You’ve heard about it, but are you ready?
On Call Medical can help.
Reference: UAC Provider Alert
What: Minnesota Statutes, section 62J.536, require all health care providers and group purchasers (payers, plans) to exchange eligibility inquiries and responses, claims, and remittance advices electronically, using a standard format, effective in 2009. If you submit paper claims, you should explore your options for electronic billing and prepare to be in compliance by 2009.
How: The Minnesota Department of Health (MDH) with the Minnesota’s Administrative Uniformity Committee (or AUC, the broad-based group of providers and payers listed below) will provide guides to standardize the way you check eligibility, submit claims and receive remittance advices in an electronic format for all Minnesota health payers. Visit the AUC website online at www.health.state.mn.us/asa to learn more.
Why: To reduce costs, simplify, and speed up health care transactions, and give providers and health plans one set of standards.
Who: This statute applies to all health care providers that check eligibility, submit claims and/or receive RAs. It also applies to all health plans and payers.
When: These rules will take effect, as follows:
Eligibility inquiry and response (270/271)
Jan. 15, 2009
Health care claim (837P, 837I, 837D and NCPDP 5.1)
July 15, 2009
Payment/remittance advice (835)
Dec. 15, 2009
Next Steps for You as a Provider:
- Watch for more information on the websites of Minnesota’s health plans.
- Consider your options for how you will verify eligibility, submit claims and receive your RA electronically.
- Update practice management system, billing service, clearinghouse or web-based portals.
On Call Medical will help you implement and manage highly customized, comprehensive and cost-effective medical billing and account receivable solutions that will meet the requirements of the new rules mentioned above and proven to improve the profits, revenues and quality of life for health care providers.
Does this statute also apply to secondary claims? If it does, will the payers be ready to accept? We are ready but it’s at the payer level where they are not ready to accept.
The guide put out by the UAC is not crystal clear but suggests that you will submit the claim electronically with an attachments code and send the paper attachments separate with that code. I think the matching process will be a nightmare. Because of this very issue, it would have made more sense to me to require the electronic remits first, then the claims later so that providers could get their systems updated for auto posting of the EOBs which would help with secondary submissions and eliminate the need for attachments.
Also, there is encouragement but no mandate for payers to coordinate benefits based on secondary information submitted on the claim, for group purchasers that have agreements.
But you’re right, the payers have to update their systems to accept and process electronic secondary claims. We shall see.