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Billing Organizations/Responsibilities

Date: 01-05-2011

MHCP providers may contract with billing organizations to conduct transactions on their behalf. All billing organizations must:

  • • Enroll with MHCP by completing the EDI Trading Partner Application (DHS-4049)
  • • Inform MHCP of providers for whom they bill by completing the Provider Setup Form (DHS-4087), including when this information changes
  • • Use only HIPAA-compliant electronic transactions (see MS 62J.536 for complete and upcoming requirements affecting billing organizations)
  • Billing Organization Type

    Description

    MN–ITS Registration

    Allowed Transactions

    Billing Agent (EDI Trading Partner)

    Individual or entity that contracts with a provider. Provider employees may not be a billing agent for the provider.

    Interactive

  • • Submit claims (837)
  • • Submit authorization requests (278)
  • • Receive PDF RAs
  • • Verify eligibility (270/271)
  • • Check claim status (276/277)
  • Billing Intermediary

    A billing intermediary receives data elements from a provider and, depending on the data elements, manipulates and formats the data into HIPAA-compliant, X12 transactions. May receive payment on behalf of the provider only when the payment to the billing intermediary is all of the following:

  • • Related to the cost of processing the billing
  • • Not related to a percentage (or other basis) of the amount that is billed or collected
  • • Not dependent on collection of the payment
  • Batch

    or

    Batch and Interactive

  • • Submit claims (837)
  • • Submit authorization requests (278)
  • • Receive RAs (X12 835, PDF or both)
  • • Verify eligibility (270/271)
  • • Check claims status
  • Consolidated Billing Entity (EDI Trading Partner)

    A consolidated billing entity is a designation that allows a provider with multiple MN–ITS mailboxes to have access to all their associated mailboxes within one mailbox.

    Batch

    or

    Batch and Interactive

  • • Submit claims (837)
  • • Submit authorization requests (278)
  • • Receive RAs (X12 835, PDF or both)
  • • Verify eligibility (270/271)
  • • Check claim status (276/277)
  • Value Added Network (VAN)

    A VAN acts as a conduit, value-added network, or switch for the provider and exchanges data elements with the provider. The VAN processes health information data into a standard format (such as information from a provider to MHCP for billing) or from a standard format into nonstandard data content (such as information from MHCP to a provider).The VAN does not manipulate the data elements received from the provider.

    Batch

  • • Submit claims (837)
  • • Submit authorization requests (278)
  • • Receive RAs (X12 835, PDF or both)
  • • Verify eligibility (270/271)
  • • Check claims status (276/277)
  • Eligibility Verification Vendor (EDI Trading Partner)

    An eligibility verification vendor provides MHCP recipient eligibility information to a provider and must not alter or retain any of that data to or from the provider.

    Batch

    Verify eligibility (270/271

    Health Care Data Trading Partner (HCDTP) (EDI Trading Partner)

    A health care data trading partner may be a state-contracted vendor, state and federal agencies, or federally-contracted vendors, with whom MHCP has a need to exchange health care-related data.

    Batch

    Data exchange

    Medicare Carrier

    A Medicare carrier contracts with Medicare to pay Medicare Part A or B claims. MHCP retrieves claim transactions from the Medicare carrier’s MN–ITS mailbox to cover the coinsurance and deductible. Medicare carriers do not receive RAs or use MN–ITS for any other reason.

    Batch

    Submit claims (837)

    Legal References

    MS 62J.50 to 62J.60 Minnesota Health Care Administrative Simplification Act of 1994
    45 CFR 160.103 General Provisions, Definitions

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