1.1 A bill for an act
1.2 relating to health; allowing insurers to provide explanation of benefits electronically;
1.3 amending Minnesota Statutes 2024, sections 62J.51, subdivision 19a; 62J.581.
1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.5 Section 1. Minnesota Statutes 2024, section 62J.51, subdivision 19a, is amended to read:
1.6 Subd. 19a.Uniform explanation of benefits document."Uniform explanation of
1.7benefits document" means either the document associated with and explaining the details
1.8of a group purchaser's claim adjudication for services rendered or its electronic equivalent
1.9under section 62J.581, which is sent to a patient.
1.10 Sec. 2. Minnesota Statutes 2024, section 62J.581, is amended to read:
1.11 62J.581 STANDARDS FOR MINNESOTA UNIFORM HEALTH CARE
1.12REIMBURSEMENT DOCUMENTS.
1.13 Subdivision 1.Minnesota uniform remittance advice.All group purchasers shall
1.14provide a uniform claim payment/advice transaction to health care providers when a claim
1.15is adjudicated. The uniform claim payment/advice transaction shall comply with section
1.1662J.536, subdivision 1, paragraph (b), and rules adopted under section 62J.536, subdivision
1.172.
1.18 Subd. 2.Minnesota uniform explanation of benefits document.(a) All group
1.19purchasers shall provide a uniform explanation of benefits document to health care patients
1.20when an explanation of benefits document is provided as otherwise required or permitted
1.21by law. The uniform explanation of benefits document shall comply with the standards
1.22prescribed in this section.
1Sec. 2.
25-00302 as introduced12/11/24 REVISOR EB/MI
SENATE
STATE OF MINNESOTA
S.F. No. 3297NINETY-FOURTH SESSION
(SENATE AUTHORS: WIKLUND)
OFFICIAL STATUSD-PGDATE
Introduction and first reading04/07/2025
Referred to Health and Human Services 2.1 (b) Notwithstanding paragraph (a), this section does not apply to group purchasers not
2.2included as covered entities under United States Code, title 42, sections 1320d to 1320d-8,
2.3as amended from time to time, and the regulations promulgated under those sections.
2.4 Subd. 3.Scope.For purposes of sections 62J.50 to 62J.61, the uniform claim
2.5payment/advice transaction and uniform explanation of benefits document format specified
2.6in subdivision 4 shall apply to all health care services delivered by a health care provider
2.7or health care provider organization in Minnesota, regardless of the location of the payer.
2.8Health care services not paid on an individual claims basis, such as capitated payments, are
2.9not included in this section. A health plan company is excluded from the requirements in
2.10subdivisions 1 and subdivision 2 if they comply with section 62A.01, subdivisions 2 and
2.113.
2.12 Subd. 4.Specifications.(a) The uniform explanation of benefits document shall be
2.13provided by use of a paper document conforming to the specifications in this section or its
2.14electronic equivalent under paragraph (b).
2.15 (b) Group purchasers may make the uniform explanation of benefits available in a version
2.16that can be accessed by health care patients electronically if:
2.17 (1) the group purchaser making the uniform explanation of benefits available
2.18electronically provides health care patients the ability to choose whether to receive paper,
2.19electronic, or both paper and electronic versions of their uniform explanation of benefits;
2.20 (2) the group purchaser provides clear, readily accessible information and instructions
2.21for the patient to communicate their choice; and
2.22 (3) health care patients not responding to the opportunity to make a choice will receive
2.23at a minimum a paper uniform explanation of benefits.
2.24 (c) The commissioner, after consulting with the Administrative Uniformity Committee,
2.25shall specify the data elements and definitions for the paper uniform explanation of benefits
2.26document. The commissioner and the Administrative Uniformity Committee must consult
2.27with the Minnesota Dental Association and Delta Dental Plan of Minnesota before requiring
2.28under this section the use of a paper document for the uniform explanation of benefits
2.29document or the uniform claim payment/advice transaction for dental care services. Any
2.30electronic version of the uniform explanation of benefits must use the same data elements
2.31and definitions as the paper uniform explanation of benefits.
2Sec. 2.
25-00302 as introduced12/11/24 REVISOR EB/MI 3.1 Subd. 5.Effective date.The requirements in subdivisions 1 and 2 are effective June 30,
3.22007. The requirements in subdivisions 1 and 2 apply regardless of when the health care
3.3service was provided to the patient.
3Sec. 2.
25-00302 as introduced12/11/24 REVISOR EB/MI