The Minnesota Court of Appeals case, Western National v. Nguyen, held that all medical providers who DO NOT submit bills electronically to the “responsible” insurance vendors within six-months will be barred from recovering payment from ANYONE, pursuant to Minn. Stat. 62Q.75. Based on this, the case denied payment of a large No-Fault arbitration award because the medical provider had not electronically billed a No-Fault company following the denial of benefits.
MN Doc’s, what does this mean for you?
First, remember that in Minnesota you are required to bill all claims electronically if the provider has the means to receive electronic claims. This holds true for all insurance, including auto and work comp carriers.
Secondly, once No-Fault denies, many providers will hold claims until arbitration or decide to discontinue billing No-Fault and bill the private insurance as primary instead. This means you need to stop, or you run the risk of not getting paid on any services provided after the No-Fault denies.
Once the No-Fault denies, you must continue to bill the No-Fault as primary until the case has settled, or the patient has reached MMI (Maximum Medical Improvement) status. As the No-Fault denies payment on each claim, you should then bill the patient’s personal insurance as secondary.
You should also bill their private insurance, even if there is a large deductible and/or a provider reduction, as this protects you and the patient from the effects of this case. In many states, if you are an in-network provider for their private insurance, this is an obligation not an option.
Lastly, this statute also defines a six-month timely filing limit. Meaning, not only do you need to continue to bill to the No-Fault carrier, you also need to follow-up and make sure the claims are on file and responded to within 6 months of the treatment date.
Unfortunately, as a Minnesota Chiropractor, this means the extra step of billing two insurances and the possibility of additional paperwork, however, this is the only way to ensure your best chances of getting paid for the services you have provided.
Note: Money Tree Clients, this has always been our recommendation and we have sent out a couple of blasts previously discussing this topic and showing exactly how to set it up in your software. Please email firstname.lastname@example.org if you would like another copy.