Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 24 - Division of Health
Rule 016.24.06-008 - 2006 Hospital Discharge Data Submittal Guide

Notes: 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.

An example of the diskette label

Click here to view image

'ZIP' for a file compressed with PKZIP or 'EXE' for a self-extracting file

Example: 06QTR1.TXT - ASCII data file for the first quarter of 2006

An example of the tape label

Click here to view image

FILE TRANSFER PROTOCOL

No FTP discharge data submissions are permitted at the present time. FTP and other data submission methods are always under review. If implemented, all Arkansas hospitals will receive notice of the ability to submit discharge data using the new method.

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:

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

X. If you are a hospital or subsidiar2006DHHSDATAGUIDE.docy of a hospital, replace 'Hospital:' with 'Agent:' and your hospital name.

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

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

X. If multiple files are placed on diskette, 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 tape must be provided with tax id, number of records, and hospital contact.

INTERMEDIARIES

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

DATA RECORD FORMATS

The accepted data record formats are the UB-92 1450 version 6 format and UB-92 1300 flat file format. Both of these formats have been altered slightly. These alterations are the result of standardizing similar data elements of the two formats. The definition specified for each data element is in general agreement with the definition in the UB-92 Users Manual. Hospitals using data sources other than uniform billing should evaluate definitions for agreement with the definitions specified in this Guide and UB-92 Users Manual. See the EXCEPTIONS section for each format to identify possible changes to your current formats. Each record must be followed by a carriage return/line feed sequence.

'UB-92-1450' RECORD SPECIFICATION

The UB-92 1450 claim 'record' is made up of a series of 192-character physical records. Not all of the physical claim records are used in the Hospital Discharge Data System, such as the Claim Request Data. Records not specified in the Hospital Discharge Data System 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 Hospital Discharge Data System, when possible. A complete copy of the patient's 1450 records would satisfy the requirements, with exceptions noted in 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

Thru = Rightmost position in the record (low order). 10. Form Locator: Number found on the UB-92 Form and associated with the field in that location.

1450 -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.

*An asterisk denotes the field is required and must contain data if applicable.

1450 -RECORD TYPE 20 - PATIENT DATA

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.

1450 Y2K-RECORD TYPE 20 - PATIENT DATA

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:

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.

1450 -RECORD TYPE 27 - HEALTH DEPT. SPECIFIC DATA

All positions must be fully coded. See UB-92 guidelines for codes and definitions. In most situations, the discharge should be coded as '111'.

Patient Social Security Number The Social Security Number of the patient receiving inpatient care.

If the patient is a newborn, use the mother's SSN.

If a patient does not have a social security number, fill with zeroes.

Patient Race

This item gives the race of the patient. Use the following codes:

1 = American Indian or Alaskan Native

2 = Asian or Pacific Islander

3 = Black

4 = White

5 = Other Any possible options not covered in the above categories

6 = Unknown A person who chooses not to answer the question Blank Space The hospital made no effort to obtain the information

***************************************************************************** Patients may self identify themselves as Hispanic or the admissions registration person may identify the patient as Hispanic. However, Hispanic is not a correct race classification for our data gathering purposes. Hispanic is considered to be an ethnicity group. Hispanic patients should be registered as Hispanic for the ethnicity field and white for the race field unless the patient self identifies as being of a race other than white. Other should not be used for the race field for Hispanic patients. *****************************************************************************

Patient Ethnicity

This item gives the ethnicity of the patient. Use the following codes:

1 = Hispanic origin

2 = Not of Hispanic origin

6 = Unknown A person who chooses not to respond to the inquiry Blank Space = The hospital made no effort to obtain the information

Birth Weight

Birth weight in grams for a newborn. Zero fillif unknown.

Total Charges

Total of charges for this inpatient occurrence.

Estimated Collection Rate

Collection rate (percentage) expected from all sources for this inpatient occurrence.

This percentage could be the result of bad debt, contracted amounts or rates with insurance carriers, etc.

Charitable / Donation Rate

This item identifies the inpatient discharge fully or partially as charitable or a donation of services. (This should not be confused with a bad debt.)

Use the following rates:

APGAR Score

APGAR score for a newborn. Zero fillif unknown or does not apply.

1450 -RECORD TYPES 30-31 - THIRD PARTY PAYER

The use of these record types for the Hospital Discharge Data System (HDDS) is the same as the UB-92 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-92.

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 3l, 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.

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.

1450 -RECORD TYPE 30 - THIRD PARTY PAYER DATA

NOTE: 'Payments Received' and 'Estimated Amount Due' should reflect a single discharge per payer if multiple claims have been submitted.

1450 -RECORD TYPE 31 - THIRD PARTY PAYER DATA

1450 -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: 100through21X.

1450 -RECORD TYPE 60 - INPATIENT ANCILLARY SERVICES DATA

The sequence number for record type 60 can go from 0l to 99, each such physical record containing 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.

