SF2104 (Legislative Session 94 (2025-2026))
Data on fully denied claims requirement to be submitted to the all-payer claims database
Related bill: HF1487
AI Generated Summary
This bill proposes amendments to Minnesota Statutes 2024, section 62U.04, to enhance data collection and access related to healthcare claims. The key provisions of the bill include:
Collection of Fully Denied Claims Data:
- Health plan companies, dental organizations, and third-party administrators will be required to submit data on fully denied claims to the state’s all-payer claims database (APCD).
- Submitted data must include details such as:
- An indicator of denied claim lines.
- Reasons for denial.
- Claim line adjudication status.
- A claim identifier to track subsequent actions on the claim.
Expanded Access to All-Payer Claims Data:
- The bill establishes guidelines for individuals and organizations engaged in health research and transformation efforts to access APCD data.
- Data cannot be used to:
- Create unfair market advantages.
- Reidentify individuals.
- Publicly disclose contract details between health plan companies and providers.
- A research advisory group will review data access applications.
- The Department of Health will publish approved projects annually.
Fee Structure for Data Access:
- The bill introduces a fee schedule for accessing different types of data:
- Standard data set: $3,500 per file per year.
- Limited-use data set: $7,000 per file per year.
- Custom data set or report: $100 per hour of staff time (up to 40 hours).
- Fee waivers may be granted for financial hardship, academic researchers, self-insured data submitters, or those requesting a high volume of data.
- Collected fees will go into a special revenue fund for maintaining and providing access to the APCD.
- The bill introduces a fee schedule for accessing different types of data:
Funding for Data Collection:
- Appropriations from the general fund will fund the collection of fully denied claims data in fiscal years 2026 and 2027.
The bill aims to improve transparency and data accessibility for healthcare research while maintaining patient confidentiality and ensuring appropriate use of data.
Bill text versions
- Introduction PDF file
Actions
Date | Chamber | Where | Type | Name | Committee Name |
---|---|---|---|---|---|
March 02, 2025 | Senate | Floor | Action | Introduction and first reading | |
March 02, 2025 | Senate | Floor | Action | Referred to | Health and Human Services |
Citations
[ { "analysis": { "added": [ "Requirements for submitting data on fully denied claims, including specific details such as reason for denial and claim status.", "Provisions for expanded access to all-payer claims data for research purposes, with detailed criteria and restrictions.", "Establishment of a fee schedule for accessing different types of data sets." ], "removed": [], "summary": "This bill modifies reporting and data access requirements under section 62U.04 related to health data submissions to the all-payer claims database.", "modified": [ "Expanded the type of encounter data required from health plan companies and third-party administrators.", "Adjusted conditions for the release and publication of data collected from providers." ] }, "citation": "62U.04" }, { "analysis": { "added": [], "removed": [], "summary": "This section is referenced to define the type of encounter information required for submissions to the database.", "modified": [] }, "citation": "62J.536" }, { "analysis": { "added": [], "removed": [], "summary": "This section is referenced to define data privacy classifications of information collected under section 62U.04.", "modified": [] }, "citation": "13.02" }, { "analysis": { "added": [], "removed": [], "summary": "Federal regulation section is referenced for standards on the de-identification of health information, applicable to data submissions and releases.", "modified": [] }, "citation": "45 C.F.R. § 164.514" } ]