Arkansas Administrative Code
Agency 007 - Arkansas Department of Health
Division 11 - Division of Health Statistics
Rule 007.11.09-001 - Hospital Discharge Data System and Hospital Discharge Data Submittal Guide

Universal Citation: AR Admin Rules 007.11.09-001

Current through Register Vol. 49, No. 9, September, 2024

1.0 DATA REPORTING SOURCE

All facilities operating and licensed as a hospital in the state of Arkansas by ADH, Division of Health Facility Services, will report discharge data to ADH for each patient admitted as an inpatient or with at least one full day of stay (overnight). Discharge data means the consolidation of complete billing, medical, and personal information describing a patient, the services received, and charges billed for a single inpatient hospital stay. The consolidation of discharge data is a discharge data record. The formats are defined later in this Guide.

For a patient with multiple discharges, submit one discharge data record for each discharge. For a patient with multiple billing claims (refer to Section 5.6 Multi - Hospital Submission), consolidate the multiple billings into one discharge data record for submission after the patient's discharge. A discharge data record is submitted for each discharge, not for each bill generated. The discharge data record should be submitted for the reporting period within which the discharge occurs. If a claim will not be submitted to a provider or carrier for collection (e.g., charitable service), a hospital discharge data record should still be submitted to the ADH, with the normal and customary charges, as if the claim was being submitted. All acute and intensive care discharges or deaths, including newborn discharges or deaths, should be reported.

A hospital may submit discharge data directly to ADH, or may designate an intermediary, such as a commercial data clearinghouse. Use of an intermediary does not relieve the hospital from its reporting responsibility.

In order to facilitate communication and problem solving, each hospital should designate a person as contact. Please provide the office name, telephone number, job title and name of the person assigned this responsibility.

2.0 CONFIDENTIALITY OF DATA

Act 670 of 1995, A.C.A. 20-7-301 et seq. (refer to Appendix D5) provides for the strictest confidentiality of data and severe penalties for the violation of the Act. Any information collected from hospitals which identifies a patient, provider, institution, or health plan cannot be released without promulgation of rules and regulations by the Arkansas State Board of Health in accordance with Act 670 Section (2)(g) and (h). ADH will only release data, except as allowed by law that has sufficiently masked these identities.

Since ADH needs patient specific information to complete our analyses, we will take every prudent action to ensure the confidentiality and security of the data submitted to us. Procedures include, but are not limited to, physical security and monitoring, access to the files by authorized personnel only, passwords and encryption. Not all measures taken are documented or mentioned in this Guide to further protect our data.

3.0 SUBMITTAL SCHEDULE

Discharge data records will be submitted to ADH as specified below. The data to be submitted is based on the discharges occurring in a calendar quarter. If a patient has a bill generated during a quarter but has not yet been discharged by the end of the quarter, data for that stay should not be included in the quarter's data. Deadlines for data submission are 40 days after the end of the quarter for the first through third quarters and 60 days for the fourth quarter.

While most hospitals will be submitting data directly to ADH, some are utilizing third-party intermediaries. When using an intermediary, the reporting deadlines are still to be met. Refer to Section 5.7 Intermediaries for further details.

3.1 Reporting Schedule

Patients' date of discharge is:	Discharqe data must be received by:
January 1 through March 31	QTR 1 -May 10th
April 1 through June 30	QTR 2 -August 10th
July 1 through September 30	QTR 3 - November 10th
October 1 through December 31	QTR 4-March 1st

3.2 Request for Extension

All hospitals will submit discharge data in a form consistent with the requirements unless an extension has been granted. Request for extension should be in writing or E-mail and be directed to:

Arkansas Department of Health

Center for Health Statistics, Slot #H19

Hospital Discharge Data Section

4815 West Markham Street

Little Rock, AR 72205

Phone (501) 661-2231

FAX (501) 661-2544

E-mail: Lynda.Lehing@arkansas.gov

The Center for Health Statistics will review requests submitted to them for extensions to the reporting schedule requirement. A request for an extension should be submitted at least 10 working days prior to the reporting deadline. Extensions may be granted for a maximum of 20 calendar days. Additional 20-day extensions must be requested separately. Extensions may be granted when the hospital documents that unforeseen difficulties, such as technical problems, prevent compliance.

4.0 DATA ERRORS AND CERTIFICATION

Hospitals will review the discharge data records prior to submission for accuracy and completeness. Correction of invalid records and validation of aggregate tabulation are the responsibility of the hospital. All hospitals will certify the data submitted for each quarter in the manner specified.

4.1 Error Correction

Edits that indicate a high probability of error will be highlighted for review, comment, and correction when applicable. The invalid record will be printed in a simplified format providing record identification, an indication or explanation of the error, and space to record corrections. The error report will be sent by fax or E-mail to the attention of the individual designated to receive the correspondence at the hospital. The corrections made by the hospital are to be returned within seven days of receipt to the Center for Health Statistics.

In the event one (1) percent or more of the records for a quarter are indicated as having a high probability of error, the entire submittal may be rejected. A record is in error when one or more required data elements are in error.

Notification of the rejection will accompany the error report and will be sent by fax or e-mail to the attention of the individual designated to receive the correspondence at the hospital. After correction, the submittal is to be returned within seven days of receipt, to the Center for Health Statistics. In some situations, the HDDS staff will make corrections to the hospital's submissions, based on information obtained from hospital staff and/or internal health department databases. When this is done, notice will be given to the hospital.

5.0 DATA SUBMITTAL SPECIFICATIONS

Currently, data must be submitted via encrypted E-mail, CD's or FTP. Alternate modes of transmission may be established by agreement with the Center for Health Statistics. Data submittals not in compliance with media or format specifications will be rejected unless approval is obtained prior to the scheduled due date from the Center for Health Statistics. Data submittal on physical media should be mailed to:

Arkansas Department of Health

Center for Health Statistics

Hospital Discharge Data System

4815 West Markham Street, Slot H19

Little Rock, AR 72205

If you are submitting data for more than one hospital on one media submission, the additional specifications found in Section 5.6 Multi - Hospital Submission must be followed.

5.1 File Compression

WINZIP is the compression utility of choice by HDDS. If a compression utility other that WINZIP is used, the resulting file must be able to be unzipped by HDDS. Please contact an HDDS colleague prior to sending a file compressed with any compression software other than WINZIP.

5.2 File Encryption

Crypt-text is the freeware, encryption software that HDDS recommends. An HDDS colleague can be contacted on how to receive this software. Encryption of data files sent as email attachments is required. Refer to Section 5.4 E-Mail Attachment Submissions - Secondary Submittal Format. All passwords used with encryption software will be supplied by the HDDS. Please contact an HDDS colleague for the correct password for your hospital.

5.3 File Transfer Protocol (FTP) - Primary Submittal Format (preferred) The following specifications must be met when submitting data using the FTP:

A. The secured web site is at: https://dhhs.arkansas.gov/wa_DHHSSecureUpload/.

1) File names must be created in the:

(a) HHHYYQNVN.dat, where by,

(b) HHHH = four letters for the hospital,

(d) QN= quarter Number,

(e) VN= shipment Number,

HDDS07Q1V1.dat will tell us Hospital Discharge Data Systems uploaded quarter 1 of 2007 one time. If you do not know the four letter code for the hospital (HHHH), please contact an HDDS colleague for that information.

B. Files are to be encrypted by using Cryptext.

C. Upload by accessing the secured web site and inputting your user name and password that you created. If you or your organization has not created one, then please create one.

1) How to create an account on the FTP server:

(a) Access the website of https://dhhs.arkansas.gov/wa_DHHSSecureUpload/

(b) Click on request access

(d) Wait for the e-mail for confirmation, which takes about 48 hours.

5.4 E-Mail Attachment Submissions - Secondary Submittal Format

The following specifications must be met when submitting data by e-mail attachment via the Internet:

A. Hospitals must use encryption software and passwords provided by the Center for Health Statistics. To receive encryption software and/or passwords, please contact Lynda Lehing, (501) 661-2231, or by E-mail, Lynda.Lehing@arkansas.gov.

1) The physical characteristics of the attached file must have the following attributes:

(a) Record Length -192 bytes, Fixed (1450 format), 198 Fixed (1450Y2K format)

(b) PC Text File (ASCII), WINZIP file or self-extracting executable file, refer to Section 5.1 File Compression.

2) Each E-mail submission must include a general message that contains the following information:

(a) The description: 'HOSPITAL DISCHARGE DATA' in SUBJECT field,

(b) Hospital's name,

(d) Beginning and ending dates of the reporting period (e.g., 1/1/01-3/30/01),

(e) The name and telephone number of the contact person.

3) Refer to paragraph C, Section 5.5 CD-ROM Submittal Specifications - Server Down Submittal for 'filename.extension' naming standard for the attached file.

5.5 CD-ROM Submittal Specifications - Server Down Submittal

The following specifications must be met when submitting data on PC CD'S:

A. Hospitals will submit no more than one CD per quarter.

B. The physical characteristics of the CD Rom must have the following attributes:

1) Record Length -192 bytes, Fixed (1450 format), 198 bytes, Fixed (1450Y2K format),

2) ASCII, WINZIP file or self-extracting executable file.

Note: Self-extracting executable file must run on Windows XP or higher operating system. Source and target of WINZIP or executable file must be ASCII. ASCII file must have a carriage-return (CR) and line-feed (LF) at the end of each data record.

C. All CD's must have an external label or accompanying data sheet containing the following information:

1) The description: 'HOSPITAL DISCHARGE DATA',

2) Hospital's name,

3) Date of submittal as MM/DD/YY,

4) Beginning and ending dates of the reporting period (e.g., 1/1/01- 3/30/01),

5) Number of records,

6) Record format (1450),

7) The name and telephone number of the contact person

8) PC extension, ASCII or ZIP or EXE (refer to paragraph D, 4).

9) If encrypted, the description: 'ENCRYPTED' (refer to Section 5.2 - File Encryption). An example of the label for the case is as follows:

HOSPITAL DISCHARGE DATA

Hospital Name:

Date: mm/dd/yy Quarter: mm/dd/yy

Total Record Count: ###### Format: ####

Contact Person___________Phone:________

Extension:_____

ENCRYPTED

D. Use the following 'filename.extension' file naming standard:

1) The first two positions of the filename will be the last two digits of the calendar year,

2) The next three characters will be 'QTR',

3) The last position must be the quarter from one through four that indicates the quarter of the calendar year of the data submitted,

4) The extension will be TXT' or 'DAT for a PC Text file or 'ZIP' for a file compressed with WINZIP or 'EXE' for a self-extracting file.

