In May of 2009, The Minnesota Department of Health released an electronic transaction update announcing that, “Minnesota Law Requires Standard, Electronic Exchange of Eligibility, Claims, and Payment/Advice Transactions in 2009.”  This update, directed to Healthcare clearinghouses, billing services and other vendors of services for healthcare administrative transactions, served to clarify the impact of Minnesota Statues, section 62J.536 which requires electronic, standard data content and format for an extensive list of healthcare transactions. The rules regarding this change in the law were announced in 2008, and they take effect in 2009.

What does the law require?

Minnesota Statutes, section 62J.536, requires all health care providers and group purchasers (payers, plans) to exchange eligibility inquiries and responses, claims, and payment remittance advices electronically, using a single, standard data content and format.

How will this be implemented?

The Minnesota Department of Health (MDH) is consulting with the Minnesota Administrative Uniformity Committee (AUC), a voluntary, broad-based group of health care providers and payers, including several Minnesota state agencies, to develop uniform standard companion guides (rules) for the standard data content and format of the required electronic transactions. Providers will be able to use these guides to standardize the way they check eligibility, submit claims, and receive remittance advices in an electronic format for all Minnesota health payers. Payers/group purchasers will use these guides to plan for, program, and accommodate these electronic transactions.

Why is this law being enacted?

To reduce costs, simplify and speed up health care transactions, and give providers and health plans one set of standards.

Who does this effect?

This statute applies to all healthcare providers as defined in MN Statutes §62J.03 and §62J.536, and to all group purchasers (payers) as defined in MN Statutes §62J.03.  It is important to note that the definition of group purchaser also applies to payers not covered by HIPAA (i.e., workers’ compensation, auto, and property-casualty carriers). 
In effect, if your organization is licensed or doing business in Minnesota as an insurer, TPA, or other health care payer and if your organization (or someone on your behalf) is paying, or could potentially have to pay for medical, dental, or pharmacy claims from a doctor, hospital, or other health care provider who is billing you for services they provided in Minnesota for a fee, the law (Minnesota Statutes, section 62J.536) applies to you.
Additional information regarding the applicability of MN Statutes § 62J.536 is available at:  http://www.health.state.mn.us/asa/faq62j536.pdf.

When will the law take effect?

 

Are there any exceptions or exemptions from the law?

Minnesota Statutes, section 62J.536 does NOT apply to:
Transactions with Medicare or Medicare Advantage products
Claims submitted by a patient/insured to the insurer/payer
Non-HIPAA covered group purchasers have a limited exemption from the requirements for the eligibility inquiry/response transaction only. Payers not covered by federal HIPAA transactions and code sets requirements (i.e., property casualty, auto, and workers’ compensation carriers) have a limited exception from only the requirement to electronically exchange eligibility inquiries and responses. However these carriers must still comply with the requirements for the standard, electronic exchange of claims and payment remittance advices. This limited exception is based on criteria in state statute and there are no other exceptions.

We’re a healthcare provider, how can HERAE help?

HERAE is the leading provider of electronic eligibility, claim and remittance services for healthcare providers, hospitals and pharmacies. HERAE has direct connections to all payers and can integrate with your bank to provide powerful, automated re-association of electronic remittance advice (ERA) and electronic funds transfer (EFT) data. HERAE services provide electronic patient eligibility, claim scrubbing, claim editing, online presentment of claim and remittance data with standardized layout and adjustment codes and workflow so flexible it can easily replace every aspect of your paper-based processes for posting, deposit verification, coordination of benefits, refunds and more – with a secure, HIPAA-compliant service that requires no software or IT upgrades on your part.

We’re a financial institution, how can HERAE help?

Healthcare corporations, medical groups and labs are looking for banking partners that provide HIPAA-compliant ERA (electronic remittance advice) transactions – now. The challenge: bank infrastructures can’t support ERA and they’re not HIPAA - compliant. Banks must either build a solution, or partner with a technology provider that has a proven infrastructure, a direct connection to payers and HIPAA compliance in place.
HERAE offers co-branding or private labeling for “electronic lockbox” services to the healthcare market. Our standardized formats provide simplicity for your customer’s back office, while our free sales and training enable your staff to easily land new business. There’s no software to purchase, no government compliance applications or fees, and you get the benefit of our established Direct Connect to insurance payers, as well as the customer support piece. Start landing new customers with HERAE today.

We’re a healthcare billing system vendor, how can HERAE help?

Of course you're heard of the claim of eliminating paper – probably many times. This time it's for real. Why? Because HERAE has studied your provider’s payment workflow and understands what it takes for a healthcare provider to be able to process payments electronically, with no further need for paper in either the form of an EOB, an EDI transaction, or a check. In fact, we've patented our solution.*

HERAE wants to work, in concert with selected Partners, to allow every hospital, physician's office and lab to eliminate the mountains of paper associated with handling and processing healthcare payments from payers: all of the varying EOB formats, the endless stream of envelopes, dealing with underpayments, secondary insurance claims and searching for an EOB you received three months ago.

The HERAE Billing System Partner Program provides you with access to additional revenue from existing customers while providing electronic remittance services they need.

We’re an insurance payer, how can HERAE help?

Our cutting edge payment delivery system provides payers the ability to transmit remittance and payment information to the providers in a combined package, saving your organization treasury services charges with our batch payment service. End the issues of ACH delivery lag and the headaches of your providers attempting to manually match electronic payments while allowing your claims departments to focus on delivering remittance information quickly. Our services work with your existing banks, or allows the ability to partner with local banks to provide same day delivery payments.

HERAE payer program provides your organization the benefits of being Minnesota E3 compliant for all electronic payments without changing your claim services. Our unique matching engine and provider facing workflow also eliminates state compliance related to prompt pay laws by eliminating the payment delivery time of paper checks. Change your payment delivery from 10 days to 2, or even same day delivery. Be a part of the healthcare payment revolution, call us today.

 

* The HERAE system patent is on file pending USPTO approval.