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 8 - Claims

ALL of the segments/fields/elements that are classified as REQUIRED in the HIPAA Implementation Guides and the NCPDP Guides must be sent by the submitter. In some instances that are identified in the Minnesota Uniform Companion Guides for Implementation of the Health Care Claim: Professional, Institutional, and Dental (837), the receiver may choose to not use the submitted element when processing the transaction.

Claims transactions that have passed basic edits which have not been rejected due to general envelope, formatting or transaction validation issues, and for which claim processing has been initiated in the payer’s system, require a Health Care Claim Payment/Advice (835) transaction. The 835 transaction must document the claim adjustments via Claim Adjustment Reason Codes (CARC), claim adjustment group codes, and Remittance Advice Remark Codes (RARC), including claim denials, as outlined for use in Table B.1 in the Minnesota Uniform Companion Guide for the Implementation of the Health Care Payment/Advice (835).

There are several claim numbers in the transaction. All are situational.

  • The Original Reference Number (ICN/DCN) is situational, and only required when claim submission reason codes are 6 (Corrected claim), 7 (Replacement claim) or 8 (Void) and the payer has assigned a number to the original claim.
  • The Property and Casualty (P&C) Claim Number is situational and should be reported when known. You should not deny the bill simply because it is missing this number but you could deny it if you are unable to match the bill to a P&C claim. (The claim number field is situational but is required if the claim is a P&C or Workers’ Compensation claim. As such, if a clearinghouse knows that the destination group purchaser is a P&C-only carrier, they can edit it at the clearinghouse and deny it back to the provider to obtain the P&C claim number.)
  • The Repriced Claim Number is situational.

The Minnesota AUC Medical Code TAG develops coding recommendations. Those that have been approved by the Minnesota AUC are included in the “Minnesota Community Coding Practice/Recommendation Table”. The table:

  • Provides clarification and answers to frequently asked questions about recommended ways to code for health and medical services on the 837I and 837P electronic claim;
  • Is intended for use in conjunction with “Appendix A, Table A.5.1” of the “Minnesota Uniform Companion Guides for the 837 Institutional (I) and 837 Professional (P) transactions;
  • Is regularly updated; and
  • Is informational only – It is not part of the Minnesota uniform companion guides and does not serve as a rule.

Claims attachments are addressed in all Minnesota Uniform Companion Guides for Implementation of the Health Care Claim: Professional, Institutional, and Dental (837) in section 4.2.3.

A supplemental AUC best practice for the submission of claims attachments and the claims attachment cover sheet can be found on the Minnesota AUC website.

If you have additional questions about sending claims attachments, the Minnesota Department of Health (MDH) suggests you contact your clearinghouse or the appropriate payer. Do not send claims attachments to MDH.

Claims adjustments and appeals are addressed in all Minnesota Uniform Companion Guides for Implementation of the Health Care Claim: Professional, Institutional, and Dental (837) in section 4.2.3.

A supplemental AUC best practice for requesting a claims appeal and the appeal request form can be found on the Minnesota AUC website.

If you have additional questions about requesting a claims adjustment or appeal, MDH suggests you contact your clearinghouse or the appropriate payer. Do not send appeal request forms to MDH.

Claims replacements and voids are addressed in all Minnesota Uniform Companion Guides for Implementation of the Health Care Claim: Professional, Institutional, and Dental (837) in section 4.2.3.

A supplemental AUC best practice for claims replacements and voids can be found on the Minnesota AUC website.

If you have additional questions about replacing or voiding claims, MDH suggests you contact your clearinghouse or the appropriate payer.

Yes. The Minnesota Uniform Companion Guides for Implementation of the Health Care Claim: Professional, Institutional, and Dental (837) offer guidance on this topic in each guide’s respective appendix section.

Updated Tuesday, 07-Apr-2020 15:08:17 CDT