Example: 08QTR1 TXT - ASCII data file for the first quarter of 2008

5.6 Multi - Hospital Submission

Data from more than one hospital may be submitted on one media submission as one file per hospital. Change the following items on your external label or accompanying information sheet:

A. If you are not a hospital, replace 'Hospital:' with your company name.

B. If you are a hospital or subsidiary of a hospital, replace 'Hospital:' with 'Agent:' and your hospital name.

C. If multiple files are on the submission, replace Total Record Count:' with 'Number of Files:'

D. The contact person and phone number should be that of the agent or company, not the hospital.

E. If multiple files are placed on a CD, the 'filename.extension' file-naming standard must change. The last two positions of the filename (follows 'QTR' and quarter number) must be the file number provided.

In addition to the above changes, a list of hospitals on the medium must be provided, with tax id, number of records, and hospital contact.

5.7 Intermediaries

Third-party intermediaries may be utilized by hospitals for the delivery of data to ADH. To better manage data collection, intermediaries must be registered with ADH. Additions and deletions to the intermediary's list of hospitals represented must be submitted at least 10 days prior to ADH reporting due date. The intermediary must specify hospitals being represented, media, formats, contacts, and length of contractual obligation.

5.7.1 Editing Intermediaries

The following additional requirements and information apply to intermediaries delivering edited data to the ADH:

A. The data must not have an error rate greater than 1 percent.

B. Each hospital's data must be submitted in a separate file.

C. Data may be submitted on any approved media - declared at the time of registration.

D. Data may be submitted in any approved data format - declared at the time of registration.

5.7.2 Pass-Thru Intermediaries

The following additional requirements and information apply to intermediaries delivering unedited data to ADH:

A. The data must not have an error rate greater than 1 percent.

B. Each hospital's data must be submitted in a separate file.

5.8 Subject to Change

Data submission methods are always under review. If implemented, all Arkansas hospitals will receive notice of the changes to be implemented.

6.0 DATA RECORD FORMATS

The accepted data record formats are the UB-04 1450 version 6 formats. This format has altered slightly. The definition specified for each data element is in general agreement with the definition in the UB-04 Users Manual. Hospitals using data sources other than uniform billing should evaluate definitions for agreement with the definitions specified in this Guide and UB-04 Users Manual. Refer to Section 7.0 EXCEPTIONS TO 1450 FORMAT identify possible changes to your current format. Each record must be followed by a carriage return/line feed sequence.

6.1 'UB-04-1450' Record Specification

The UB-04 1450 claim 'record' is made up of a series of 192-character physical records and the 1450 Y2K claim "record" is made up of a series of 198-character physical records. Not all of the physical claim records are used in the HDDS, such as the Claim Request Data. Records not specified in the HDDS will be ignored, if included in the submittal. Fields not referenced in the record formats may contain information but will not be processed by computer programs; this also includes fields reserved for national use. The exact record sequence and format of the 1450 is used for the HDDS, when possible. A complete copy of the patient's 1450 records would satisfy the requirements, with exceptions noted in Section 7.0 - EXCEPTIONS TO 1450 FORMAT. The physical records for each claim are divided into logical subsets as follows:

Subset 1 Patient Data - Record Codes 20-29

Subset 2 Third Party Data - Record Codes 30-39

Subset 3 Claim Request Data - Record Codes 40-49

Subset 4 Inpatient Accommodations Data - Record Codes 50-59

Subset 5 Ancillary Services Data - Record Codes 60-69

Subset 6 Medical Data - Record Codes 70-79

Subset 7 Physician Data - Record Codes 80-89

The record layouts that follow will provide the following information:

A. Record Name: The name of the data record.

B. Record Type: Code indicating the type of record.

C. Record Size: Physical length of record is a constant 192 for the 1450 and constant 198 for the 1450 Y2K.

D. Required Field Annotation: An asterisk '*' denotes the field is required and must contain data if applicable.

E. Field Number. Field number as specified on the UB-04 1450 version 4 file layout. This number is not the Form Locator number found on the UB-04 1450 form.

F. Field Name: Name generally used with the UB-04 1450 Form.

G. Picture: This is the COBOL picture. Pic X is initialized to blanks and Pic 9 is initialized to zeroes. All money and date fields are Pic 9.

H. Field Specification: Indicates how the data field is justified. L = Left justification, and R = Right justification.

I. Position: From = Leftmost position in the record (high order). Thru = Rightmost position in the record (low order).

J. Form Locator: Number found on the UB-04 Form and associated with the field in that location.

6.2 1450 & 1450Y2K -Record Type 10 - Provider Data

Only one type '10' record is required per hospital per submittal. Only the first type '10' record and each type '10' record following a type '95' record will be processed, all others will be ignored. This record type will be processed as a header record and a record type '95' will be processed as a trailer record. The records encapsulated between the first type '10' and '95' will be processed using the hospital specified on the type '10' record. It is absolutely imperative that each submission includes at least one type '10' record with correct Federal Tax Number. If the Federal Tax Number is not unique to a facility or cost center, the Federal Tax Sub ID must be included.

*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*POSITION*		*FORM LOCATOR*
*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*FROM*	*THRU*	*FORM LOCATOR*
* 1	Record Type '10'	XX	L	1	2
* 2	Federal Tax Number or EIN	9(10)	R	8	17	FL05
3	Federal Tax Sub ID	X(4)	L	18	21	FL05
* 4	National Provider Identifier	X(13)	L	22	34	FL56
* 5	Medicaid Provider Number	X(13)	L	35	47
* 6	Provider Telephone Number	9(10)	R	87	96	FL01
* 7	Provider Name	X(25)	L	97	121	FL01
* 8	Provider (Hospital) Data ID	X(4)	L	122	125
*PROVIDER ADDRESS (FIELDS 9 - 13)*		*126*	*185*	*FL01*
9	Address	X(25)	L	126	150
* 10	City	X(14)	L	151	164
* 11	State	XX	L	165	166
* 12	Zip Code	X(9)	L	167	175
13	Provider Fax Number	9(10)	R	176	185

6.3 1450-Record Type 20 - Patient Data

*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*POSITION*		*FORM LOCATOR*
*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*FROM*	*THRU*	*FORM LOCATOR*
* 1	Record Type '20'	XX	L	1	2
* 2	Patient Control Number	X(20)	L	5	24	FL3A
*PATIENT NAME (FIELDS 3-5)*					*FL08*
3	Last Name	X(20)	L	25	44
4	First Name	X(9)	L	45	53
5	Middle Initial	X	54	54
6	Patient Sex	X	55	55	FL11
7	Patient Birthdate (mmddccyy)	9(8)	R	56	63	FL10
8	Patient Marital Status	X	64	64
9	Type Of Admission	X	65	65	FL14
* 10	Source Of Admission	X	66	66	FL15
*PATIENT ADDRESS (FIELDS 11-15)*					*FL09*
* 11	Address Line 1	X(18)	L	67	84
12	Address Line 2	X(18)	L	85	102
* 13	City	X(15)	L	103	117
* 14	State	XX	L	118	119
* 15	Zip Code	X(9)	L	120	128
* 16	Admission Date	9(6)	R	129	134	FL12
* 17	Admission Hour	XX	R	135	136	FL13
*STATEMENT COVERS PERIOD (FIELDS 18 - 19)*					*FL06*
* 18	From (mmddyy)	9(6)	R	137	142
* 19	Thru (mmddyy)	9(6)	R	143	148
* 20	Patient Status	99	R	149	150	FL17
* 21	Discharge Hour	XX	R	151	152	FL16
22	Payments Received (Patient Line)	9(8)V99S	R	153	162	FL54
23	Estimated Amt Due (Patient Line)	9(8)V99S	R	153	167	FL55
* 24	Medical Record Number	X(17)	L	173	189	FL3B

Note: 'Statement Covers Period From' should be the date of the first medical service related to the hospital stay. 'Statement Covers Period Thru' should be the discharge date. 'Payments Received' and 'Estimated Amt Due'

should reflect a single discharge if multiple claims have been submitted.

6.4 1450Y2K-RECORD Type 20 - Patient Data

*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*POSITION*		*FORM LOCATOR*
*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*FROM*	*THRU*	*FORM LOCATOR*
* 1 Record Type '20'		XX	L	1	2
* 2 Patient Control Number		X(20)	L	5	24	FL3A
*PATIENT NAME (FIELDS 3-5)*						*FL08*
* 3 Last Name		X(20)	L	25	44
* 4 First Name		X(9)	L	45	53
5 Middle Initial		X	54	54
6	Patient Sex	X	55	55	FL11
7	Patient Birthdate (mmddccyy)	9(8)	R	56	63	FL10
8	Patient Marital Status	X	64	64
9	Type Of Admission	X	65	65	FL14
* 10	Source Of Admission	X	66	66	FL15
*PATIENT ADDRESS (FIELDS 11-15)*						*FL09*
* 11	Address Line 1	X(18)	L	67	84
12	Address Line 2	X(18)	L	85	102
* 13	City	X(18)	L	103	120
* 14	State	XX	L	121	122
* 15	Zip Code	X(9)	L	123	131
* 16	Admission Date (mmddccyy)	9(8)	R	132	139	FL12
* 17	Admission Hour	XX	R	140	141	FL13
*STATEMENT COVERS PERIOD (FIELDS 18 - 19)*						*FL06*
* 18	From (mmddyy)	9(8)	R	142	149
* 19	Thru (mmddyy)	9(8)	R	150	157
* 20	Patient Status	99	R	158	159	FL17
21	Discharge Hour	XX	R	160	161	FL16
22	Payments Received (Patient Line)	9(8)V99S	R	162	171	FL54
23	Estimated Amt Due (Patient Line)	9(8)V99S	R	172	181	FL55
* 24	Medical Record Number	X(17)	L	182	198	FL3B

Date changes made by some hospitals for the year 2000 and following require spacing changes in the type 20 and type 70 records for the 1450 record format. For hospitals using the 1450 record format that began using an eight-digit date format in 2000, the date must be given as CCYYMMDD. In this case, February 7, 2001 is entered 20010207. Where this change is made, all dates (birth date, admission date, statement from data and statement through date) must use this format. The following position changes in the type 20 record are required:

6.5 1450 & 1450Y2K -Record Type 27 - Health Dept. Specific Data

*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*POSITION*		*FORM LOCATOR*
*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*FROM*	*THRU*	*FORM LOCATOR*
* 1	Record Type '27'	XX	L	1	2
* 2	Sequence '01'	99		3	4
* 3	Patient Control Number	X(20)	L	5	24	FL03
* 4	Type of Bill	X(3)	L	25	27	FL04
5	Patient Social Security Number	9(10)	R	28	37
* 6	Patient Race	X	38	38
* 7	Patient Ethnicity	X	39	39
* 8	Birth Weight	9999	R	40	43
* 9	Total Charges	9(8)V99S	R	44	53
10	Estimated Collection rate	999	R	54	56
11	Charitable / Donation rate	999	R	57	59
* 12	APGAR Score	9999	R	60	63
13	Diagnosis-Related Group (DRG)	9999	R	64	67
14	Major Diagnostic Categories (MDC)	99	R	68	69

6.6 1450 Record Types 30-31 - Third Party Payer Data

The use of these record types for the HDDS is the same as the UB-04 claim. When reporting for HDDS, records may need to be consolidated and amounts accumulated by payer. Below are specifications and an example as taken from UB-04.

