Minnesota Department of Labor and Industry Orange bar
Minnesota Department of Labor and Industry Powered by google

Workers' compensation -- HIPAA 835 Health care claim payment/remittance advice



5221.0650 Data collection, retention and reporting requirements

Subpart 1. Scope. This part applies to workers' compensation insurers, self-insurers, group self-insurers, adjusters, and third-party administrators who act on behalf of an insurer, self-insurer, the assigned risk plan, and the Minnesota Insurance Guaranty Association.

Subp. 2. Purpose. The purpose of this part is to establish procedures and requirements for reporting medical and related data regarding treatment of work-related injuries. The data shall be provided in order for the department to monitor and evaluate medical services and supplies under Minnesota Statutes, chapter 176.

Subp. 3. Retention period. Data described in subpart 4 shall be collected and stored by the parties listed in subpart 1, beginning July 1, 1994, for all medical services and supplies provided to an employee under Minnesota Statutes, chapter 176, for 10 years from the date of injury, or four years from the date the claim is closed, whichever is later.

Subp. 4. Required data. The data in items A and B shall be collected and stored by the parties listed in subpart 1.

A. Required data for professional services and supplies includes all elements required on the uniform billing form under part 5221.0700, subpart 2a, and:

(1) an indication of open or closed claim status;

(2) an indication of whether the employee was incapacitated from performing labor or service for more than three calendar days under Minnesota Statutes, section 176.231, subdivision 1;

(3) the amount of payments made for individual medical services, articles, and supplies; and

(4) the name of the managed care plan if services were provided under contract with or referral by a certified workers' compensation managed care plan.

B. Required data for inpatient and outpatient hospital services and supplies includes all elements required on the uniform billing form under part 5221.0700, subpart 2b, and:

(1) an indication of open or closed claim status;

(2) an indication of whether the employee was incapacitated from performing labor or service for more than three calendar days under Minnesota Statutes, section 176.231, subdivision 1; and

(3) the name of the managed care plan if services were provided under a contract with or referral by a certified managed care plan for workers' compensation.

Subp. 5. Reporting requirements. The data in subpart 4 shall be periodically sampled according to the sampling specifications prescribed by the research design for a study initiated by the commissioner under Minnesota Statutes, sections 175.17, 175.171, 176.103, and 176.1351. The samples shall be reported within 90 days of the request of the commissioner. The requested data shall be provided without charge to the department by a mutually agreeable standard of information exchange such as hard copy, computerized form, or electronic data interchange.

Statutory authority:  MS s 175.171; 176.101; 176.135; 176.136; 176.231; 176.83

History:  18 SR 1472

Posted:  June 11, 2008

DLI home page | Directions and maps | News and media | Website disclaimer