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

1450 -RECORD TYPE 70 - MEDICAL DATA (SEQUENCE 1)

1450 Y2K-RECORD TYPE 70 - MEDICAL DATA (SEQUENCE 1)

Date changes made by some hospitals for the year 2000 and following require spacing changes in the type 20 and the 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, statement through date and procedure dates) must use this format. The following position changes in the type 70 record are required:

FOR BOTH 1450 AND 1450 Y2K

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:

If you report 99999, it translates to 999.99. If you report V9999, it translates to V99.99. If you report E9999, it translates to E999.9. 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.

-RECORD TYPE 80 - 8N - PHYSICIAN DATA 1450

Physician Name is to be broken down as follows:

Physician Number Qualifying Codes:

UP = Universal Physician Identification Number (UPIN)- Alpha and 5 digits

FI = Federal Taxpayer's Identification Number

SL = State License Number - Alpha and 4 digits

SP = Specialty License Number

NI = National Provider Identifier (NPI) - 10 digit number

1450 -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.

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).

EXCEPTIONS TO 1450 FORMAT

In general, the submittal is identical to the current UB-92 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 is a new field and must be the same as specified on the type '10' record.

'Number of Claims' in record type '95' should be the number of discharges in the batch, the number of type '20' records.

Record type '27' is not a record type used in the UB-92 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.

UB-92 1300 RECORD SPECIFICATION

The UB-92 1300 flat file contains one record per discharge, except in the case of multi-page claims. However, the standard 1300 format does not contain some fields that are found on the 1450 format. To make the 1450 and 1300 compatible, only those elements we deemed necessary for effective analysis have been included in an enhanced version of the 1300; these exceptions are documented in EXCEPTIONS TO 1300 FORMAT. Variations of the 1300 from other states have been examined and their usage of free space incorporated, standardizing whenever possible.

The record layouts that follow will provide the following information:

An asterisk '*' denotes the field is a required field and must contain data if applicable.

L = Left justification, and R = Right justification.

Thru = Rightmost position in the record (low order).

1300 DISCHARGE RECORD

Only one record per patient discharge is allowed except for multi-page claims. The last entry in the series of Revenue Code/Total Charges fields must be the Total Charge (0001) Revenue Code and the Charge Amount must be the total of all previous entries. Any remaining revenue and charge fields must be blank or zero filled. No zero or space filled fields should precede the 0001 entry.

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.

EXCEPTIONS TO 1300 FORMAT

With the inclusion of the 1300 format as an accepted data format, the standard 1300 required the addition of data elements not found on the 1300 format but found on the 1450 format. Formats used by other states have been reviewed in an attempt to use standard data layouts. Their usage of free space has been incorporated whenever possible.

The following fields are the additional data elements:

DATA DICTIONARY

The definition specified for each data element is in general agreement with the definition in the UB-92 Users Manual. Hospitals using existing UB-92 record formats should reference the sections, EXCEPTIONS TO 1450 FORMAT and EXCEPTIONS TO 1300 FORMAT, for differences from the established UB-92 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-92 Users Manual.

N = numeric

A = alphanumeric

Level: Required = must be reported

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

Data Reporting Level: Required (1450 only)

Definition: A numeric count of accommodations days in accordance with payer instructions. Includes UB-92 revenue codes 10X through 21X. General Comments: This field should be a numeric value greater than zero. Edit: The total number of days between admission date and discharge date must be within +/- 2 days of Accommodations Days.

Data Reporting Level: Required

Definition: Per-diem rate for related UB-92 accommodations revenue codes. General Comments: The rate should be right justified with leading zeroes.

There is an implied decimal place 2 positions from the right. Edit: If present, rate must be greater than zero.

Data Reporting Level: Required

Definition: The date the patient was admitted to the hospital.

General Comments: The admission date is to be entered as month, day, and year. The format is MMDDYY for 1450 record and MMDDCCYY for 1300 record. The month is recorded as two digits ranging from 01-12. The day is recorded as two digits ranging from 01-31. The year is recorded as two digits ranging from 00 -99. Each of the three components (month, day, year) must be right justified within its two digits. The 1300 record also contains a two digit century. Any unused space to the left must be zero filled. For example February 7, 1992 is entered as 020792 (1450) or 02071992 (1300).

For hospitals using the 1450 record format that began using a different 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 must use this format. Edit: Admission date must be present and a valid date. The date cannot be before date of birth or be after ending date in Statement Covers Period.

Data Reporting Level: Required

Definition: The hour during which the patient was admitted for inpatient care.

General Comments: Military time should be used to represent the hour of admission. If admitted between midnight and noon, use the values from 00 to 11; if admitted between noon and 11:59 pm, use the values from 12 to 23.

Edit: Valid numeric value for the hour of admission or blank.

Data Reporting Level: Required

Definition: The ICD-9-CM diagnosis code provided at the time of admission as stated by the physician.

General Comments: This field is to contain the appropriate ICD-9-CM code without a decimal. In the ICD-9-CM codebook there are three, four and five digit codes plus 'V' and 'E' codes. Use of the fourth, fifth, 'V' and 'E' is not optional, but must be entered when present in the code.

