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Minnesota AUC Administrative Simplification
 

Forms

Claims Attachment Cover Sheet

Claims Attachment Cover Sheets should be sent to the appropriate payer and not the Minnesota Department of Health or the AUC.

Claims Appeal Request Form

Claims Appeal Request Form is to be used when a provider is requesting a reconsideration of a previously adjudicated claim but there is no additional or corrected data to be submitted.
Claims Appeal Request Forms should be sent to the appropriate payer and not to the MN Department of Health or the AUC.

SBARs and Work Requests

  • Use the SBAR Form in accordance with Policy #10 (pdf: 2 pages) to request that the AUC conduct work on a particular administrative simplification issue.

  • Use the Minnesota Uniform Companion Guide Work Request Form to suggest changes to uniform companion guides.

 
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