Streamlining Health Care Administrative Transactions in Minnesota
AUC ELIGIBILITY TAG AGENDA
Wednesday, April 27th, 2016
2:00 p.m. – 4:00 p.m.
Teleconference line: 1-712-832-8300
Participant passcode: 337213
WebEx instructions:
1. To start the WebEx session, go to: https://health-state-mn-ustraining.webex.com
2. Under “Attend a Session,” click “Live Sessions”
3. Click on the session for “AUC Eligibility TAG”
4. Provide your name, email address, and the following password: Elg2010! (Note: The
exclamation mark at the end is part of the password.)
5. Click “Join now”
Meeting Objectives:
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Public Comment Period for the 271 Premium Payment Grace Period
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2016 Work Plan Review
Agenda items
1. Meeting to order – Theresa Noponen
2. Anti-trust statement: http://www.health.state.mn.us/auc/pdfs/antitrust.pdf
3. Introductions - Please e-mail your attendance to [email protected]
4. Approve March 23rd, 2016 minutes – May need to do an email vote.
5. Public Review Period for the 271, Premium Payment Grace Period Notification (007030X344). The
public review will commence March 9, 2016 and will close on May 9, 2016 at 5:00 PM Pacific Time.
a. Review notes from last month’s meeting in order to pass along to Operations for
approval of submission.
6. 2016 Work Plan Review
a. Non-HIPAA payors
b. AAA Errors
7. Other Business
Next Meeting – May 25th, 2016
Teleconference/WebEx only
Agenda Item
AUC ELIGIBILITY TAG
Meeting Minutes – March 23, 2016
Discussion
1. Meeting to order – Theresa Noponen
Theresa convened meeting.
2. Anti-trust
statement: http://www.health.state.mn.us/auc/pdfs/antitrust.pdf
Theresa reminded TAG members to comply with the AUC anti-trust statement
and that it is available for review on the AUC website there are any questions.
3. Introductions - Please e-mail your attendance to
[email protected]
Pulled off webex and reviewed.
4. Minutes for February 2016
Approved as published
5. Limited exception for non-HIPAA payers complying with MN
270/271 transaction requirements
BJ will be attending the meeting in June and offered to take a white paper
forward if completed, presenting on behalf of MN AUC. If there are questions
about individual organizations connection to AUC, Lauri Darst may be able to
help, she has been a chair of AUC and has been in this same situation.
Theresa to follow up with BJ to create documentation, bring to TAG for review
and approval.
6. AAA Errors and 2016 Work Plan – Best Practices and Education
Payor/Providers examples, this is going both ways Provider to Payor and Payor to
Provider:
What works, what does not work? Please bring forward and we will build off of
those scenarios to create educational materials for the AUC website. At April’s
meeting we will start to work on them, but this will be an ongoing topic at each
meeting, so send anytime.
Insurance cards are confusing –
• Interpretation of the card, multiple logos, how do we select the correct
payor or plan to map with our organization’s contract for modeling? At
times the true payor isn’t even one of the logos.
• There are state guidelines, possibly federal guidelines, for what is required to
be on a card, the following is for
Minnesota. https://www.revisor.mn.gov/statutes/?id=62J.60. If these
guidelines are not followed do we have any recourse? If there are specific
problems we could contact Department of Health or Department of
Commerce.
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Agenda Item
Discussion
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7. Review TR3
There is a difference between who we are contracted with vs who we are
sending the claim to.
Back Door network to take advantage of a certain contract. What network is
patient accessing our organization, but that creates confusion for us
regarding claims and contracting.
Medicare Replacement, the H=plan in RTE.
Medicaid Program Codes used, but not all payors provide.
Use the EDI# (claims) or have a different Submitter ID for the eligibility
transaction? Trading Partner agreements are with the clearinghouse and
may depend upon your clearinghouse.
o From February’s presentation by Tim – We send our 270 to MN
BCBS, but our patient has another state BCBS coverage. (Tim)
Additional Info re: BCBS, trading partner # with our clearinghouse,
goes to MN BCBS, they will then parse those Out of State subscribers
by using the alpha prefix (3 letters) of the ID, along with the ISA and
Trading Partner.
MN AUC did have a TAG working on HPID, became somewhat controversial,
so it was shelved and waiting to see if CMS will become involved.
TR3 is available free at www.wpc-edi.com, if you want to review. I was able to
download without problem.
Will this remain as a best practice that we have in place today with AUC ASC
X12/005010X279A1 Health Care Eligibility Benefit Inquiry and Response
(270/271) (PDF) vs X12? Yes this would remain in place, until X12 officially
adopts, if they adopt.
Does this TR3 have some improvements compared to our Best Practice? Should
Best Practice be replaced by TR3?
Our comments:
• Would this be a separate transaction from the 270/271 or would it be an
expansion?
• If it were to be a separate transaction, it should be streamlined.
• What if transaction received for a non-HIX member?
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Agenda Item
Discussion
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Is there a way to say “we found the member, but they are inactive? Another
option needs to be available for simply “inactive”.
Confusion about the use of “pending” with “active” and “inactive”. Just say
something like “member is active, in first month of the grace period” or
“member is inactive in 2nd or 3rd month of grace period”.
EB06 – is 90 days correct for 3 months? (statute – 3 consecutive months
could be 93 days)
EB09 and EB10 – Why tracking months and days?
Ask X12 for more information or clarification regarding the non-HIX grace
period types (PID05)
Typo on page 83 (segmens) – purpose of segment.
Purpose of NM1 on Page 84?
Dependent coverage for newborns?
Other miscellaneous typos and corrections to comment on are:
o Page 14 – Three transactions are listed in the first set of bullets
under 1.7 Related Transactions, but the text references “the above
four transactions”. See Example a below.
o Page 15 – Text says “006020X344” but given that the IG under
review is for the 007030X344, it would be assumed that 006020 is a
typo and should read 007030.
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