Minnesota
Workers' compensation -- medical benefits
Payment of medical expenses
Payer and health care provider payment and billing responsibilities are covered under
Minnesota Statutes 176.135 Subd. 6 and 7, and Minnesota Rules Part 5221.0600. Excessive
charges are under Minnesota Rules Part 5221.0500, while excessive services are under
Minnesota Rules Part 5221.0550.
Payer responsibilities
No later than 30 calendar-days after receiving the charge for service and the medical records, the
insurer must:
pay the charge or portion of the charge that is not in dispute. request specific additional
information to substantiate the nature of the charge and its relationship to the work injury.
When the requested information is received, the insurer has 30 days to either pay or deny the
charge in question.
deny all or part of the charge if it is not compensable.
deny all or part of the charge if the charge is excessive.
If the charge is denied, the insurer must send the provider a written notification outlining the
basis of the denial by the 30-day deadline. A copy of the notification must be sent to the
employee.
Health care provider responsibilities
The health care provider is responsible for:
submitting an itemized statement of charges on the prescribed billing form to the payer within
60 days of the service.
submitting copies of medical records or reports that substantiate the nature of the charge and its
relationship to the work injury.
A health care provider cannot attempt to collect or initiate any action for collection of the
charge from any party until the information required has been furnished.
If the insurer has denied primary liability, the health care provider can
Workers' compensation -- medical benefits
Payment of medical expenses
Payer and health care provider payment and billing responsibilities are covered under
Minnesota Statutes 176.135 Subd. 6 and 7, and Minnesota Rules Part 5221.0600. Excessive
charges are under Minnesota Rules Part 5221.0500, while excessive services are under
Minnesota Rules Part 5221.0550.
Payer responsibilities
No later than 30 calendar-days after receiving the charge for service and the medical records, the
insurer must:
pay the charge or portion of the charge that is not in dispute. request specific additional
information to substantiate the nature of the charge and its relationship to the work injury.
When the requested information is received, the insurer has 30 days to either pay or deny the
charge in question.
deny all or part of the charge if it is not compensable.
deny all or part of the charge if the charge is excessive.
If the charge is denied, the insurer must send the provider a written notification outlining the
basis of the denial by the 30-day deadline. A copy of the notification must be sent to the
employee.
Health care provider responsibilities
The health care provider is responsible for:
submitting an itemized statement of charges on the prescribed billing form to the payer within
60 days of the service.
submitting copies of medical records or reports that substantiate the nature of the charge and its
relationship to the work injury.
A health care provider cannot attempt to collect or initiate any action for collection of the
charge from any party until the information required has been furnished.
If the insurer has denied primary liability, the health care provider can
| Minnesota WORKERS COMPENSATION COLLECTION PUBLICATIONS AND INFORMATION FOR MEDICAL PROVIDERS |
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February 21, 2012:: Minnesota: News:
Workers' compensation -- COMPACT 'The
newsletter for workers' compensation
professionals'
December 13, 2011: Minnesota: News:
Workers' compensation -- COMPACT 'The
newsletter for workers' compensation
professionals'
November 22, 2011: Minnesota: News:
Study presents statistics about
minimum-wage workers in Minnesota
Oct. 21, 2011
Survey shows Minnesota workplace injury
rate near all-time low
A recent survey estimates Minnesota's
workplace injury and illness rate to be near an
all-time low. According to the annual Survey
of Occupational Injuries and Illnesses, the
state had an estimated 3.9 nonfatal workplace
injuries and illnesses per 100
full-time-equivalent (FTE) workers in 2010.
This is up slightly from the 2009 estimate of
3.8 cases per 100 FTE workers, but
substantially below the rate of 5.1 from five
years ago (2005). It is also the second-lowest
since the survey began in 1972.
Workers' compensation -- COMPACT 'The
newsletter for workers' compensation
professionals'
December 13, 2011: Minnesota: News:
Workers' compensation -- COMPACT 'The
newsletter for workers' compensation
professionals'
November 22, 2011: Minnesota: News:
Study presents statistics about
minimum-wage workers in Minnesota
Oct. 21, 2011
Survey shows Minnesota workplace injury
rate near all-time low
A recent survey estimates Minnesota's
workplace injury and illness rate to be near an
all-time low. According to the annual Survey
of Occupational Injuries and Illnesses, the
state had an estimated 3.9 nonfatal workplace
injuries and illnesses per 100
full-time-equivalent (FTE) workers in 2010.
This is up slightly from the 2009 estimate of
3.8 cases per 100 FTE workers, but
substantially below the rate of 5.1 from five
years ago (2005). It is also the second-lowest
since the survey began in 1972.
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- Medical Control
The injured employee may select the initial treating provider unless the employer has chosen to
implement a certified managed care plan. In that case, the injured employee chooses a provider
from the list of providers under that managed care plan. The injured employee may change treating
provider once within the first sixty (60) days without approval of the employer/insurer. Any
subsequent changes must be approved by the employer/insurer. The employer may designate a
pharmacy or network of pharmacies that the injured employees must use to obtain outpatient
prescription and non-prescription medications. Emergency medical care does not require
preapproval and should be secured at the nearest location.