One third party payer record packet (record types 30 3N) must appear in the bill record for each payer involved in the bill. Each third party payer packet must contain a record type 30. However, each record type 30 may or may not have an associated record type 31, depending on the specific third party payer data required by the particular payer.

Example: Medicare is primary, and the secondary payer requires the insured's address.

	Record Type Code	Seq.No.
Medicare	30	01
Secondary Payer	30	02
Secondary Payer	31	02

Because the sequence number of the type 31 record for the secondary payer matches the sequence number of the secondary payer's type 30 record, it serves as a matching criterion for the specific third party payer record packet.

Sequence 01 represents the primary payer, sequence 02 represents the secondary payer, and sequence 03 represents the tertiary payer.

6.6.1 1450-Record Type 30 - Third Party Payer

*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*POSITION*		*FORM LOCATOR*
*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*FROM*	*THRU*	*FORM LOCATOR*
* 1	Record Type '30'	XX	L	1	2
* 2	Sequence Number	99	R	3	4
* 3	Patient Control Number	X(20)	L	5	24	FL03
* 4	Source of Payment Code (Payer)	X	25	25	FL50
5	Health Plan ID	X(9)	L	26	34	FL51
* 6	Insured's Unique ID	X(19)	L	35	53	FL60
7	Insurance Group Number	X(17)	L	80	96	FL62
8	Insured Group Name	X(14)	L	97	110	FL61
*INSURED'S NAME (FIELDS 9-11)*						*FL58*
9	Last Name	X(20)	L	111	130
10	First Name	X(9)	L	131	139
11	Middle Initial	X	140	140
12	Insured Sex	X	141	141
13	Patient Relationship to Insured	99	R	144	145	FL59
14	Employment Status Code	9	146	146
15	Payments Received	9(8)V99S	R	173	182	FL54
16	Estimated Amount Due	9(8)V99S	R	183	192	FL55

Note: 'Payments Received' and 'Estimated Amt Due' should reflect a single discharge if multiple claims have been submitted.

6.6.2 1450-Record Type 31 - Third Party Payer

*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*POSITION*		*FORM LOCATOR*
*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*FROM*	*THRU*	*FORM LOCATOR*
* 1	Record Type '31'	XX	L	1	2
* 2	Sequence Number	99	R	3	4
* 3	Patient Control Number	X(20)	L	5	24	FL03
*INSURED'S ADDRESS (FIELDS 4-8)*
4	Address Line 1	X(18)	L	25	42
5	Address Line 2	X(18)	L	43	60
6	City	X(15)	L	61	75
7	State	XX	L	76	77
8	Zip Code	X(9)	L	78	86
9	Employer Name	X(24)	L	87	110	FL65
*EMPLOYER LOCATION (FIELDS 10-13)*
10	Employer Address	X(18)	L	111	128
11	Employer City	X(15)	L	129	143
12	Employer State	XX	L	144	145
13	Employer Zip Code	X(9)	R	146	154

6.7 1450 & 1450Y2K -Record Type 50 - Inpatient Accommodations Data

The sequence number for record type 50 can go from 01 to 99, each such physical record containing four accommodations, thus making provision for reporting up to 396 accommodations on a single claim. Accommodation revenue codes: 100 through 21X.

*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*POSITION*		*FORM LOCATOR*
*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*FROM*	*THRU*	*FORM LOCATOR*
* 1	Record Type '50'	XX	L	1	2
* 2	Sequence Number	99	R	3	4
* 3	Patient Control Number	X(20)	L	5	24	FL03
*ACCOMMODATIONS (OCCURS 4 TIMES)*
*ACCOMMODATIONS 1*		*X(42)*	25	66
* 4	Revenue Code	9(4)	R	25	28	FL42
* 5	Accommodations Rate	9(7)V99	R	29	37	FL44
* 6	Service Units (Accommodations Days)	9(4)	R	38	41	FL46
* 7	Total Charges by Revenue Code	9(8)V99S	R	42	51	FL47
8	Non-covered Charges by Revenue Code	9(8)V99S	R	52	61	FL48
*ACCOMMODATIONS 2*		*X(42)*	67	*108*
9	Revenue	9(4)	R	67	70	FL42
* 10	Accommodations Rate	9(7)V99	R	71	79	FL44
* 11	Service Units (Accommodations Days)	9(4)	R	80	83	FL46
* 12	Total Charges by Revenue Code	9(8)V99S	R	84	93	FL47
13	Non-covered Changes by Revenue Code	9(8)V99S	R	94	103	FL48
*ACCOMMODATIONS 3*		*X(42)*	*109*	*150*
14	Revenue Code	9(4)	R	109	112	FL42
* 15	Accommodations Rate	9(7)V99	R	113	121	FL44
* 16	Service Units (Accommodations Days)	9(4)	R	122	125	FL46
* 17	Total Charges by Revenue Code	9(8)V99S	R	126	135	FL47
18	Non-covered Charges by Revenue Code	9(8)V99S	R	136	145	FL48
*ACCOMMODATIONS 4*		*X(42)*	*151*	*192*
19	Revenue Code	9(4)	R	151	154	FL42
* 20	Accommodations Rate	9(7)V99	R	155	163	FL44
* 21	Service Units (Accommodations Days)	9(4)	R	164	167	FL46
* 22	Total Charges by Revenue Code	9(8)V99S	R	168	177	FL47
23	Non-covered Charges by Revenue Code	9(8)V99S	R	178	187	FL48

6.8 1450 & 1450Y2K-RECORD Type 60 - Inpatient Ancillary Services Data

The sequence number for record type 60 can go from 01 to 99, each such physical record contains up to three inpatient ancillary service codes, thus making provision for reporting up to 297 inpatient ancillary services on a single claim. Payer and related information revenue codes: codes 001 - 099. Inpatient ancillary services revenue codes: codes 220 - 99x.

*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*POSITION*		*FORM LOCATOR*
*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*FROM*	*THRU*	*FORM LOCATOR*
* 1	Record Type '60'	XX	L	1	2
* 2	Sequence Number	99	R	3	4
* 3	Patient Control Number	X(20)	L	5	24	FL03
*INPATIENT ANCILLARY SERVICES DA TA (OCCURS 3 TIMES)*
*INPATIENT ANCILLARIES 1*		X(56j		25	80
* 4	Revenue Code	9(4)	R	25	28	FL42
5	HCPCS / Procedure Code	X(5)	L	29	33
6	Modifier 1 (HCPCS&CPT4)	X(2)	L	34	35
7	Modifier 2 (HCPCS & CPT 4)	X(2)	L	36	37
* 8	Units of Service	9(7)	R	38	44	FL46
* 9	Total charges by Revenue Code	9(8)V99S	R	45	54	FL47
10	Non-covered Charges by Revenue Code	9(8)V99S	R	55	64	FL48
*INPATIENT ANCILLARIES 2*		X(56j		81	*136*
11	Revenue Code	9(4)	R	81	84	FL42
12	HCPCS / Procedure Code	X(5)	L	85	89
13	Modifier 1 (HCPCS & CPT 4)	X(2)	L	90	91
14	Modifier 2 (HCPCS & CPT 4)	X(2)	L	92	93
15	Units of Service	9(7)	R	94	100	FL46
16	Total Charges by Revenue Code	9(8)V99S	R	101	110	FL47
17	Non-covered Charges by Revenue Code	9(8)V99S	R	111	120	FL48
*INPA TIENT ANCILLARIES 3*		X(56j		*137*	*192*
18	Revenue Code	9(4)	R	137	140	FL42
19	HCPCS / Procedure Code	X(5)	L	141	145
20	Modifier 1 (HCPCS & CPT 4)	X(2)	L	146	147
21	Modifier 2 (HCPCS & CPT 4)	X(2)	L	148	149
22	Units of Service	9(7)	R	150	156	FL46
23	Total Charges by Revenue Code	9(8)V99S	R	157	166	FL47
24	Non-covered Charges by Revenue Code	9(8)V99S	R	136	145	FL48

Note: Identical revenue codes should be combined and their charges added together for reporting purposes.

