ASA Requirements & Compliance
Rules & Requirements
Minnesota law requires group purchasers and health care providers to use electronic eligibility, claims, payment/advice, and acknowledgment transactions with a single, uniform companion guide to the implementation guides described under Code of Federal Regulations, title 45, part 162. The rules for single, uniform companion guides are known as “Minnesota Uniform Companion Guides”.
Minnesota Law requires that prescription drug prior authorization requests must be accessible and submitted by health care providers, and accepted by group purchasers, electronically through secure electronic transmissions, based on the Minnesota Companion Guide Version 1.1 for the Implementation of NCPDP Electronic Prior Authorization (ePA) transactions [NCPDP SCRIPT Standard version 2013101] (PDF). See also the related Fact Sheet (PDF).
Minnesota Law requires that health care providers requesting exceptions from group purchaser formularies must use the Minnesota Uniform Form for Prescription Drug Prior Authorization (PA) Requests and Formulary Exceptions (PDF) as instructed on the form.
The Minnesota Department of Health (MDH) ensures compliance with Minnesota Statutes, section 62J.536 and related rules. The statute provides that:
- MDH is to achieve voluntary compliance to the extent practicable, and may provide technical assistance;
- Enforcement will be complaint-driven;
- MDH may investigate complaints, and is to seek informal resolution of complaints, for example through demonstrated compliance or a completed corrective action plan or other agreement;
- If informal resolution is not possible, MDH may impose civil money penalties of up to $100 for each violation, but not to exceed $25,000 for identical violations during a calendar year;
- Mitigating factors, such as whether attempts are being made to come into compliance, may be considered in determining any penalties; and
- If a fine is levied, it may be appealed or a contested case hearing requested.
MDH’s approach to enforcement and meeting the goals for standard, electronic transactions will be consistent with the overall statutory enforcement policy of:
- Seeking voluntary compliance and offering technical assistance;
- Responding to complaints;
- Working toward informal resolution of complaints; and
- Considering possible mitigating factors.
In enforcing the statute and related rules, MDH will be especially interested in:
- Whether good faith efforts are being made to comply;
- The extent of compliance efforts; and
- Progress toward compliance.
- Limited exception for non-HIPAA payers from Minnesota's requirements for only the standard, electronic exchange of eligibility transactions (270-271), is continued for 2019 (PDF)
- Electronic Funds Transfer (EFT) Encouraged for Health Care Claims. Comply with federal EFT operating rules by January 1, 2014 (PDF)
- Payers (or their agents) may not charge for receiving a standard transaction (PDF); Cover Memo (PDF)