transmit
1.15to providers the health care payment and remittance advice transaction described under
1.16Code of Federal Regulations, title 45, part 162, subpart P.
1.17 (c) Beginning January 15, 2009, all health care providers must submit to group
1.18purchasers the eligibility for a health plan transaction described under Code of Federal
1.19Regulations, title 45, part 162, subpart L. Beginning July 15, 2009, all health care
1.20providers must submit to group purchasers the health care claims or equivalent encounter
1.21information transaction described under Code of Federal Regulations, title 45, part 162,
1.22subpart K.
1.23 (d) Beginning January 15, 2009, all health care providers must accept from group
1.24purchasers the eligibility for a health plan transaction described under Code of Federal
2.1Regulations, title 45, part 162, subpart L. Beginning December 15, 2009, all health care
2.2providers must accept from group purchasers the health care payment and remittance
2.3advice transaction described under Code of Federal Regulations, title 45, part 162, subpart
2.4P.
2.5(e) Beginning January 1, 2012, all health care providers, health care clearinghouses,
2.6and group purchasers must provide an appropriate, standard, electronic acknowledgment
2.7when receiving the health care claims or equivalent encounter information transaction
2.8or the health care payment and remittance advice transaction, unless those claims were
2.9prescription drug claims submitted electronically by an entity licensed as a pharmacy. The
2.10acknowledgment provided must be based on one or more of the following American
2.11National Standards Institute, Accredited Standards Committee X12 standard transactions:
2.12(1) TA1;
2.13(2) 997;
2.14(3) 999; or
2.15(4) 277CA.
2.16Health care providers, health care clearinghouses, and group purchasers may send and
2.17receive more than one type of standard acknowledgment as mutually agreed upon. The
2.18mutually agreed upon acknowledgments must be exchanged electronically. Electronic
2.19exchanges of acknowledgments do not include e-mail or facsimile.
2.20 (f) Each of the transactions described in paragraphs (a) to (e) shall require the use
2.21of a single, uniform companion guide to the implementation guides described under
2.22Code of Federal Regulations, title 45, part 162. The companion guides will be developed
2.23pursuant to subdivision 2.
2.24 (g) Notwithstanding any other provisions in sections
2.25purchasers and health care providers must exchange claims and eligibility information
2.26electronically using the transactions, companion guides, implementation guides, and
2.27timelines required under this subdivision. Group purchasers may not impose any fee on
2.28providers or providers' clearinghouses for the use of the transactions prescribed in this
2.29subdivision. Health care providers may not impose a fee on group purchasers or group
2.30purchasers' clearinghouses for the use of the transactions prescribed in this subdivision.
2.31A clearinghouse may not charge a fee solely to receive a standard transaction from a
2.32health care provider, a health care provider's clearinghouse, a group purchaser, or a group
2.33purchaser's clearinghouse when it is not an agent of the sending entity. A clearinghouse
2.34may not charge a fee solely to send a standard transaction to a health care provider, a health
2.35care provider's clearinghouse, a group purchaser, or a group purchaser's clearinghouse
2.36when it is not an agent of the receiving entity.
3.1 (h) Nothing in this subdivision shall prohibit group purchasers and health care
3.2providers from using a direct data entry, Web-based methodology for complying with
3.3the requirements of this subdivision. Any direct data entry method for conducting
3.4the transactions specified in this subdivision must be consistent with the data content
3.5component of the single, uniform companion guides required in paragraph (f) and the
3.6implementation guides described under Code of Federal Regulations, title 45, part 162.