6.9 1 450-Record Type 70 Sequences 1, 2, & Y2K - Medical Data

6.9.1 Sequence 1-1450 &1450Y2K

*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*POSITION*		*FORM LOCATOR*
*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*FROM*	*THRU*	*FORM LOCATOR*
* 1	Record Type '70'	XX	L	1	2
* 2	Sequence '01'	XX	R	3	4
* 3	Patient Control Number	X(20)	L	5	24	FL03
* 4	Principle Diagnosis Code	X(7)	L	25	31	FL67
* 5	Other Diagnosis Code 1	X(7)	L	32	38	FL67A
* 6	Other Diagnosis Code 2	X(7)	L	39	45	FL67B
* 7	Other Diagnosis Code 3	X(7)	L	46	52	FL67C
* 8	Other Diagnosis Code 4	X(7)	L	53	59	FL67D
* 9	Other Diagnosis Code 5	X(7)	L	60	66	FL67E
* 10	Other Diagnosis Code 6	X(7)	L	67	73	FL67F
* 11	Other Diagnosis Code 7	X(7)	L	74	80	FL67G
* 12	Other Diagnosis Code 8	X(7)	L	81	87	FL67H
* 13	Other Diagnosis Code 9	X(7)	L	88	94	FL67I
* 14	Other Diagnosis Code 10	X(7)	L	95	101	FL67J
* 15	Other Diagnosis Code 11	X(7)	L	102	108	FL67K
* 16	Other Diagnosis Code 12	X(7)	L	109	115	FL67L
* 17	Other Diagnosis Code 13	X(7)	L	116	122	FL67M
* 18	Other Diagnosis Code 14	X(7)	L	123	129	FL67N
* 19	Other Diagnosis Code 15	X(7)	L	130	136	FL670
* 20	Other Diagnosis Code 16	X(7)	L	137	143	FL67P
* 21	Other Diagnosis Code 17	X(7)	L	144	150	FL67Q
* 22	POA - Present on Admission	X(1)		151	151
* 23	POA 1 - Present on Admission	X(1)		152	152
*	24	POA 2 - Present on Admission	X(1)	153	153
*	25	POA 3 - Present on Admission	X(1)	154	154
*	26	POA 4 - Present on Admission	X(1)	155	155
*	27	POA 5 - Present on Admission	X(1)	156	156
*	28	POA 6 - Present on Admission	X(1)	157	157
*	29	POA 7 - Present on Admission	X(1)	158	158
*	30	POA 8 - Present on Admission	X(1)	159	159
*	31	POA 9 - Present on Admission	X(1)	160	160
*	32	POA 10 - Present on Admission	X(1)	161	161
*	33	POA 11 - Present on Admission	X(1)	162	162
*	34	POA 12 - Present on Admission	X(1)	163	163
*	35	POA 13 - Present on Admission	X(1)	164	164
*	36	POA 14- Present on Admission	X(1)	165	165
*	37	POA 15 - Present on Admission	X(1)	166	166
*	38	POA 16 - Present on Admission	X(1)	167	167
*	39	POA 17 - Present on Admission	X(1)	168	168

6.9.2 Sequence 2-1450

*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*POSITION*		*FORM LOCATOR*
*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*FROM*	*THRU*	*FORM LOCATOR*
* 1	Record Type '70'	XX	L	1	2
* 2	Sequence '02'	XX	R	3	4
* 3	Patient Control Number	X(20)	L	5	24	FL3A
* 4	Principle Procedure Code	X(8)	L	25	32	FL74
* 5	Principle Procedure Code Data (mmddyy)	X(6)	L	33	38
* 6	Other Procedure Code 1	X(8)	L	39	46	FL74A
* 7	OPC 1 - Date (mmddyy)	X(6)	R	47	52
* 8	Other Procedure Code 2	X(8)	L	53	60	FL74B
* 9	OPC 2 - Date (mmddyy)	X(6)	R	61	66
* 10	Other Procedure Code 3	X(8)	L	67	74	FL74C
* 11	OPC 3 - Date (mmddyy)	X(6)	R	75	80
* 12	Other Procedure Code 4	X(8)	L	81	88	FL74D
* 13	OPC 4- Date (mmddyy)	X(6)	R	89	94
* 14	Other Procedure Code 5	X(8)	L	95	102	FL74E
* 15	OPC 5 - Date (mmddyy)	X(6)	R	103	108
* 16	Other Procedure Code 6	X(8)	L	109	116
* 17	OPC 6 - Date (mmddyy)	X(6)	R	117	122
* 18	Other Procedure Code 7	X(8)	L	123	130
* 19	OPC 7 - Date (mmddyy)	X(6)	R	131	136
20	FILLER (empty fields)			137	159
* 21	Admitting Diagnosis Code	X(8)	L	160	167	FL69
* 22	External Cause of Injury Code 1	X(8)	L	168	175	FL72
* 23	External Cause of Injury Code 2	X(8)	L	176	183	FL72
* 24	External Cause of Injury Code 3	X(8)	L	184	191	FL72
* 25	Procedure Coding Method Used	9(1)		192	192

6.9.3 Sequence 2 - 1450Y2K

*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*POSITION*		*FORM LOCATOR*
*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*FROM*	*THRU*	*FORM LOCATOR*
* 1	Record Type '70'	XX	L	1	2
* 2	Sequence '02'	XX	R	3	4
* 3	Patient Control Number	X(20)	L	5	24	FL3A
* 4	Principle Procedure Code	X(8)	L	25	32	FL74
* 5	Principle Procedure Code Date (ccyymmdd)	X(8)	L	33	40
* 6	Other Procedure Code 1	X(8)	L	41	48	FL74A
* 7	OPC 1 - Date (ccyymmdd)	X(8)	R	49	56
* 8	Other Procedure Code 2	X(8)	L	57	64	FL74B
* 9	OPC 2 - Date (ccyymmdd)	X(8)	R	65	72
* 10	Other Procedure Code 3	X(8)	L	73	80	FL74C
* 11	OPC 3 - Date (ccyymmdd)	X(8)	R	81	88
* 12	Other Procedure Code 4	X(8)	L	89	96	FL74D
* 13	OPC 4 - Date (ccyymmdd)	X(8)	R	97	104
* 14	Other Procedure Code 5	X(8)	L	105	112	FL74E
* 15	OPC 5 - Date (ccyymmdd)	X(8)	R	113	120
* 16	Other Procedure Code 6	X(8)	L	121	128
* 17	OPC 6 - Date (ccyymmdd)	X(8)	R	129	136
* 18	Other Procedure Code 7	X(8)	L	137	144
* 19	OPC 7 - Date (ccyymmdd)	X(8)	R	145	152
20	FILLER (empty fields)			153	159
* 21	Admitting Diagnosis Code	X(8)	L	160	167	FL69
* 21	External Cause of Injury Code 1	X(8)	L	168	175	FL72
* 22	External Cause of Injury Code 2	X(8)	L	176	183	FL72
* 23	External Cause of Injury Code 3	X(8)	L	184	191	FL72
* 24	Procedure Coding Method Used	9(1)		192	192

6.10 For Both 1450 &1450Y2K

ICD 9 CM is required for diagnosis coding. Do not report the decimal in the code. The ICD 9 CM diagnosis codes are assigned a COBOL picture of X. Format the actual code in one of four general ways, as follows:

A. If you report 99999, it translates to 999.99.

B. If you report V9999, it translates to V99.99.

C. If you report E9999, it translates to E999.9.

D. If you report M99999, it translates to M9999/9.

To determine the location of the decimal position and the potential number of decimal positions it is necessary only to examine the high order (left most) position of the field.

6.11 1450 & 1450Y2K-RECORD Type 80 - 8N - Physician Data

*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*POSITION*		*FORM LOCATOR*
*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*FROM*	*THRU*	*FORM LOCATOR*
* 1	Record Type '80'	XX	L	1	2
* 2	Sequence	99	R	3	4
* 3	Patient Control Number	X(20)	L	5	24	FL03
* 4	Physician Number Qualifying Code	X(2)	L	25	26
* 5	Attending Physician Number	X(16)	L	27	42	FL76
* 6	Operating Physician Number	X(16)	L	43	58	FL77
* 7	Other Physician Number	X(16)	L	59	74	FL78
* 8	Other Physician Number	X(16)	L	75	90	FL79
* 9	Attending Physician Name Last Name First Name Middle Initial	X(25) X(16) X(8) X	L L L	91 91 107 115	115 106 114 115
*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*POSITION FROM THRU*		*FORM LOCATOR*
10	Operating Physician Name	X(25)	L	116	140
11	Other Physician Name	X(25)	L	141	165
12	Other Physician Name	X(25)	L	166	190

Physician Number Qualifying Codes:

A. 0B = State License Number - Alpha and 4 digits

B. 1G = Universal Physician Identification Number (UPIN)- Alpha and 5 digits

C. G2 = Provider Commercial Number

D. Nl = National Provider Identifier (NPI) - 10 digit number (preferred)

6.12 1450 & 1450Y2K-RECORD Type 95 -Provider Batch Control

Only one type '95' is allowed per hospital per submittal. The Federal Tax Number must match the type '10' record. This record type will be processed as a trailer record and a record type '10' will be processed as a header record. The records encapsulated between the first type '10' and '95' will be processed using the hospital specified on the type '10' record.

*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*POSITION*		*FORM LOCATOR*
*FIELD NO.*	*NAME*	*PICTURE*	*SPEC*	*FROM*	*THRU*	*FORM LOCATOR*
* 1	Record Type '95'	XX	L	1	2
* 2	Federal Tax Number (EIN) Federal Tax Sub ID	9(10) X(4)	R L	3 13	12 16	FL05 FL05
* 3	Number of Claims	9(6)	R	25	30

Note: Federal Tax Sub ID must be the same as specified on the type '10' record. 'Number of Claims' should be the number of discharges in the batch (number of type '20' records).

7.0 EXCEPTIONS TO 1450 FORMAT

In general, the submittal is identical to the current UB-04 1450 version 6 format used. The differences are minor but nevertheless important. The most notable difference is the requirement for one discharge record for one patient, as opposed to the possibility of multiple claim records for one patient. For discharges with multiple claim records, they should be consolidated into a single discharge, accumulating amounts where necessary (e.g., amounts by Payer).

Only one type '10' is required per hospital per submittal. Only the first type '10' record and each type '10' record following a type '95' record will be processed, all others will be ignored. A record type '10' will be processed as a header record and a record type '95' will be processed as a trailer record. The records encapsulated between the first type '10' and '95' will be processed using the hospital specified on the type '10' record.

In record type '20', 'Statement Covers Period Thru' should be the discharge date.

In record type '95', Federal Tax Sub ID must be the same as specified on the type '10' record.

'Number of Claims'i n record type '95' should be the number of discharges reported in the batch, after the batch equal to the number of type '20' records.

Record type '27' is not a record type used in the UB-04 claim. It contains data that may come from other record types, such as 'Type of Bill' or may be computable, such as 'Total Charges' or should be found in your current databases, 'Patient Social Security Number' for example.

8.0 USE OF MULTI-PAGE CLAIMS

All data except revenue code and charge fields should be duplicated on successive records. All available revenue and charge fields should be completely filled before using additional records. The '0001' revenue code should be the last entry on the last record for a multi-page claim and its charge should be equal to the total charge for all pages.

APPENDICIES

APPENDIX A

DATA DICTIONARY

The definition specified for each data element is in general agreement with the definition in the UB-04 Users Manual. Hospitals using existing UB-04 record formats should reference Section 7.0 - EXCEPTIONS TO 1450 FORMAT, for differences from the established UB-04 record formats. Hospitals using data sources other than uniform billing should evaluate their definitions for agreement with the definitions specified in this Guide and the UB-04 Users Manual.

