Administrative Simplification Best Practices

• Provider Eligibility Verification (PDF)

• Attachments (completing and sending an attachment that is related to a submitted claim) (PDF)

  Cover sheet (DOC)

  AUC payer contact information for faxing claims attachments and appeals forms (PDF)

  Note:  Claims attachments and cover sheets should be sent to the appropriate group purchaser. Do NOT send them to MDH or the AUC.

• Replacement/Void Claims (PDF)

  Note:  Replacement claims may also be referred to as "corrected claims;" void claims may also be referred to as "cancel claims."

• Appeals (submitting an appeal by a provider to a Minnesota group purchaser) (PDF)

  Appeal Request Form Instructions (PDF)

  Appeal Request Form (PDF)

  Note:  Claims appeal request forms should be sent to the appropriate group purchaser. Do NOT send them to MDH or the AUC. The attachment cover sheet must not be sent with the appeal request form.

  AUC Payer Contact Information for Faxing Claims Attachments and Appeals Forms (PDF)

• Electronic Funds Transfer (EFT) (PDF)

  Note:  Revised 10-21-13 to be consistent with federal operating rules.

Below is a list of archived best practices that are available upon request by contacting health.asaguides@state.mn.us.

Acknowledgments (TA1, 999, 277CA)

• Acknowledgments Best Practice Summary
• Acknowledgments Best Practice PowerPoint Presentation
• Acknowledgments Best Practice

Eligibility (270-271)

• Reporting Health Care Home (HCH) Benefits 
• Reporting Minnesota Department of Human Services (DHS) Two Digit Major Program Code for Prepaid Medical Assistance Plans (PMAP)
• Service Type 60 Response (active coverage, no benefits reported)
• Reporting Termination Date for Inactive Coverage
• Service Type Inquiry/Response
• Reporting Restricted Recipient Program
• Multiple Service Type Inquiry/Response
• Reporting Other or Additional Payor Information
• Reporting Funding Type

Claims (837I, 837P, 837D, NCPDP D.0)

• Payer to Payer Coordination of Benefits (COB)
  Note:  MS §62J.536 does not apply to payer to payer COB.
• Formatting, Submitting Patient Control/Account Numbers
• When to Use Taxonomy Code(s)
• Claim Service Dates Restricted to Same Calendar Month
• Billing for Postage Services
• Billing for Covered and Non-Covered Services (e.g. elective, cosmetic, upgrade procedures)
• Examples for NTE and PWK Usage

Payment/Advice (835)

• Reporting APR-DRGs on the v5010 ERA (835)
  Note:  No longer a best practice, it has been incorporated as part of the Minnesota Uniform Companion Guide rule for the 835 transaction.
• Correct reporting of CAGC & CARC to consider the claim for payment as a secondary or tertiary payer (payer of last resort)

HIX Grace Period Notifications (835, 270/271, 277CA)

• ASC X12N/005010X221 Health Care Claim Remittance/Advice (835)
• ASC X12/005010X279A1 Health Care Eligibility Benefit Inquiry and Response (270/271)
• ASC X12/005010X214E2 Health Care Claim Acknowledgment (277CA)

Other

• Creating Companion Guides Compliant with Minnesota Statutes, Section 62J.536
• ACO-Attributed Member and Provider Data Elements and Data Formats