Appendix B of the Minnesota Uniform Companion Guide for the ASC X12/005010X221A1 Health Care Claim Payment Advice (835) sets forth the requirements for use of that electronic transaction standard in the workers' compensation system.
This standard requires workers' compensation payers to specify, in loop 2100 REF 02 or loop 2110 REF 02 of the 835 claim payment/advice transaction, an enumerated code to identify the basis for its adjustment or denial of a medical bill or charge. This code specifies the workers' compensation statute and rule the payer is citing as support for its adjustment or denial. The following lists provide a link to the text of the specified statutes (codes that start with "176") and rules (codes that start with "5221") that may be cited.
Note: Links to all sections of Minnesota Statutes, chapter 176 and all parts of Minnesota Rules, chapter 5221 are provided below. However, not all of the statutes and rules listed below provide a legal basis for denial or adjustment of a medical charge. The primary statutes governing the delivery, billing and payment of medical treatment are in Minnesota Statutes, sections 176.135, 176.1351 and 176.136. The primary rules governing the delivery, billing and payment of medical treatment are in Minnesota Rules chapter 5221.
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|Minnesota Statutes chapter 176||Minnesota Rules chapter 5221|
For example, code "176.136 S 1a (a)" in Ref 02 means Minnesota Statutes, section 176.136, subdivision 1a, paragraph (a). Code "5221.4035 S 5 D" means Minnesota Rules, Part 5221.4035, subpart 5, item D.
Contact the payer if you believe the statute or rule cited on the 835 claim payment/advice is not an appropriate reason to deny payment. If you are unable to resolve the issue with the payer, you may call the Department of Labor and Industry's customer assistance hotline at (651) 284-5005 or toll-free at 1-800-342-5354, or at
(218) 733-7810 in the Duluth area. If you have any questions about the statutes or rules, call Lisa Wichterman at (651) 284-5173 or at the above toll-free number.