A1 The dictionary format that follows will provide the following information:

1. Data Element: The name of the data element

2. Char Type: Character type for the data element

N = numeric

A = alphanumeric

3. Char Length: Character length of data element. For fields with an implied decimal point, the first number is the total length, the second number is the length after the implied decimal point (e.g., '9, 2' represents the COBOL picture clause 9(7)V99).

4. Data Reporting Requirement for the Data Element Level:

Required = must be reported

As available = must be present, if captured in your database

5. Definition: A definition of the data element

6. General Comments: These comments help to further define or explain the data Comments: elements and give permissible values for code and type data elements.

7. Edit: Minimal edits that will be performed on the data element; these edits should be performed by the hospital prior to submission.

Table 1. Definition Breakdown

Click here to view image.Click here to view image.Click here to view image.Click here to view image.Click here to view image.Click here to view image.Click here to view image.Click here to view image.Click here to view image.Click here to view image.Click here to view image.Click here to view image.Click here to view image.Click here to view image.Click here to view image.Click here to view image.Click here to view image.Click here to view image.

APPENDIX B

REVENUE CODES AND UNITS OF SERVICE

This section defines acceptable revenue codes representing services provided to a patient, and the unit of measure associated with each revenue service. Any codes not assigned are assumed to be non-applicable unless found in the NUBC's published manual or addenda to this manual.

B1 Revenue Code

A three-digit code that identifies a specific accommodation, ancillary service or billing calculation. The first two digits of the three-digit code indicate major category; the third digit, represented by 'x' in the codes, indicates a subcategory.

B2 Units of Service

A quantitative measure of services rendered by revenue category to or for the patient, to include items such as number of accommodation days, miles, pints or treatments.

