HF4831
Provider-based clinics required to obtain and use a unique National Provider Identifier (NPI) for reimbursement claims, and data submitted as all-payer claims data required to include a provider-based clinic's unique NPI.
Legislative Session 94 (2025-2026)
Related bill: SF4740
AI Generated Summary
Purpose
- To require provider-based clinics to obtain and use a unique National Provider Identifier (NPI) for all reimbursement claims.
- To ensure that all-payer claims data includes the provider-based clinic’s unique NPI.
- To amend Minnesota law (62U.04) and codify the new requirements in Minnesota Statutes chapter 62J.
Main Provisions
- Define key terms to clarify scope, including National Provider Identifier (NPI), provider-based clinic, health care clearinghouse, and all-payer claims data.
- Require provider-based clinics to apply for, obtain, and use a unique NPI on every claim for services provided at the clinic.
- The provider-based clinic’s unique NPI must be different from and distinct from the hospital’s NPI.
- The unique NPI must be included on all reimbursement or payment claims for services from the provider-based clinic, regardless of who files the claim (e.g., hospital central office or other intermediaries).
- Update all-payer data reporting to ensure that data submitted about provider-based clinics includes this unique NPI, separate from the hospital’s NPI.
Definitions and Key Concepts
- Provider-based clinic: an off-campus clinic or clinic site located at least 250 yards from the main hospital buildings (or as CMS determines) that is owned by a hospital licensed under chapter 144 or by a health system operating one or more hospitals, and primarily provides diagnostic and therapeutic care (history, exams, health status assessments, treatment monitoring). Clinics that exclusively provide laboratory, X-ray testing, therapy, pharmacy, or educational services are not considered provider-based clinics.
- National Provider Identifier (NPI): the standard unique health identifier for health care providers, issued under federal rules.
- Health care clearinghouse: as defined by federal regulations.
- All-payer claims data: data used to capture claims information across multiple payers.
Data Submission and Compliance
- All data submitted under the referenced section relating to a provider-based clinic must include the provider-based clinic’s unique NPI.
- The provider-based clinic’s NPI must be used on all reimbursement-related claims, regardless of whether the claim is filed directly by the clinic, a hospital central office, a health care clearinghouse, or another intermediary.
Significant Changes to Existing Law
- Adds a new subdivision to Minnesota Statutes 62J.825 establishing the unique NPI requirement for provider-based clinics and defining the clinic as a specific off-campus site with distinct criteria.
- Amends Minnesota Statutes 62U.04 by adding a subdivision requiring that all-payer data related to provider-based clinics include the clinic’s unique NPI, distinct from the hospital’s NPI.
- Establishes a framework for separating billing identifiers between provider-based clinics and hospitals to ensure clear, separate reimbursement and data reporting.
Relevant Terms - National Provider Identifier (NPI) - provider-based clinic - unique NPI - all-payer claims data - hospital NPI - off-campus clinic - Centers for Medicare and Medicaid Services (CMS) - health care clearinghouse - Minnesota Statutes 62U.04 - Minnesota Statutes chapter 62J - reimbursement claims - data submission - provider-based clinic’s unique NPI
Bill text versions
- Introduction PDF PDF file
Actions
| Date | Chamber | Where | Type | Name | Committee Name |
|---|---|---|---|---|---|
| April 07, 2026 | House | Action | Introduction and first reading, referred to | Health Finance and Policy |
Citations
[
{
"analysis": {
"added": [
"Defines 'Providerbased clinic' as an off-campus clinic or provider office located at least 250 yards from main hospital buildings (as CMS determines) and owned by a hospital licensed under chapter 144 or by a health system operating hospitals licensed under chapter 144.",
"Defines 'National Provider Identifier' (NPI) as the standard unique health identifier for health care providers issued by the national provider system in accordance with 45 CFR Part 162.",
"Defines 'Health care clearinghouse' as the entity defined in 45 CFR 160.103."
],
"removed": [],
"summary": "This subdivision defines key terms for the providerbased clinic NPI framework, including providerbased clinic, National Provider Identifier (NPI), and health care clearinghouse, and clarifies characteristics of providerbased clinics.",
"modified": []
},
"citation": "62J.825",
"subdivision": "Subd.1"
},
{
"analysis": {
"added": [
"Providerbased clinics must apply for, obtain, and use on all claims for reimbursement or payment for health services provided at the providerbased clinic a unique NPI that is distinct from the hospital's NPI."
],
"removed": [],
"summary": "Requires providerbased clinics to obtain and use a unique NPI on all reimbursement claims.",
"modified": []
},
"citation": "62J.825",
"subdivision": "Subd.2"
},
{
"analysis": {
"added": [
"Data submitted under section 62U.04 relating to a providerbased clinic must include the providerbased clinic's unique NPI that is distinct from the hospital's NPI."
],
"removed": [],
"summary": "Adds a data submission requirement tying the providerbased clinic NPI to data submitted under section 62U.04.",
"modified": []
},
"citation": "62U.04",
"subdivision": "Subd.14"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Cites the federal regulation that defines 'health care clearinghouse' as used in this bill.",
"modified": []
},
"citation": "45 CFR 160.103",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Cites the federal regulation governing the issuance of the National Provider Identifier (NPI).",
"modified": []
},
"citation": "45 CFR Part 162",
"subdivision": ""
},
{
"analysis": {
"added": [
"Notes that providerbased clinics may be owned by hospitals licensed under chapter 144 or by health systems operating such hospitals."
],
"removed": [],
"summary": "References hospitals licensed under chapter 144 in the definition of providerbased clinics.",
"modified": []
},
"citation": "Minn. Stat. ch. 144",
"subdivision": ""
}
]Progress through the legislative process
In Committee