2009 Electronic Claim Requirements for Minnesota Dentists

2009 Electronic Claim Requirements for Minnesota Dentists

Virgil M. Mylan, D.D.S.*:

Abstract

This article explains Minnesota Statute 62J.536, which is a new law requiring all health care providers and payers doing business in Minnesota to use electronic formats for billing, eligibility, and remittance advice. The focus of this article is on dentists and what they must do to be in compliance.

 


Introduction

This year brings a significant change in the way Minnesota dentists and payers communicate and conduct business. A new state law requiring dental offices to use electronic formats instead of paper claims and printed remittance advice goes into effect in 2009. Starting July 15, 2009, dentists can no longer send paper claims to insurance companies. Even now (as of January 15, 2009), you must use an electronic method to check a patient’s coverage instead of calling the payer on the telephone. The new law (Minnesota Statute 62J.536) requires all health care providers to use electronic formats when billing, requesting eligibility, and receiving remittance advice.

Implementation Dates

The new requirements are in effect on the following dates:

  • Eligibility: January 15, 2009
  • Claims: July 15, 2009
  • Remittance Advice: December 15, 2009

Eligibility Requests

This part of the new law is already in effect (as of January 15, 2009). You will no longer call payers on the telephone to check for eligibility, but instead process the request electronically.

Various payers will handle this differently. One solution is a portal in the payer’s website where the dental office uses a secure sign-on; inputs provider, patient, and subscriber information; and receives a response. This works best for single requests, but it is likely at least some payers will handle multiple requests (multiple patients) in one session.

Another option is transmitting a Request for Eligibility file (similar to sending an electronic claim file). When you send this file, you receive an electronic response from the payer defining eligibility for patients included in the file. This is useful when requesting eligibility for multiple patients; however, there is an exception in Minnesota law for this file, and the payer may legitimately refuse to accept it. In this case, the dental office reverts to a request for eligibility using the payer’s web page as described above. You can also expect your clearinghouse to provide this service.

In any case, Minnesota law now requires a payer to accept an electronic request for eligibility, and provide an electronic response that either confirms or denies coverage.

Claims

Beginning on July 15, 2009, dentists in Minnesota can no longer send paper claims and must bill payers (insurance companies, third-party administrators, etc.) in a standard electronic format. If you have a dental software management program, the only difference will be selecting “electronic transmission of claims” instead of “printing” in the software. Although payers accept electronic claims directly from a provider, most dental offices will use a clearinghouse that batches and forwards claims to individual payers.

The claim standard supports attachments (examples are periodontal charting and radiographs). The electronic claim does not include the attachment, but instead provides an indicator that an attachment exists and is sent under a different cover. Faxing paper documents, or, as in the case of radiographs, scanning the document to create a digital image sent electronically, are ways to deliver attachments to a payer. Your clearinghouse will provide any assistance you may require transmitting attachments. Since handling physical documents reduces the efficiency of an electronic system, it is likely that payers will adjudicate the claim immediately, and ask for documentation at some later time.

 

*Dr. Mylan is chair of the Dental Marketplace Committee of the Minnesota Dental Association. He is a general dentist in private practice in Edina, Minnesota. E-mail is smylan@visi.com.