Table 2. Data Element Description Breakdown

CODE	UNIT	DEFINITION	SUBCATEGORY 'x'
001	None	Total Charges
01xto 06x	Reserved for National Assignment
07x to 09x	Reserved for State Use
10x	Days	All inclusive rate - a flat fee charge incurred on either a daily basis or total stay basis for services rendered. Charge may cover room and board plus ancillary services or room and board only.	0 = All inclusive room and board plus ancillary 1 = All inclusive room and board
11x	Days	Room and board - private medical or general routine services for single bed rooms	0 = General Classification 1 = Medical/surgical/GYN 2 = OB 3 = Pediatric 4 = Psychiatric 5 = Hospice 6 = Detoxification 7 = Oncology 8 = Rehabilitation 9 = Other
12x	Days	Room and board - semi-private (two beds) medical or general - routine service charges incurred for accommodations with two beds	0 = General classification 1 = Medical/Surgical/GYN 2 = OB 3 = Pediatric 4 = Psychiatric 5 = Hospice 6 = Detoxification 7 = Oncology 8 = Rehabilitation 9 = Other
13x	Days	Semi-private - three and four beds - routine service charges incurred for accommodations with three and four beds	0 = General classification 1 = Medical/Surgical/GYN 2 = OB 3 = Pediatric 4 = Psychiatric 5 = Hospice 6 = Detoxification 7 = Oncology 8 = Rehabilitation 9 = Other
14x	Days	Private deluxe - deluxe rooms are accommodations with amenities substantially in excess of those provided to other patients	0 = General classification 1 = Medical/Surgical/GYN 2 = OB 3 = Pediatric 4 = Psychiatric 5 = Hospice 6 = Detoxification 7 = Oncology 8 = Rehabilitation 9 = Other
15x	Days	Room and board - ward medical or general routine service charge for accommodations with five or more beds	0 = General classification 1 = Medical/Surgical/GYN 2 = OB 3 = Pediatric 4 = Psychiatric 5 = Hospice 6 = Detoxification 7 = Oncology 8 = Rehabilitation 9 = Other
16x	Days	Other room and board - any routine service charges for accommodations that cannot be included in the more specific revenue center co	0 = General classification 4 = Sterile environment 7 = Self care 9 = Other
17x	Days	Nursery - charges for nursing care to newborn and premature infants in nurseries	0 = General classification 1 = Newborn - Level I 2 = Newborn - Level II 3 = Newborn - Level III 4 = Newborn - Level IV 9 = Other
18x	Days	Leave of absence - charges for holding a room while the patient is temporarily away from the provider	0 = General classification 1 = Reserved 2 = Patient convenience 3 = Therapeutic leave 4 = ICF/MR (any reason) 5 = Nursing home (for hospitalization) 9 = Other leave of absence
19x	Not Assigned
20x	Days	Intensive care - routine service charge for medical or surgical care provided to patients who require a more intensive level of care than is rendered in the general medical or surgical unit	0 = General classification 1 = Surgical 2 = Medical 3 = Pediatric 4 = Psychiatric 6 = Intermediate ICU 7 = Burn care 8 = Trauma 9 = Other intensive care
21x	Days	Coronary care - routine service charge for medical care provided to patients with coronary illness who require a more intensive level of care than is rendered in the more general medical care unit	0 = General classification 1 = Myocardial infarction 2 = Pulmonary care 3 = Heart transplant 4 = Intermediate ICU 9 = Other coronary care
22x	None	Special charges-charges incurred during an inpatient stay or on a daily basis for certain services	0 = General classification 1 = Admission charge 2 = Technical support charge 3 = U. R. service charge 4 = Late discharge, medically necessary 9 = Other special charges
23x	None	Incremental nursing charge rate - charge for nursing service assessed in addition to room and board	0 = General classification 1 = Nursery 2 = OB 3 = ICU (includes transitional care) 4 = CCU (includes transitional care) 5 = Hospice 9 = Other
24x	None	All inclusive ancillary - a flat rate charge incurred on either a daily basis or total stay basis for ancillary services only	0 = General classification 9 = Other inclusive ancillary
25x	None	Pharmacy - charges for medication produced, manufactured, packaged, controlled, assayed, dispensed and distributed under the direction of a licensed pharmacist	0 = General classification 1 = Generic drug 2 = Non-generic drug 3 = Take home drug 4 = Drugs incident to other diagnostic services 5 = Drugs incident to radiology 6 = Experimental drug 7 = Non-prescription 8 = IV solutions 9 = Other pharmacy
26x	None	IV therapy - equipment charge or administration of intravenous solution by specially trained personnel to individuals requiring such treatment	0 = General classification 1 = Infusion pump 2 = IV therapy/pharmacy service 3 = IV therapy/drug/supply/delivery 4 = IV therapy/supplies 9 = Other IV therapy
27x	Item	Medical/surgical supplies and devices -charges for supply items required for patient care	0 = General classification 1 = Non-sterile supply 2 = Sterile supply 3 = Take home supplies 4 = Prosthetic/orthotic devices 5 = Pace maker 6 = Intraocular lens 7 = Oxygen take home 8 = Other implants 9 = Other supplies/devices
28x	None	Oncology - charges for the treatment of tumors and related diseases	0 = General classification 9 = Other oncology
29x	Item	Durable Medical Equipment (other than rental) charges for medical equipment that can withstand repeated use	0 = General classification 1 = Rental 2 = Purchase of new DME 3 = Purchase of used DME 4 = Supplies\drugs for DME effectiveness (HHA's only) 9 = Other equipment
30x	Test	Laboratory - charges for the performance of diagnostic and routine clinical laboratory tests	0 = General classification 1 = Chemistry 2 = Immunology 3 = Renal patient (home) 4 = Non-routine dialysis 5 = Hematology 6 = Bacteriology and microbiology 7 = Urology 9 = Other laboratory
31x	Test	Laboratory pathological - charges for diagnostic and routine lab tests on tissue and culture	0 = General classification 1 = Cytology 2 = Histology 4 = Biopsy 9 = Other
32x	Test	Radiology diagnostic - charges for diagnostic radiology services provided for the examination and care of patients. Includes: taking, processing, examining and interpreting radiographs and fluorographs	0 = General classification 1 = Angiocardiography 2 = Arthrography 3 = Arteriography 4 = Chest x-ray 9 = Other
33x	Test	Radiology therapeutic - charges for therapeutic radiology services and chemotherapy required for care and treatment of patients. Includes therapy by injection or ingestion of radioactive substances	0 = General classification 1 = Chemotherapy injected 2 = Chemotherapy oral 3 = Radiation therapy 5 = Chemotherapy IV 9 = Other
34x	Test	Nuclear medicine - charges for procedures and tests performed by a radioisotope laboratory utilizing radioactive materials as required for diagnosis and treatment of patients	0 = General classification 1 = Diagnostic 2 = Therapeutic 9 = Other
35x	Scan	CT scan - charges for Computer Tomographic scans of the head and other parts of the body	0 = General classification 1 = Head scan 2 = Body scan 9 = Other CT scan
36x	None	Operating room services - charges for services provided by specifically trained nursing personnel who provide assistance to physicians in the performance of surgical and related procedures during and immediately following surgery	0 = General classification 1 = Minor surgery 2 = Organ transplant other than kidney 7 = Kidney transplant 9 = Other operating room services
37x	None	Anesthesia - charges for anesthesia services in the hospital	0 = General classification 1 = Anesthesia incident to RAD 2 = Anesthesia incident to other diagnostic services 4 = Acupuncture 9 = Other anesthesia
38x	Pint	Blood storage and processing - charges for the storage and processing of whole blood	0 = General classification 1 = Blood administration 2 = Whole blood 3 = Plasma 4 = Platelets 5 = Leucocytes 6 = Other components 7 = Other derivatives (cryoprecipitates) 9 = Other blood storage and processing
39x		Blood storage and processing - charges for the storage and processing of whole blood	0 = General classification 1 = Blood administration 9 = Other blood storage & processing
40x	Test	Other imaging services	0 = General classification 1 = Diagnostic mammography 2 = Ultrasound 3 = Screening mammography 9 = Other imaging services
41x	Treatment	Respiratory services - charges for administration of oxygen and certain potent drugs through inhalation or positive pressure and other forms of rehabilitative therapy, through measurement of inhaled and exhaled gases and analysis of blood, and evaluation of the patient's ability to exchange oxygen and other gases	0 = General classification 2 = Inhalation services 3 = Hyper baric oxygen therapy 9 = Other respiratory services
42x	Treatment	I Physical therapy - charges for therapeutic I exercises, massage, and utilization of effective properties of light, heat, cold, water, electricity and assistive devices for diagnosis I and rehabilitation of patients who have I neuromuscular, orthopedic and other I disabilities	0 = General classification 1 = Visit charge 2 = Hourly charge 3 = Group rate 4 = Evaluation or re-evaluation 9 = Other physical therapy
43x	Treatment	I Occupational therapy - charges for teaching I manual skills and independence in personal care to stimulate mental and emotional activity on the part of patients	0 = General classification 1 = Visit charge 2 = Hourly charge 3 = Group rate 4 = Evaluation or re-evaluation 9 = Other occupational therapy
44x	Treatment	I Speech language pathology-charges for I services provided to persons with impaired I functional communications skills	0 = General classification 1 = Visit charge 2 = Hourly charge 3 = Group rate 4 = Evaluation or re-evaluation 9 = Other speech language pathology
45x	Visit	I Emergency room - charges for emergency I room treatment to those ill and injured persons who require immediate unscheduled I medical or surgical care	0 = General classification 1 = EMTALA emergency medical screening services 2 = ER beyond EMTALA screening 6 = Urgent care 9 = Other emergency room
46x	Test	I Pulmonary function - charges for tests that I measure inhaled and exhaled gases and I analysis of blood, and for tests that evaluate I the patient's ability to exchange other gases	0 = General classification 9 = Other pulmonary function
47x	Test	Pulmonary function - charges for tests that measure inhaled and exhaled gases and analysis of blood, and for tests that evaluate the patient's ability to exchange other gases	0 = General classification 1 = Diagnostic 2 = Treatment 9 = Other audiology
48x	Test	Cardiology - charges for cardiac procedures 1 rendered in a separate unit within the hospital. 1 Such procedures include, but are not limited 1 to: heart catheterization, coronary 1 angiography, Swan-Ganz catheterization and 1 exercise stress test.	0 = General classification 1 = Cardiac cath lab 2 = Stress test 9 = Other cardiology
49x	None	1 Ambulatory surgical care - charges for 1 ambulatory surgery that are not covered by 1 other categories	0 = General classification 9 = Other ambulatory surgical care
50x	None	Outpatient service- charges for services rendered to an outpatient who is admitted as 1 an inpatient before midnight of the day 1 following the date of service. These charges 1 are incorporated on the inpatient bill of 1 Medicare patients.	0 = General classification 9 = Other outpatient services
51x	Visit	1 Clinic - charges for providing diagnostic, 1 preventive, curative, rehabilitative and 1 education services on a scheduled basis to an 1 ambulatory patient	0 = General classification 1 = Chronic pain center 2 = Dental clinic 3 = Psychiatric clinic 4 = OB-GYN clinic 5 = Pediatric clinic 6 = Urgent care clinic 7 = Family practice 9 = Other clinic
52x	1 Free 1 Standing	Provides a breakdown of some clinics that hospitals or third party payers may require	0 = General classification 1 = Rural health -clinic 2 = Rural health - home 3 = Family practice clinic 6 = Urgent care clinic 9 = Other free standing clinic
53x	1 Visit	Osteopathic services - charges for a structural evaluation of the cranium, entire cervical, dorsal and lumbar spine by a doctor of osteopathy	0 = General classification 1 = Osteopathic therapy 9 = Other osteopathic services
54x	1 Mile	Ambulance - charges for ambulance service, usually on an unscheduled basis, to the ill and injured who require immediate medical attention	0 = General classification 1 = Supplies 2 = Medical transport 3 = Heart mobile 4 = Oxygen 5 = Air ambulance 6 = Neonatal ambulance services 7 = Pharmacy 8 = Telephone transmission EKG 9 = Other ambulance
55x	Skilled 1 Nursing	Charges for nursing services that must be provided under the direct supervision of a licensed nurse to assure the safety of the patient and to achieve the medically desired result. This code may be used for nursing home services or a service charge for home health billing.	0 = General classification 1 = Visit charge 2 = Hourly charge 9 = Other skilled nursing
56x	Visit	Medical social services such as counseling patients, intervening on behalf of patients, and interpreting problems of social situation rendered to patients on any basis.	0 = General classification 1 = Visit charge 2 = Hourly charge 9 = Other medical social services
57x	1 Home Health Aide	Charges made by an HHA for personnel who are primarily responsible for the personal care of the patient	0 = General classification 1 = Visit charge 2 = Hourly charge 9 = Other home health aide
58x	Other Visits	Code indicates the charge by an HHA for visits other than physical therapy, occupational therapy or speech therapy, which must be specifically identified.	0 = General classification 1 = Visit charge 2 = Hourly charge 9 = Other home health visits
59x	Units of Service	This revenue code is used by an HHA that bills (Home Health) on the basis of units of service.	0 = General classificatio 9 = Home health other units
60x	Oxygen	Code indicates the charges by an HHA for (Home Health) oxygen equipment supplies or contents, excluding purchased equipment. If a beneficiary purchased a stationary oxygen system, and oxygen concentrator or portable equipment, current revenue code 292 or 293 applies. DME (other than oxygen systems) is billed under current revenue codes 291, 292 or 293.	0 = General classification 1 = Oxygen - state/equip/supply/ or content 2 = Oxygen - state/equip/supply under 1 LPM 3 = Oxygen - state/equip/ over 4 LPM 4 = Oxygen - portable add-on
61x	I Test	MRI - charges for Magnetic Resonance Imaging of the brain and other parts of the body.	0 = General classification 1 = Brain including brain stem 2 = Spinal cord including spin 9 = Other MRI
62x	I Days	Medicare/Surgical supplies - charges for supply items required for patient care. The category is an extension of code 27x for reporting additional breakdown where needed. Sub code 1 is for providers that cannot bill supplies used for radiology procedures under radiology.	1 = Supplies incident to radiology 2 = Supplies incident to other diagnostic services 3 = Surgical dressing 4 = Investigational device
63x	1 Drugs Requirin	g Specific Identification	0 = General classification 1 = Single source drug 2 = Multiple source drug 3 = Restrictive prescription 4 = Erytropepoetin (EPO) - less than 10,000 units 5 = Erytropepoetin (EPO) -10,000 or more units 6 = Drugs requiring detailed coding
64x	Home 1 Therapy Services	Charge for intravenous drug therapy services performed in the patient's residence. For home IV providers the HCPCS code must be entered for all equipment, and all types of covered therapy.	0 = General classification 1 = Non-routine nursing 2 = IV site care, central line 3 = IV start/change peripheral line 4 = Non-routine nursing, peripheral line 5 = Training patient/caregiver, central line 6 = Training, disabled patient, central line 7 = Training patient/caregiver, peripheral line 8 = Training, disabled patient, peripheral line 9 = Other IV therapy services
65x	1 Day	Hospice service - charges for hospice care services for a terminally ill patient if he/she elects these services in lieu of other services for the terminal condition	0 = General classification 1 = Routine home care 2 = Continuous home care 3 = Reserved 4 = Reserved 5 = Inpatient respite care 6 = General non-respite inpatient care 7 = Physician services 9 = Other hospice
70x	1 None	Cast room - charges for services related to the application, maintenance and removal of casts	0= General classification 9 = Other cast room
71x	1 None	Recovery room	0 = General classification 9 = Other recovery room
72x	Labor Room / Delivery Room	Labor room and delivery - charges Delivery Room for labor and delivery room services provided by specially trained nursing personnel to patients, including prenatal care during labor, assistance during delivery, postnatal care in the recovery room, and minor gynecological procedures if they are performed in the delivery suite.	0 = General classification 1 = Labor 2 = Delivery 3 = Circumcision 4 = Birthing center (unit is days) 9 = Other labor room and delivery
73x	Test	EKG/ECG (electrocardiogram) - charges for operation of specialized equipment to record electromotive variations in actions of the heart muscle on an electrocardiography for diagnosis of heart ailments	0 = General classification 1 = Holter monitor 2 = Telemetry 9 = Other EKG/ECG
74x	Test	EEG (electroencephalogram) - charges for operation of specialized equipment to measure impulse frequencies and differences in electrical potential in various areas of the brain to obtain data for use in diagnosing brain disorders	0 = General classification 9 = Other EEG
75x	I Test	Gastrointestinal services - procedure room charges for endoscopic procedures not performed in the operating room.	0 = General classification 9 = Other gastrointestinal
76x	None	Treatment or observation room - charges for minor procedures performed outside the operating room	0 = General classification 1 = Treatment room 2 = Observation room 9 = Other treatment room
77x	Preventative Care Services	Charges for the administration of vaccines	0 = General classification 1 = Vaccine administration 9 = Other
79x	None	Lithotripsy - charges for the use of lithotripsy in the treatment of kidney stones	0 = General classification 9 = Other lithotripsy
80x	Session	Inpatient renal dialysis - a waste removal process performed in an inpatient setting that uses an artificial kidney when the body's own kidneys have failed. The waste may be removed directly from the blood (hemodialysis) or indirectly from the abdominal covering and the tissue (peritoneal dialysis).	0 = General classification 1 = Inpatient hemodialysis 2 = Inpatient peritoneal 3 = Inpatient continuous ambulatory peritoneal dialysis 4 = Inpatient continuous cycling peritoneal dialysis 9 = Other inpatient dialysis
81x	None	Organ acquisition - the acquisition of a kidney, liver or heart for use in transplantation	0 = General classification 1 = Living donor- kidney 2 = Cadaver donor - kidney 3 = Unknown donor- kidney 9 = Other organ acquisition
82x	Hemodialysis I Outpatient or I Home Dialysis	A waste removal performed in an outpatient or home setting necessary when the body's own kidneys have failed. Waste is removed directly from the blood.	0 = General classification 1 = Hemodialysis/composite or other rate 5 = Support services 9 = Other hemodialysis outpatient
83x	Peritoneal Dialysis Outpatient or I Home	A waste removal process performed in an outpatient or home setting, necessary when the body's own kidneys have failed. Waste is removed indirectly by flushing a special solution between the abdominal covering and the tissue.	0 = General classification 1 = Peritoneal/composite or other rate 5 = Support services 9 = Other peritoneal
84x	Continuous Ambulatory Peritoneal Dialysis (CAPD) Outpatient	A continuous dialysis process performed in an outpatient or home setting, which uses the patient's peritoneal membrane as a dialyzer.	0 = General classification 1 = CAPD/composite or other rate 5 = Support services 9 = Other CAPD dialysis
85x	Continuous Cycling Peritoneal Dialysis (CCPD) Outpatient	A continuous dialysis process performed in an outpatient or home setting, which uses the patient's peritoneal membrane as a dialyzer.	0 = General classification 1 = CCPD/composite or other rate 5 = Support services 9 = Other CCPD dialysis
86x	Reserved for Dialysis (National Assignment)
87x	Reserved for Dialysis (State Assignment)
88x	Session	Miscellaneous dialysis - charges for dialysis services not identified elsewhere	0 = General classification 1 = Ultrafiltration 9 = Other miscellaneous dialysis
89x	None	Other donor bank - charges for the acquisition, storage and preservation of all human organs, excluding kidneys	0 = General classification 1 = Bone 2 = Organ other than kidney 3 = Skin 4 = Activity therapy 9 = Other donor bank
90x	Visit	Psychological treatments	0 = General classification 1 = Electroshock treatment 2 = Milieu therapy 3 = Play therapy 4 = Activity therapy 9 = Other 6 = Family therapy
91x	Visit	Psychiatric or psychological services -charges for providing nursing care, employee and professional services for emotionally disturbed patients, including patients admitted for diagnosis and those admitted for treatment.	0 = General classification 1 = Rehabilitation 2 = Partial hospitalization 4 = Individual therapy 5 = Group therapy 7 = Biofeedback 8 = Testing 9 = Other
92x	Test	Other diagnostic services	0 = General classification 1 = Peripheral vascular lab. 2 = Electromyelogram 3 = Pap smear 4 = Allergy test 5 = Pregnancy test 9 = Other diagnostic service
94x	Visit	Other therapeutic services - charges for other therapeutic services not otherwise categorized	0 = General classification 1 = Recreational therapy 2 = Education or training 3 = Cardiac rehabilitation 4 = Drug rehabilitation 5 = Alcohol rehabilitation 6 = Routine complex medical equipment 7 = Ancillary complex medical equipment 9 = Other therapeutic services
96x	None	Professional fees - charges for medical professionals that the hospitals or third party payers require to be separately identified on the billing form	0 = General classification 1 = Psychiatric 2 = Ophthalmology 3 = MD anesthesiologist 4 = CRNA anesthetist 9 = Other professional fees
97x	None	Professional fees - continued 1 = Laboratory	2 = Radiology - diagnostic 3 = Radiology - therapeutic 4 = Radiology - nuclear medicine 5 = Operating room 6 = Respiratory therapy 7 = Physical therapy 8 = Occupational therapy 9 = Speech pathology
98x	None	Professional fees - continued 1 = Emergency room	2 = Outpatient services 3 = Clinic 4 = Medical; social services 5 = EKG 6 = EEG 7 = Hospital visit 8 = Consultation 9 = Private duty nurse
99x	None	Patient convenience items - charges for items I	0 = General classification that are generally considered by the third 1 = Cafeteria/guest tray party payer to be strictly convenience items 2 = Private linen service and as such, are not covered 3 = Telephone/telegraph 4 = TV/radio 5 = Non-patient room rentals 6 = Late discharge charge 7 = Admission kits 8 = Beauty shop/barber 9 = Other convenience items

