Frequently Asked Questions (FAQs)
The following FAQs are provided for information and clarification. They will be revised and updated as needed. Additional information regarding Minnesota Statutes, section 62J.536 and related rules is available at on the Minnesota Department of Health Administrative Simplification Act website.
Last revised: 1/30/2012
Category 4 - Transaction-specific questions: Eligibility inquiry and response, claims, payment and remittance advice, and acknowledgments
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.
Even with the best communication and planning, providers and payers may still encounter possible problems during the initial implementation of version 5010 of the standard, electronic administrative HIPAA transactions.
MDH is committed to working with the industry to help identify and solve problems as quickly as possible while also achieving the goals of more standard, efficient transactions. As part of this commitment, MDH will use its considerable regulatory flexibility to help minimize the possibility of delays or interruptions in routine administrative transactions during implementation of the rules.
MDH’s enforcement goal is to help assure that routine health care business transactions can flow more rapidly and efficiently—not to collect fines for noncompliance. 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.
In summary, MDH’s approach to enforcement and meeting the goals for standard, electronic transactions will be flexible, practical, and consistent with an 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.
Complaint form: MDH strongly encourages all providers and payers to review and consider the information provided here. However, as noted, MDH is charged with investigating any complaints submitted related to Minnesota Statutes, section 62J.536.
Payers and their clearinghouses (or any organization acting on the payer’s behalf) must be able to demonstrate they have the capability to accept Minnesota-compliant, standard, electronic transactions. However, MDH does not require payers to reject noncompliant claims. MDH encourages payers to work with providers to aid them in coming into compliance before taking steps to reject noncompliant claims.
MDH does not require any particular information from payers, providers, or their clearinghouses regarding their readiness to comply with Minnesota Statutes, section 62J.536.
It will be important for trading partners to communicate and work together before, during, and after the law’s effective dates to be compliant. Per statute, enforcement of Minnesota’s requirements for standard, electronic health care business transactions is complaint-driven. The statute also states that MDH is to seek informal resolution of complaints, and, if informal resolution is not possible, it may consider a number of mitigating factors before imposing any fines or penalties. During the initial implementation phases of the rules especially, we encourage trading partners to find ways to work together for compliance.
Parties may also consider filing a complaint of noncompliance with MDH for investigation and possible follow-up. However, it is important to note that the complaint filing and follow-up process is prescribed in statute, and that it requires specific steps in filing the complaint, providing notice to the subject(s) of the complaint, investigation of the complaint, and other steps. While complaints are an important and necessary option in some instances, the complaint process does require time and/or effort that may also be usefully spent in communicating about problems and working toward solutions.
Reading the MDH Implementation and Compliance Updates is strongly encouraged to learn more about MDH’s approach to enforcement of Minnesota Statutes, section 62J.536.