Minnesota AUC Home News Calendar Technical Advisory Groups About Archives Administrative Simplification Forms MN Uniform Companion Guides Best Practices Coding FAQs Links MN Department of Health		5010 Best Practices Minnesota AUC best practice documents are consensus recommendations of the AUC to further standardize and harmonize health care administrative transactions for providers and group purchasers. While adoption or adherence to the best practices is voluntary, it is strongly encouraged to further reduce health care administrative burdens and costs. Notice: Version 4010 of the Minnesota Uniform Companion Guides was discontinued as of December 31, 2011. To view best practices that were applicable to version 4010, please consult the 4010 Best Practices Grid (posted for archival purposes only). The best practices below are for use with the applicable version 5010 transactions. Best Practice Transaction Summary/Purpose V5010 270/271 Eligibility Inquiry and Response 271 eligibility response for health care home (HCH) benefits 271 Provides instructions for reporting of patient eligibility for care coordination services (i.e. health care home). pdf-2pgs Explicit service type inquiry/ response 270/271 Provides a mechanism for information receivers to request eligibility on specific service types. pdf-5pgs Reporting two digit Medicaid program code 271 Provide instructions for reporting the Minnesota Department of Human Services (DHS) two digit major program code for Prepaid Medical Assistance Plans (PMAP). pdf-2pgs 837 Health Care Claim: Professional (P), Institutional (I), and Dental (D) MN community coding recommendation grid 837P, 837I The MN community coding grid consists of medical coding recommendations. It is updated on a regular basis as needed, and the recommendations in the grid are approved and used in the same manner as best practices. pdf-23pgs Provider coordination of benefits (COB) claims data population 837P, 837I, 837D Provides assistance to providers and group purchasers for payer to payer COB transactions. Note: MS 62J.536 does not apply to payer to payer COB. pdf-2pgs Format of claim submitter’s identifier 837P, 837I, 837D Outlines for providers how to best format and submit patient control/account numbers in the claims transaction. pdf-2pgs Taxonomy submission requirements 837P, 837I, 837D Indicates situations where taxonomy code(s) should be included in the claim record as it will impact the adjudication of the claim. pdf-2pgs Claims attachments 837P, 837I, 837D Provides guidance on how to complete and send an attachment that is related to a submitted claim. Attachment cover sheet instructions Attachment cover sheet AUC member contact information for faxing claims attachments and appeals forms Note: Claims attachment cover sheets should be sent to the appropriate group purchaser and not MDH or AUC. pdf-3pgs Claim service dates restricted to same calendar month 837P, 837I, 837D Most patient eligibility changes occur at the beginning/end of a calendar month. Some systems require claims contain only services that are associated with a particular eligibility period, and current practice is to split these claims. The purpose of this best practice is to provide guidance in order to avoid split claims and rejections. pdf-2pgs Replacement/ void claims 837P, 837I, 837D Clarifies definitions, identification and handling of replacement and void claim types. Note: Replacement claims may also be referred to as “corrected claims”; void claims may also be referred to as “cancel claims”. pdf-3pgs Submission of appeals 837P, 837I, 837D Provides instruction for submitting an appeal by a provider to a Minnesota group purchaser. Appeal request form instructions Appeal request form AUC member contact information for faxing claims attachments and appeals forms Note: Claims appeal request forms should be sent to the appropriate group purchaser and not MDH or AUC. The attachment cover sheet must not be sent with the appeal request form. pdf-2pgs Billing for postage services 837P, 837I, 837D Provides instructions for postage billing, which only apply if the provider bills the group purchaser for postage. Some providers do not bill the group purchaser for postage and some contracts exclude coverage for postage. Providers are not required to bill for postage nor are group purchaser required to reimburse for postage. pdf-2pgs Billing for covered and non-covered services (e.g. elective, cosmetic, upgrade procedures) 837P, 837I, 837D Submission of non-covered services. It is recommended that providers submit all services on one claim. It is the payer’s responsibility to adjudicate the services in accordance with plan benefits. pdf-2pgs Examples for NTE and PWK usage 837P, 837I This best practice illustrates examples of where to populate data as appropriate in the NTE or PWK segments. pdf-3pgs 835 Claim Payment/Remittance Advice Electronic funds transfer (EFT) 835 Use of the EFT process with two ACH formats (CTX and CCD+) in connection with the 835 transaction. pdf-2pgs Prepaid Medical Assistance Program (PMAP) program codes for Medicaid Remittances 835 Group purchasers that report Medicaid claims in the 835 electronic remittance include the two-digit PMAP code with the claim. This code is used by providers when reporting encounters to the state. pdf-2pgs Other Dataset to be provided for skilled nursing facility admissions decisions N/A The dataset described in this best practice is an inventory of the information needed by skilled nursing facilities to decide whether they can adequately care for a resident and to prepare for providing that care. pdf-4pgs Back to top		Most Viewed Claims Forms * Attachment Cover Sheet         (Instructions-pdf) * Appeal Request Form    (Instructions-pdf) * Submission Info (pdf) Contact us If you have questions or comments about information on this page email: health.auc@state.mn.us Subscribe to AUC updates Adobe Acrobat Reader to view PDF files (free download from Adobe website)