APPENDIX C

ACRONYM LISTING

ACRONYM	DESCRIPTION
ADH	Arkansas Department of Health
ASCII	PC Text File
CAH	Critical Access Hospital
CAPD	Continuous Ambulatory Peritoneal Dialysis
CCPD	Continuous Cycling Peritoneal Dialysis
CD	Compact Disk
COBOL	Common Business Oriented Language
CPT	Current Procedural Technology
CR	Carriage-return
CT	Computer Tomographic
DAT	PC Text File
DCN	Document Control Number
DME	Durable Medical Equipment
DRG	Diagnosis Related Group
EEG	Electroencephalogram
EIN	Employer Identification Number
EKG/ECG	Electrocardiogram
EPO	Erythropoetin alpha or Darbepoetin alpha
FTP	File Transfer Protocol
HCFA	Health Care Financing Administration
HCPCS	HCFA Common Procedural Coding System
HDDS	Hospital Discharge Data System
HH	Home Health
HHA	Home Health Agency
HIPPA	Health Insurance Portability and Accountability Act of 1996
ICD	International Classification of Diseases
ICF	Intermediate Care Facility
IRF	Inpatient Rehabilitation Facility
LF	Line-feed
LTCH	Long Term Care Hospital
MDC	Major Diagnostic Categories
MRI	Magnetic Resonance Imaging
NPI	National Provider Identifier
NUBC	National Uniform Billing Committee
PPS	Perspective Payment System
QTR	Quarter
RTC	Residential Treatment Center
SNF	Skilled Nursing Facility
TIN	Tax Identification Number
TOB	Type of Bill
TXT	Text
UB	Uniform Billing
UPIN	Universal Physician Identification Number
ZIP	Compressed file

APPENDIX D REFERENCES

D1 RESOURCE LIST

D2 RULES AND REGULATIONS PERTAINING TO HOSPITAL DISCHARGE DATA SYSTEM

D3 ARKANSAS CODE - "STATE HEALTH DATA CLEARING HOUSE ACT"

D4 ACT 616

D5 ACT 670

D6 ACT 1470

D1. RESOURCE LIST

Current Procedural Terminology

Published by the American Medical Association; ISBN 3-89970-792 -0.

May be purchased from:

Order Department Reference OP054194HA American Medical Association PO Box 10950 Chicago, IL 60610 (800)621-8335

National Uniform Billing Committee (NUBC)

Official UB-04 Data Specifications Manual 2009, Version 3.00, July 2008

Uniform Billing (UB-04)

CMS Manual System, Pub100-04 Medicare Claims Processing, Transmittal 1104, November 3, 2006, Department of Health and Human Services, Centers for Medicare & Medicaid Services or www.cms.hhs.gov/transmittals/downloads/R1104CP.pdf

HCFA Common Procedural Coding System (HCPCS)

Published by the Centers for Medicare and Medicaid Service, (formerly HCFA)

International Classification of Diseases, Ninth Edition (ICD-9)

Published by the Centers for Medicare and Medicaid Service, and the National Center for Health Static.

The materials published by the Centers for Medicare and Medicaid Service may be purchased from:

U.S. Department of Commerce National Technical Information Service Subscription Department 5285 Port Royal Road Springfield, VA 22161 (800) 553-6847

Some materials may also be purchased from large commercial bookstores and from medical office supply firms. These documents are also available for use by the general public at the Arkansas State Library and may be available from your local library by an interlibrary loan.

Arkansas State Library Documents Service One Capitol Mall Little Rock, AR 72201 (501)682-2326

D2. RULES AND REGULATIONS PERTAINING TO HOSPITAL DISCHARGE DATA SYSTEM (HDDS)

SECTION I. AUTHORITY.

The following Rules and Regulations pertaining to [he Hospital Discharge Data System are duly adopted and promulgated by the Arkansas Board of Health pursuant to the authority expressly conferred by the Slate of Arkansas including, without limitation. Act 670 of 1995 (the Act), as amended, the same being Ark. Code Ann. § 20-7-301 et seq. The Act established the State Health Data Clearing House within the Arkansas Department of Heaith. The Clearing House is mandated by the Act to acquire and disseminate health care information in order to understand patterns and trends in the availability, use and costs of health cure services in the state. Subsection (h) of the Act directs the Arkansas State Board of Health to prescribe and enforce such rules and regulations as may be necessary to carry out the purpose of this Act.

SECTION II. PURPOSE.

It is the purpose of these regulations to provide direction about the required collection, submission, management and dissemination of health data.

SECTION III. DEFINITIONS.

For the purposes of these Regulations, the following words and phrases when used herein shaJl be construed as follows:

A. "Act" means the Stale Health Data Clearing House Act 670 of 1995, Ark. Code Ann. § 20-7-301 etseq;

B. "Aggregate data set" means a compilation of raw data that has been subject to a critical edit check and consists of at least a small cell count. Aggregate daia sets shall not include the following data elements: hospital control number; patient control number; attending physician number, or any element which might be used to identify an individual patient;

C. "Board" of "State Board" means the Arkansas State Board of Health;

D. "Confidential information" means that infoiTnation which the State Board has defined to be confidential in these regulations and procedures;

E. Department" means the Arkansas Department of Health:

F. "Director" means the director of the Arkansas Department of Health;

G. "Hospital" means any institution, place, building or agency, public or private, whether organized for profit or not Tor-profit, which is subject to licensure by (he Arkansas Department of Health (Ark. Code Ann. § 20-9-201 el seq);

H. "Submit," "submission" or "submittal" means, with Tespect to data, reports, surveys, staiements and documents required to be filed with the Department:

1) delivery to the Arkansas Department of Health, by Ihe close of business on the prescribed filing date, or

2) deposit with the United States Postal Service, postage prepaid, addressed to the Arkansas Department of Health, in sufficient time so that the mailed materials will arrive by the close of business on the prescribed filing date;

"Guide" means the Hospital Discharge Data Submittal Guide published by the Arkansas Department of Health. This Guide contains technical information relating to data format, media and submittal time frames.

SECTION IV. GENDER AND NUMBER.

All terms used in any one gender or number shall be construed to include any other gender or number.

SECTION V. HOSPITAL DISCHARGE DATA SUBMITTAL.

Each Arkansas hospital which performs activities meeting the definition of inpatient discharges, as set forth in the Guide, shall submit data to the Department in a manner that complies with the provisions of the Guide for all inpatient hospital discharges occurring on or after January 1. 1996,

SECTION VI. ADDITIONAL DATA REQUIRED TO BE SUBMITTED.

In addition to data prescribed for Submission in the Guide, the following data must be submitted according to the schedule provided: Each hospital shall provide a complete and accurate copy of the American Hospital Association's Annual Survey to the Arkansas Department of Health or the Arkansas Hospital Association, The required submission date will be published annually with the distribution of the survey.

SECTION VII. EXTENSION OF TIME.

The Stale Board or the Director shall, upon a showing of good cause and if lime permits, extend the time allowed for the performance of any function or duly required by the provisions of the Actor of these regulations and rules. In making any determination with regard to good cause, the Hoard and the Director shall give due consideration to all relevant facts and circumstances, including such considerations as the complexity of the issues or ihe existence of extraordinary circumstances or unforeseen evenls which have led to the request for an extension of lime. The State Board or the Director shall act upon a request for an extension of time within thirty (30} days of receiving the written request by the hospital, Failure to act within thirty (30) days shall be deemed as a grant of the extension.

SECTION VIII. AUTHORIZED USE OF DATA.

