Billing Organizations/Responsibilities
Minnesota Health Care Programs (MHCP) providers may contract with billing organizations to conduct transactions on their behalf. All billing organizations must:
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 | |
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: | Batch or Batch and Interactive | |
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 | |
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 | |
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) |
Changing Your Billing Organization
Providers may add or change billing organizations at any time. Follow these steps to change your billing organization:
MHCP will review complete submissions within 30 days.
Additional Resources
Visit Clearinghouses.org for a list of clearinghouses.
*MHCP does not recommend any specific company or vendor. This may not be an all-inclusive list. If you have questions, contact the clearinghouse directly to determine your needs.
Legal References
Minnesota Statutes, 62J.50 ̶ 62J.60 (Minnesota Health Care Administrative Simplification Act of 1994)
Code of Federal Regulations, title 45, section 160.103 (General Provisions, Definitions)
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