Frequently Asked Questions

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 6 - Transaction-specific questions: Eligibility inquiry and response, claims, payment and remittance advice, and acknowledgments

Minnesota has developed rules for the standard, electronic exchange of four types of health care administrative transactions, as described below:

The health care eligibility benefit inquiry and response transaction is the transmission of either of the following:

  • An inquiry from a health care provider to a group purchaser, or from one group purchaser to another group purchaser, to obtain any of the following information about a benefit plan for an enrollee:

    - Eligibility to receive health care under the group purchaser;
    - Coverage of health care under the group purchaser; and/or
    - Benefits associated with the group purchaser.

  • A response from a group purchaser to a health care provider's (or another group purchaser's) inquiry described in paragraph (a) of this section.

The health care claims or equivalent encounter information transaction is the transmission of either of the following:

  • A request to obtain payment, and the necessary accompanying information from a health care provider to a group purchaser, for health care; or
  • If there is no direct claim, because the reimbursement contract is based on a mechanism other than charges or reimbursement rates for specific services, the transaction is the transmission of encounter information for the purpose of reporting health care.

The health care claim payment/remittance advice transaction is the transmission of the following from a group purchaser to a health care provider: explanation of benefits; and remittance advice.

The health care claim acknowledgment transactions are used to: report syntax errors; report HIPAA TR3 errors; acknowledge receipt; and accept or reject.

Acknowledgment transactions include:

  • Delivery or interchange (TA1);
  • Syntax and HIPAA TR3 response, or implementation (999); and
  • Business application or claims (277CA).
Updated Friday, 03-Apr-2020 11:16:45 CDT