(1) Tables
2 and 3 list the required data elements. Each hospital shall collect and report
all data elements shown in Table 2. Each hospital shall report data elements
shown in Table 3 whenever the information is a part of the hospital's patient
record. Hospitals shall base data submissions on the specifications in the
Submittal Manual for Inpatient Data.
(2) Each hospital shall collect patient
social security number as a required data element on the hospital discharge
record and report the patient social security number with the complete
discharge record according to the submittal schedule.
(3) The Office shall adopt an encryption
method for the patient social security number by creating a record linkage
number as the control number.
(4)
Each hospital shall submit the reported data elements on encrypted electronic
media acceptable to the Office or send electronically through the Utah Health
Information Network or another compatible electronic data interchange network
or other secure upload or secure email method.
(5) The Office shall accept data that
complies with data standards established in Rule R590-164, Uniform Health
Billing Rule.
TABLE (2) LEVEL 1 DATA ELEMENTS CATEGORY NAME
Provider
1. Provider
identifier (hospital name) Patient
2. Patient control number
3. Patient's medical record number
4. Patient Social Security Number
5. Patient name
6. Patient's address, city, state,
zip
7. Patient's date of
birth
8. Patient's gender
Service
9. Admission date
10. Type of admission/visit
11. Point of origin for admission or
visit
12. Patient's discharge
status
13. Statement covers
period
14. Condition codes (do not
resuscitate, homeless, others) Charge
15. Service line
16. Revenue codes
17. HCPCS Procedure codes including
modifiers
18. Unit or basis for
measurement code
19. Service
units/days
20. Total charges by
revenue code Payer
21. Payer's
identification
22. Patient's
relationship to insured Diagnosis and Treatment
23. Diagnosis version qualifier
24. Principal diagnosis with present on
admission
25. Other diagnosis codes
with present on admission
26.
Admitting diagnosis code
27.
Patient's reason for visit codes
28.
External cause of injury codes (E-code) with present on admission
29. Principal ICD procedure code
30. Other ICD procedure codes
31. Date of principal procedure
Physician
32. Attending provider
primary ID
33. Operating physician
primary ID
34. Other operating
physician primary ID
35. Rendering
physician primary ID
36. Referring
provider primary ID Other
37. Type
of bill
TABLE (3) LEVEL 2 DATA ELEMENTS CATEGORY NAME
Patient
1. Patient
marital status
2. Patient race and
ethnicity Employer
3. Employer name
Charge
4. Prior payments
5. Estimated amount due Payer
6. Insured names
7. Certificate/Social Security Number/Health
Insurance Claim/Identification Number
8. Insured group names Physician
9. Attending provider secondary ID
10. Attending provider specialty
information
11. Operating physician
secondary ID
12. Operating
physician specialty information
13.
Other operating physician secondary ID
14. Other operating physic. specialty
information
15. Rendering physician
secondary ID
16. Rendering physician
specialty information
17. Referring
provider secondary ID
18. Referring
provider specialty information
19.
Resident ID
20. Resident ID
Type