Information reported to the Department shall not be disclosed except as authorized by the Arkansas law. See Ark. Code Ann. tj 20-7-305 as amended,

SECTION IX. ACCESS TO AGGREGATE REPORTS.

All reports generated by the Department from the aggregate data set for a member of the general public are open for public inspection. Ihe Department shall provide copies of these reports, upon request, at a cost of $.25 per page. The Department shall determine fees to be charged to cover the direct and indirect costs for providing other information requests or special compilations from aggregate data sets. The fee shall include staff lime, computer time, copying costs, postage and supplies,

SECTION X. PENALTIES FOR NON-COMPLIANCE.

Ark. Code Ann. § 20-7-301 et seu, sets forth civil and criminal penalties for non-compliance with provisions of the Act and of rules and regulations adopted by the Arkansas State Board of Health to implement the Act, as follows:

A. Any person, firm, corporation, organization or institution that violates any of the provisions of Ark. Code Ann. § 20-7-301 el seq,. or any rules or regulations promulgated thereunder, regarding confidentiality of information, shall be guilty of a misdemeanor and. upon convictiun thereof. shaf be fined not less than one hundred dollars (SI00) nor mote than ($500), Or by imprisonment not exceeding one month, or both, Each day of violation shall constitute a separate offense.

B. Any person, firm, corporation, organization or institution knowingly violating any of the provisions of Ark. Code Ann, § 20-7-301 et seq,, or any rules or regulations promulgated Thereunder, shall beguihy of a misdemeanor and, upon a plea of guilty, apleaof nolo contendere or conviction, shall be fined not more than five hundred dollars (S500j-

C. Every person, firm, corporation, organization or institution that violates any of the rules or regulations adopted by the Arkansas State Board of Health or that violates any provision of Act 670 may be assessed a civil penalty by the Board, The penalty shall rtoi exceed two hundred fifty dollars t$250) for each violation. No civil penalty may be assessed uniil the person charged with the violation has been given the opportunity for a heating on the violation pursuant to the Arkansas Administrative Procedure Act, Ark, Code Ann. § 25-15-101, et seq.

SECTION XI HEARING AND APPEAL.

Hearings and appeals will be conducted according to the Adjudication and Rule Making Sections of the Department's Administrative Procedures previously promulgated by the Department and any revisions thereto,

SECTION XII. MAINTENANCE OF REGULATIONS .\M> PROCEDURES.

All pages of these regulations and rules, and of the Hospital Discharge Data Submittal Guide, issued by the Department are dated at the bottom. As changes occur, replacement pages will lie issued. Al) replacement pages will be dated so that users may be certain they are referring to the most recent

information.

SECTION XIII. INCORPORATION BY REFERENCE.

The following documents are hereby incorporated by reference:

A. The most recent edition of the International Classification of Diseases, Clinical Modific;iiioris. Copies are available from the World Health Organization. P.O. Box 5284. Church Street Station, New York. New York 10249.

B. Uniform Hospiial Billing Form 2004 <UB04/CMS-1450>. Copies are available from the Office of Public Affairs, Center for Medicare and Medicaid Services. Humphrey Building, Room428-H, 200 Independence Avenue S.W. Washington. DC. 20201 or website, www.cms.hhs.eov/cnisfornis/. All incorporated material is available for public review at the central administrative office of the Department.

SECTION XIV. SEVERABILITY.

If any provision of these Rules and Regulations or [he application thereof to any person or circumstances is held invalid, such invalidity shall not affect other provisions or applications of these Rules and Regulations which can give effect without the invalid provisions or applications, and to

this end the provisions hereto are declared severable.

SECTION XV. REPEAL.

Al! regulations and parti of regulaiions in confiici herewith are hereby repealed.

D3. ARKANSAS CODE - "STATE HEALTH DATA CLEARING HOUSE ACT"

Arkansas Code Annotated 20-7-301 et seq.

20-7-301. Title.

This subchapter shall be entitled the "State Health Data Clearing House Act."

History. Acts 1995, No. 670, § 1.

20-7-302. Purpose.

The General Assembly finds that as a result of rising health care costs, the shortage of health professionals and health care services in many areas of the state, and the concerns expressed by care providers, consumers, third party payers, and others involved with planning for the provision of health care, there is an urgent need to understand patterns and trends in the availability, use, and costs of these services. Therefore, in order to establish an information base for patients, health professionals, and hospitals, to improve the appropriate and efficient usage of health care services, and to provide for appropriate protection for confidentiality and privacy, the Department of Health shall act as a state health data clearing house for the acquisition and dissemination of data from state agencies and other appropriate sources to carry out the purposes of this subchapter.

History. Acts 1995, No. 670, § 2.

20-7-303. Collection and dissemination of health data.

(a) The Director of the Department of Health shall, with the approval of the State Board of Health, compile and disseminate health data collected by the Department of Health.

(b) The Department of Health, in consultation with advisory groups appointed by the director with representation from hospitals, outpatient surgery centers, health profession licensing boards, and other state agencies, should:

(1)

(A) Identify the most practical methods to collect, transmit, and share required health data as described in § 20-7-304;

(B) Utilize, wherever practical, existing administrative databases and modalities of data collection to provide the required data;

(D) Ensure confidentiality of data by enforcing appropriate rules and regulations.

(2) In order to maximize limited resources and to prevent duplication of effort, the Department of Health may, when appropriate, consider contracting with private entities for the collection of data as set forth in this section subject to the provisions of this subchapter.

(c)

(1) All state agencies, including health profession licensing, certification, or registration boards and commissions, which collect, maintain, or distribute health data, including data relating to the Medicaid program, shall make available to the Department of Health such data as are necessary for the Department of Health to carry out its responsibilities as prescribed by this subchapter or such rules and regulations as may be adopted as provided in § 20-7-305.

(2) If health data are already reported to another organization or governmental agency in the same manner, form, and content or in a manner, form, and content acceptable to the department, the director may obtain a copy of such data from said organization or agency, and no duplicative report need be submitted by the organization.

(3) All hospitals and outpatient surgery centers licensed by the state shall submit information in a form and manner as prescribed by rules and regulations by the State Board of Health pursuant to § 20-7-305; however, if the same information is being collected by another state agency, the Department of Health shall obtain such data from the other state agency.

History. Acts 1995, No. 670, § 2.

20-7-304. Release of health data.

The Director of the Department of Health shall be empowered to release data collected pursuant to this subchapter, except that data released shall not include any information which identifies or could be used to identify any individual patient, provider, institution, or health plan except as provided in § 20-7-305.

History. Acts 1995, No. 670, § 2.

20-7-305. State Board of Health to prescribe rules and regulations - Data collected not subject to discovery.

(a) The State Board of Health shall prescribe and enforce such rules and regulations as may be necessary to carry out the purpose of this subchapter, including the manner in which data are collected, maintained, compiled, and disseminated, and including such rules as may be necessary to promote and protect the confidentiality of data reported under this subchapter.

(b) Provided further, that data collected under this subchapter which identifies, or could be used to identify, any individual patient, provider, institution, or health plan shall not be subject to discovery pursuant to the Arkansas Rules of Civil Procedure or the Freedom of Information Act of 1967, § 25-19-101 et seq.

(c) The Department of Health and Human Services may, only for purposes of research and aggregate statistical reporting, provide data to the Arkansas Center for Health Improvement and the Agency for Healthcare Research and Quality for its Healthcare

Cost and Utilization Project. The data shall be treated in a manner consistent with all state and federal privacy requirements, including, without limitation, the federal Health Insurance Portability and Accountability Act of 1996 privacy rule, specifically 45 C.F.R. § 164.512(i). Furthermore, any identifiable data provided, collected, or disseminated under this subsection shall not be subject to discovery pursuant to the Arkansas Rules of Civil Procedure or the Freedom of Information Act of 1967, § 25-19-101 et seq.

(d) It shall be unlawful for the center to release any patient-identifying information to any nongovernmental third party.

History. Acts 1995, No. 670, § 2.

20-7-306. Reports - Assistance.

(a) The Director of the Department of Health shall prepare and submit a biennial report to the Governor and the House and Senate Interim Committees on Public Health, Welfare, and Labor or appropriate subcommittees thereof.

(b) The Department of Health shall provide assistance to the House and Senate Interim Committees on Public Health, Welfare, and Labor or appropriate subcommittees thereof in the development of information necessary in the examination of health care issues.

History. Acts 1995, No. 670, § 2 ; 1997, No. 179, § 22.

20-7-307. Penalties.

(a)

(1) Any person, firm, corporation, organization, or institution that violates any of the provisions of this subchapter or any rules and regulations promulgated hereunder regarding confidentiality of information shall be guilty of a misdemeanor and, upon conviction thereof, shall be punished by a fine of not less than one hundred dollars ($100) nor more than five hundred dollars ($500) or by imprisonment not exceeding one (1) month, or both.

(2) Each day of violation shall constitute a separate offense.

(b) Any person, firm, corporation, organization, or institution knowingly violating any of the provisions of this subchapter or any rules and regulations promulgated hereunder shall be guilty of a misdemeanor and, upon a plea of guilty, a plea of nolo contendere, or conviction, shall be punished by a fine of not more than five hundred dollars ($500).

(c)

(1) Every person, firm, corporation, organization, or institution that violates any of the rules and regulations adopted by the State Board of Health or that violates any provision of this subchapter may be assessed a civil penalty by the board.

(2) The penalty shall not exceed two hundred fifty dollars ($250) for each violation.

(3) However, no civil penalty may be assessed until the person charged with the violation has been given the opportunity for a hearing on the violation pursuant to the Arkansas Administrative Procedure Act, § 25-15-201 et seq.

History. Acts 1995, No. 670, § 3.

20-7-308. Repealer.

All laws and parts of laws in conflict with this subchapter are hereby repealed, except that nothing herein shall be interpreted to repeal any provision which authorizes the Health Services Agency to gather such data as may be necessary to conduct permit of approval activities.

History. Acts 1995, No. 670, § 6.

Disclaimer: These regulations may not be the most recent version. Arkansas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Arkansas Administrative CodeAgency 007 - Arkansas Department of HealthDivision 11 - Division of Health StatisticsRule 007.11.09-001 - Hospital Discharge Data System and Hospital Discharge Data Submittal Guide

Arkansas Administrative Code
Agency 007 - Arkansas Department of Health
Division 11 - Division of Health Statistics
Rule 007.11.09-001 - Hospital Discharge Data System and Hospital Discharge Data Submittal Guide