62J.581 STANDARDS FOR MINNESOTA UNIFORM HEALTH CARE REIMBURSEMENT DOCUMENTS.

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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 1, paragraph (b), and rules adopted under section 62J.536 , subdivision 2.

Subd. 2. Minnesota uniform explanation of benefits.

(a)All group purchasers shall provide a uniform explanation of benefits to health care patients when an explanation of benefits is provided as otherwise required or permitted by law. The uniform explanation of benefits 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 explanation of benefits 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 subdivision 2 if they comply with section 62A.01 , subdivisions 2 and 3.

Subd. 4. Specifications.

(a)The uniform explanation of benefits shall be provided by use of a paper document conforming to the specifications in this section or its electronic equivalent under paragraph (b).

(b)Group purchasers may make the uniform explanation of benefits available in a version that can be accessed by health care patients electronically if:

(1)the group purchaser making the uniform explanation of benefits available electronically provides health care patients the ability to choose whether to receive paper, electronic, or both paper and electronic versions of their uniform explanation of benefits;

(2)the group purchaser provides clear, readily accessible information and instructions for the patient to communicate their choice; and

(3)health care patients not responding to the opportunity to make a choice will receive at a minimum a paper uniform explanation of benefits.

(c)The commissioner, after consulting with the Administrative Uniformity Committee, shall specify the data elements and definitions for the paper uniform explanation of benefits. Any electronic version of the uniform explanation of benefits must use the same data elements and definitions as the paper uniform explanation of benefits.

Subd. 5.

MS 2024 [Repealed by amendment, 1Sp2025 c 3 art 2 s 5 ]