Proposed Text
Every Each inpatient hospital shall submit, in an electronic data format, a complete filing of each patient level data element listed in the table in this section for each hospital inpatient, including a separate record for each infant, if applicable. Most of these data elements are currently collected from a Uniform Billing Form located in the latest publication of the Uniform Billing Manual prepared by the National Uniform Billing Committee. The Uniform Billing Form and the Uniform Billing Manual are located on the National Uniform Billing Committee's website at www.nubc.org. The Uniform Billing Manual provides a detailed field description and any special instruction pertaining to that element. An asterisk (*) indicates when the required data element is either not on the billing form or in the Uniform Billing Manual. The instructions provided under that particular data element should then be followed. Inpatient hospitals that submit patient level data directly to the board or the nonprofit organization shall submit it in an electronic data format.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Data Element |
1. Provider Number Enter the Medicare Provider Number |
2. Provider NPI |
3. Patient Control Number |
4. Discharge Date Discharge/ Statement Covers Period Through Date in MMDDYYYY format |
5. Patient Zip Code Zip Code of Patient Address |
6. Patient Date of Birth Date in MMDDYYYY format |
7.Patient Sex M,F, or U |
8. Admission Date and Hour Date in MMDDYYYY format, hour of admission in military time |
9. Admission Type |
10. Admission Source |
11. Patient Discharge Status |
12. Medical Record Number |
13. Revenue Center Code (up to 22) |
14. Revenue Center Units (up to 22) |
15. Revenue Center Charges (up to 22) Dollars and cents with an implied decimal |
16. Total Charges Dollars and cents with an implied decimal. If greater than $999,999.99, then use 99999999 |
17. Payor Identifier (up to 3) Enter the Board of Health approved payor designation which will be the nationally assigned payor ID, its successor, or English description of the payor |
18. Patient Relationship to Insured A |
19. Patient Social Security Number (SSN) Enter the nine-digit social security number of the patient. If a social security number has not been assigned leave blank. The nine-digit social security number is not required for patients under four years of age |
20. Employment Status Code Use the following codes 1 = Employed Full Time 2 = Employed Part Time 3 = Not Employed 4 = Self-employed 5 = Retired 6 = On Active Military Duty 9 = Unknown |
21. Employer Identifier Enter the federally approved EIN, or employer name |
22. Principal Diagnosis Code Codes set ICD-10 or their successors, omit decimal; eighth character is the Present On Admission value (Y, N, U, W or 1) |
23. Other Diagnosis Code (up to 17) Codes set ICD-10 or their successors, omit decimal; eighth character is the Present On Admission value (Y, N, U, W or 1) |
24. Admitting Diagnosis Code Codes set ICD-10 or their successors, omit decimal, eighth character is the Present On Admission value (Y, N, U, W or 1) |
25. External Cause of Injury Code (up to 3) Codes set ICD-10 or their successors, omit decimal; eighth character is the Present On Admission value (Y, N, U, W or 1) |
26. Principal Procedure Code Codes set ICD-10 or their successors, omit decimal |
27. Principal Procedure Date Date in MMDDYY format |
28. Other Procedure Codes (up to 5) Codes set ICD-10 or their successors, omit decimal |
29. Other Procedure Dates (up to 5) Date in MMDDYY format |
30. Attending Physician Physician's Individual NPI |
31. Operating Physician Physician's Individual NPI |
32. Other Physician Provider (up to 2) Physician's Individual NPI |
33. Infant Birth Weight (in grams) |
34. Patient Race Use the following codes: 0 = White 1 = Black 2 = Other, specified 3 = Asian 4 = American Indian 5 = Hispanic - White 6 = Hispanic - Black 9 = Unknown, not recorded |
35. Patient Street Address Enter the valid patent's residence street number and street name. Do not include PO Box numbers |
36. Patient City or County Enter the valid patient's complete City or County of residence |
37. Patient Legal Status Enter the legal status of a psychiatric admission: 1 = § 16.1-338 Parental admission of minors younger than 14 and nonobjecting minors 14 years of age or older 2 = § 16.1-339 Parental admission of objecting minor 14 years of age or older 3 = § 16.1-340.1 Involuntary temporary detention order of a minor 4 = § 16.1-345 Involuntary commitment of a minor 5 = § 37.2-805 Voluntary admission of an adult 6 = § 37.2-809 Involuntary temporary detention order of an adult 7 = § 37.2-904 Sexually violent predator |