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HF 4831

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.

2025-2026 Regular Session Introduced by Athena Hollins

The bill requires provider-based clinics to obtain and use a distinct NPI on all claims and include that NPI in all-payer data submissions starting Jan 1, 2027.

Introduction and first reading, referred to Health Finance and Policy
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Bill Summary · HF 4831

Summary of HF 4831 (2025-2026) – Minnesota

Purpose and Intent

HF 4831 seeks to improve payer clarity and data accuracy by requiring provider-based clinics to use a unique National Provider Identifier (NPI) for reimbursement claims and by ensuring all all-payer claims data submitted to state systems include the clinic’s distinct NPI. The bill defines what constitutes a provider-based clinic and links the use of a unique NPI to both billing and data reporting processes.

Key Provisions

Section 1: Unique NPIs for Provider-Based Clinics (New Code 62J.825)

  • Definitions
    • Establishes key terms: NPI, health care clearinghouse, and “provider-based clinic.”
    • A provider-based clinic is an off-campus clinic owned by a hospital or health system with hospitals, located at least 250 yards from main hospital buildings (or as CMS determines), primarily providing diagnostic/therapeutic care. It excludes clinics that solely provide lab, x-ray, testing, therapy, pharmacy, or educational services.
  • Unique NPI Requirement
    • Provider-based clinics must apply for and obtain a distinct NPI that is separate from the hospital’s NPI.
    • This unique NPI must be used on all reimbursement claims for services provided at the provider-based clinic.
    • The clinic’s NPI must be included on all claims regardless of whether the claim is submitted by the clinic directly, through a central hospital office, a clearinghouse, or any intermediary.

Section 2: All-Payer Claims Data (Amendment to 62U.04)

  • Subdivision 14 – Unique NPI Data Inclusion
    • Data submitted under section 62U.04 for provider-based clinics must include the provider-based clinic’s unique NPI (distinct from the hospital’s NPI).
  • Effective Date
    • The data reporting requirement becomes effective January 1, 2027.

Who and What is Affected

  • Provider-Based Clinics: Hospitals and health systems that operate off-campus provider-based clinics must secure and use a unique NPI for these clinics and ensure it appears on all reimbursement claims.
  • Payers and Clearinghouses: Must recognize and process the provider-based clinic’s distinct NPI on claims, and ensure the NPI is captured in all-payer data submissions.
  • All-Payer Claims Databases: State data systems collecting all-payer claims data will require inclusion of the provider-based clinic’s unique NPI starting in 2027.

Potential Impacts

  • Administrative/Billing Clarity: Separating the clinic’s NPI from the hospital’s NPI may improve accuracy in attribution of care and payments to the correct entity.
  • Data Quality and Transparency: All-payer data will more accurately reflect where services were provided, aiding oversight, research, and policy analysis.
  • Transition Considerations: Effective January 1, 2027 for data reporting; billing systems will need to be updated to support and transmit the clinic’s distinct NPI on all relevant claims.

Timeline

  • Law effective date for data reporting: January 1, 2027.
  • Billing changes would apply to claims for services at provider-based clinics once the clinics obtain the unique NPI (no earlier date specified beyond the 2027 data requirement).

Sponsors: Co-sponsor Athena Hollins.

Compiled from official sources — confirm details with the bill’s official record.

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