For example, a five-digit code is entered as '12345"; a 'V' code is entered as 'V270.' All entries are to be left justified with spaces to the right to complete the field length. An 'E' code should not be recorded as the principal diagnosis. Edit: A principal diagnosis must be present and valid. When the principal diagnosis is sex or age dependent, the age and sex must be consistent with the code entered.

Data Reporting Level: Required

Definition: APGAR Score for a newborn. Zero fill if not a newborn.

General Comments: Right justify the field with zeroes to the left to complete the field. Edit: If present, must be numeric.

Data Reporting Level: As available

Definition: Name of the licensed physician who would normally be expected to certify and recertify the medical necessity of the services rendered and/or who has primary responsibility for the patient's medical care and treatment. General Comments: Entered in the order of last name, first name and middle initial. Last name in positions 1-16, first name in positions 17-24 and initial in position 25. Edit: None

Data Reporting Level: Required

Definition: License number of the physician who is expected to certify and recertify the medical necessity of the services rendered or who has primary responsibility for the patient's medical care and treatment. General Comments: This field is to be left justified with spaces to the right to complete the field. Edit: This field must contain a valid license or assigned number according to 'Physician Number Qualifying Code.'

Data Reporting Level: Required

Definition: Birth weight in grams for a newborn. Zero fill if not a newborn.

General Comments: Right justify the field with zeroes to the left to complete the field. Edit: Must be numeric.

Data Reporting Level: Required

Definition: Insured's unique identification number assigned by the payer organization. Medicare purposes, enter the patient's Medicare HIC number as on the Health Insurance Card, Certificate of Award, Utilization Notice, Temporary Eligibility Notice, Hospital Transfer Form, or as reported by the Social Security Office.

General Comments: The payer organization's assigned identification number is to be entered in this field. It should be entered exactly as printed on the Insured's proof of coverage.

Edit: None

Data Reporting Level: As available

Definition: This item identifies the 'claim' fully or partially as charitable or a donation of services. (This should not be confused with a bad debt.) General Comments: Use the following percentage rates:

Edit: If present, must be a valid numeric value.

Data Reporting Level: As available

Definition: Date the service indicated by the related revenue code was performed or provided. General Comments: None Edit: If present, must be a valid date.

Data Reporting Level: As available

Definition: Hour that the patient was discharged from inpatient care.

General Comments: Military time should be used to represent the hour of discharge. If discharged between midnight and noon, use the values from 00 to 11; if discharged between noon and 11:59 pm, use the values from 12 to 23.

Edit: Valid numeric value for the hour of discharge or blank.

Data Reporting Level: As available

Definition: The specific location represented by the address of the employer of the individual identified by the second of two entries in employment information data field General Comments: This is to be the full and complete address of the employer of the individual. Edit: None

Data Reporting Level: As available

Definition: The name of the employer that might or does provide health care coverage for the individual identified by the first of two entries in the employment information data fields. General Comments: Enter the full and complete name of the employer providing health care coverage. Edit: None

Data Reporting Level: As available

Definition: The ZIP Code of the employer of the individual identified by the first of two entries in the employment information data fields. General Comments: None

Edit: None

Data Reporting Level: As available Definition: A code used to define the employment status of the individual identified in the first of two employment information data fields General Comments: This field contains the employment status of the person described in the first of two employment information data fields. The codes to be used are as follows:

1 = Employed full time - individual states that he/she is employed full time

2 = Employed part time - individual states that he/she is employed part time.

3 = Not employed - individual states that he/she is not employed part time or full time.

4 = Self employed

5 = Retired

6 = On active military duty

9 = Unknown - individual's employment status is unknown. Edit: If an entry is present, it must be a valid code.

Data Reporting Level: As available

Definition: The amount estimated by the hospital to be due from the indicated payer (estimated responsibility less prior payments).

General Comments: The format of this estimate is dollars and cents. The dollar amount can be a maximum of 6 digits with 2 additional digits for cents (no decimal is entered). If the amount has no cents then the last 2 digits must be zeros. For example, an estimate of $500 is entered as 50000; an estimate of $50.55 is entered as 5055. The entry is right justified within the field.

Edit: None

Data Reporting Level: As available

Definition: The amount estimated by the hospital to be due from the patient (estimated responsibility less prior payments).

General Comments: The format of this estimate is dollars and cents. The dollar amount can be a maximum of 6 digits with 2 additional digits for cents (no decimal is entered). If the amount has no cents then the last 2 digits must be zero. For example, an estimate of $500 is entered as 50000 and an estimate of $50.55 is entered as 5055. The entry is right justified within the field.

Edit: None

Data Reporting Level: As available

Definition: Collection rate (percentage) expected from all sources for this inpatient occurrence. This percentage could be the result of bad debt, contracted amounts or rates with insurance carriers, etc.

General Comments: The value could be for the specific patient or could be the hospital's percentage of collections against charges. The hospital collection rate should also include capitated rates against normal charges.

Edit: Numeric value; range 0 to 100

Data Reporting Level: Required

Definition: The ICD-9-CM code for the external cause of injury, poisoning or adverse effect. General Comments: Hospitals are to complete this field whenever there is a diagnosis of an injury, poisoning or adverse effect. The priorities for recording an E-code are: