Jeffrey Wade
If you have outstanding medical bills that you need to submit to your insurance company in Minnesota, there are a few things you should know. Firstly, it's important to understand common insurance and billing terms, such as co-insurance, co-pay, and deductibles. Secondly, you should verify your eligibility and insurance coverage through MN–ITS to ensure coordination between your insurance providers. Thirdly, be aware that clinics and hospitals must agree to certain discounts with insurance companies and cannot charge you more than the discounted amount. Finally, you should be aware of the time limits for submitting claims, which is typically within six months from the date of service, and the process for checking the status of your claim. If you need further assistance, you can contact the Hennepin County Managed Health Care Office or the Minnesota Attorney General's Office.
| Characteristics | Values |
|---|---|
| Who can submit past medical bills? | Health care providers and facilities |
| Time limit for submission | 6 months from the date of service or from the date the health care provider knew the name and address of the responsible health plan company or third-party administrator |
| Extension of time limit | 12 months in cases of significant disruption to normal operations |
| Submission process | MN–ITS Request Claim Status (276/277) |
| Contact for help with billing questions | Hennepin County Managed Health Care Office at 612-596-8860 |
| Contact for questions or help | Minnesota Attorney General's Office, 445 Minnesota Street, Suite 600, St. Paul, MN 55101, (651) 296-3353 (Twin Cities Calling Area), (800) 657-3787 (Outside the Twin Cities), (800) 627-3529 (Minnesota Relay) |
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What You'll Learn
- Check if you're eligible for Minnesota Health Care Programs (MHCP)
- Submit your claim within six months of the service
- Contact your insurance company to check if they've paid what they should
- Request an itemized statement from the clinic or hospital
- Use MN-ITS Direct Data Entry (DDE) to submit your claim
Check if you're eligible for Minnesota Health Care Programs (MHCP)
To check if you're eligible for Minnesota Health Care Programs (MHCP), you must meet certain eligibility rules. MHCP is available to adults with low incomes. The programs include Medical Assistance (MA), MinnesotaCare, Minnesota Family Planning Program (MFPP) and others.
MHCP members get health care services either on a fee-for-service (FFS) basis or through contracted managed care organizations (MCOs), depending on the program. Certified Minnesota Family Planning Program (MFPP) providers can determine presumptive eligibility for MFPP. You can search the MHCP Provider Directory to find enrolled FFS providers.
The Minnesota Department of Human Services Office of Inspector General, in collaboration with county agencies, works to prevent public assistance fraud. If you have a tip or complaint about potential fraud, you can report it.
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Submit your claim within six months of the service
In Minnesota, health care providers and facilities are required to submit their charges to a health plan company or third-party administrator within six months from the date of service. This is to ensure that they can be reimbursed for the charges incurred. Failure to meet this deadline will result in the provider or facility being unable to collect payment from the recipient of the service or any other payer.
It is important to note that the six-month submission deadline may be extended to 12 months in certain circumstances. This extension is permitted when a health care provider or facility can demonstrate and substantiate that they have experienced a significant disruption to their normal operations, which has materially impacted their ability to conduct business and submit claims in a timely manner. Any request for an extension must be reviewed and acted on by the health plan company within the same time frame as the original contractually agreed-upon claims filing timeline.
To submit a claim, providers can use a medical claims management system or a direct data entry system. In Minnesota, all health care providers are required by state statute to submit claims, including secondary claims, electronically using a standard format. This can be done through systems such as MN–ITS Interactive or Batch, or via approved clearinghouses, depending on the provider's specific situation.
For Minnesota Health Care Programs (MHCP)-enrolled providers, claims can be submitted through MN-ITS or a clearinghouse. Additionally, providers can check the status of their claim and receive a Remittance Advice (RA) document through these same channels. An RA provides notice and explanation of payment, adjustment, denial, and/or uncovered charges of a medical insurance claim.
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Contact your insurance company to check if they've paid what they should
To check if your insurance company has paid what they should, you will need to contact them directly. You can do this by calling the phone number on the back of your insurance ID card or, if you have insurance through your workplace, by contacting your HR team or checking your enrollment information.
When you contact your insurance company, you will need to provide them with specific information about the medical bills in question. This includes the date of service, the type of service provided, and the amount charged. You should also have your insurance policy number and personal information (such as your date of birth and address) ready to verify your identity.
Ask the insurance company representative to review the claims associated with the medical bills you have provided and confirm whether the amounts paid by the insurance company are correct. They should be able to provide you with a detailed breakdown of what was covered and what, if anything, you are responsible for paying out-of-pocket.
It is important to remember that insurance coverage can vary depending on the specific plan and network of providers. Therefore, it is always a good idea to confirm with your insurance company that the care and provider you intend to use are covered before you incur any expenses. Additionally, keep in mind that there may be time limits on submitting claims and receiving reimbursement, so act promptly to avoid any issues with your insurance coverage.
