Technical Advisory Group
SBAR and work request forms
• Faith Bauer Faith_E_Bauer@bluecrossmn.com 651-662-8068
Charge and mission statement of work
For Minnesota Statutes 62J.536 project: Create common standards in cases where Medicare does not meet Minnesota needs and Minnesota commercial health plan group purchasers require providers to code medical services differently, depending upon the group purchaser.
An overarching principle of this work is the fact that, each MN group purchaser and provider will be required to make changes to procedures, policies and/or systems in some way, as a result of the work of the AUC and the Medical Code TAG.
Work plan and/or accomplishments
Determine scope and relevance to Medical Code TAG for Minnesota Statutes 62J.536 project:
- In the Scope of the Medical Code TAG:
- HCPCS Codes (CPT Codes)
- Revenue Codes
- Units – when not addressed in the Claims Data Definition TAG and/or the MN 1500 Manual, e.g., bilateral procedures, anesthesia
- ICD 9– Procedure Codes
Not in the Scope of the Medical Code TAG – such as, but not limited to:
- Type of bill
- Late charges
- Timely filing
Items not within the above Scope of the Medical Code TAG will be forwarded on, via a spreadsheet, to the appropriate AUC TAG, e.g., Claims Data Definitions for resolution. The Medical Code TAG will bring any items with unknown ownership to the AUC Executive Committee.
Process for Minnesota Statutes 62J.536 project
- For each coding topic the Medical Code TAG will first review the CMS Medicare Manual and if group purchasers/providers agree that Medicare is the preferred coding method then that item is considered to be - DONE.
- If all group purchasers/providers do not agree to follow Medicare, then the Medical Code TAG will decide on ONE way to code for services for commercial business in MN. All participants should provide compelling business facts to support the preferred method.
- If group purchasers/providers do not reach consensus on ONE method to code for services, then action items will be assigned to group purchasers/providers, with a deadline date to report back to the Medical Code TAG.
The Medical Code TAG will then review appropriate materials and determine the ONE way to code for services for commercial MN group purchasers for those items that are NOT in the CMS Medicare Manual, such as, EPSDT, maternity, pediatrics, etc.
Overarching considerations for this work are that the Medical Code TAG will need to continue to address new code standards using the above procedures.
Work product to be developed
Minnesota rules for medical codes when commercial health plan group purchasers use codes other than those in the CMS Medicare Manual. MN medical code rules will be in an appendix to the MN Institutional Claims (837I) Companion Guide, the MN Professional Claims (837P) Companion Guide, the MN Dental Claims (837D) Companion Guide, and the MN Pharmacy Claims (NCPDP 5.1) Companion Guide.
Activation or re-activation date: 01/01/2007
(Formerly State HCPCS Committee)
Inactivation date: N/A
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