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Request an itemized statement from the clinic or hospital
Requesting an itemized statement from the clinic or hospital is a crucial step in understanding and potentially disputing your medical bill. Here's a step-by-step guide on how to request an itemized statement:
- Contact the Billing Department: Call the phone number listed on the consolidated bill you received from the hospital or clinic. This number typically connects you to the billing department.
- Speak with a Representative: Navigate through the phone menu options until you reach a human representative. You may need to choose options related to billing or payment inquiries.
- Make Your Request: When you reach a representative, clearly state your request for an itemized statement. You can ask them to post it to your online patient portal or mail you a physical copy.
- Provide Necessary Information: The representative will likely ask for identifying information, such as your name, patient ID, or guarantor number, to locate your medical record. Provide any additional details they may need to process your request.
- Accessing Online Portals: If your itemized bill is posted to an online portal, make sure you know how to access it. Ask the representative for instructions on signing up or logging in to the portal if you're unsure.
- Understanding the Itemized Bill: An itemized bill should list each individual product or service you received during your visit. It should include dates of service, procedure codes (CPT or HCPCS), revenue codes, quantities, and charges for each line item. These codes are essential for identifying and pricing specific procedures.
- Compare with Original Charges: Once you receive the itemized statement, carefully compare it with the original charges. Look for any discrepancies, such as services you never received or payments that were already made by you or your insurance company.
- Dispute Discrepancies: If you identify any errors or discrepancies, contact the clinic or hospital to resolve them. You can call or write to them, pointing out the specific issues and requesting corrections or adjustments. Keep copies of any correspondence for your records.
Remember, it is your right to receive an itemized bill, and hospitals are legally required to provide it within 30 days of your request under the HIPAA Privacy Rule. Don't hesitate to take the initiative and request an itemized statement to ensure accurate billing and protect yourself from incorrect or inflated charges.
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Use MN-ITS Direct Data Entry (DDE) to submit your claim
To submit past medical bills to your insurance in Minnesota, you can use the MN-ITS Direct Data Entry (DDE) to submit your claim. This method allows you to enter your claim information directly into the MN-ITS system, which is a secure online platform for managing healthcare claims and related transactions. Here's a step-by-step guide on how to use MN-ITS DDE to submit your past medical bills:
Step 1: Register for an Account
Visit the MN-ITS website and register for an account if you don't already have one. You will need to provide some basic information, such as your name, contact details, and social security number.
Step 2: Familiarize Yourself with the MN-ITS System
Once you have access to the MN-ITS system, take some time to navigate and understand the platform. Locate the "Direct Data Entry" section, which is typically under the "Claims" or "Billing" menu.
Step 3: Gather Your Medical Bill Information
Before starting the submission process, ensure you have all the necessary information and documents related to your past medical bills. This includes details such as the date of service, provider information, procedure codes, diagnosis codes, and the amount you were charged.
Step 4: Start the Claim Submission Process
Log in to your MN-ITS account and access the Direct Data Entry (DDE) section. Look for options like "Submit a Claim" or "Create a New Claim."
Step 5: Enter Claim Details
Carefully enter all the required information for your past medical bill. This includes patient information, provider information, dates of service, procedure codes, and charges. Double-check all the details before submitting.
Step 6: Attach Supporting Documentation
In some cases, you may need to attach supporting documentation, such as itemized bills or explanation of benefits (EOB) statements. Scan or upload these documents as per the instructions in the MN-ITS system.
Step 7: Review and Submit Your Claim
Before final submission, thoroughly review all the information you have entered and any attached documentation. Ensure everything is accurate and reflects the details of your past medical bill. Then, submit your claim.
Step 8: Follow Up and Check Status
After submitting your claim, make a note of the confirmation number or any reference number provided. Use the MN-ITS system or contact the insurance provider directly to periodically check the status of your claim. This will allow you to know if any additional information is required and when a decision is made on your claim.
Remember to keep detailed records of your past medical bills, including any correspondence or documentation related to your insurance claim. The MN-ITS DDE system is designed to streamline the claim submission process, but it's always a good idea to stay organized and follow up to ensure your claim is processed efficiently.
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Frequently asked questions
If you have insurance coverage, ensure that your insurance company has paid what it should. If you are uncertain whether you owe the bill, call your insurance company to find out whether it has received and acted on the bill and how much it will be paying. Ask your insurance company what its timetable is for paying the bill.
If you are enrolled in a managed health care plan, call your plan for transportation assistance. If you are not enrolled in a health plan, call MTM at 1-866-467-1724 for assistance with medical transportation.
If you are an undocumented resident and have applied for Minnesota Health Care Programs in the past, download the MNSure application for health coverage and help with paying costs and submit to Hennepin County.
You may have been billed for services that have not been received, billed for services that have already been paid, or billed for services that should have been submitted to your insurance company. If you are unsure whether you owe the amount requested, request an itemized statement from the clinic or hospital. Keep copies of any letters you send. Ask the clinic or hospital for an itemization of all payments, whether made by you or your insurance company.
Unless otherwise provided by contract, health care providers and facilities must submit their charges to a health plan company or third-party administrator within six months from the date of service or the date the health care provider was informed of the correct name and address of the responsible health plan company or third-party administrator.
