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(c) Data verification, review and comment procedures. There shall be no verification, review and comment procedures for published notices submitted by hospitals.
(d) Data adjustment methods. There shall be no adjustment methods for published notices submitted by hospitals.
(e) Waiver from data submission requirements. There shall be no waivers from the data submission requirements under this subsection.
(5) Uniform inpatient discharge data.
(a) Data to be collected. Hospitals shall submit to the department all of the following data for each patient:
1. Federal tax identification number of the hospital.
2. Patient control number.
3. Patient medical record or chart number.
4. Discharge date.
5. Patient zip code.
6. Patient birth date.
7. Patient gender.
8. Admission date.
9. Type of admission.
10. Source of admission.
11. Patient discharge status.
12. Condition codes.
13. Adjusted total charges and components of those charges.
14. Leave days.
15. Primary payer identifier and type.
16. Secondary payer identifier and type.
17. Principal and other diagnosis codes.
18. External cause of injury codes.
19. Principal and other procedure codes.
20. Date of principal procedure.
21. Attending physician license number.
22. Other physician license number, if applicable.
23. Patient race.
24. Patient ethnicity.
25. Type of bill identifying the location of service.
26. Encrypted case identifier.
27. Insured’s policy number.
28. Diagnosis present at admission.
(b) Data submission procedures.
1. Each hospital shall electronically submit the data elements required under par. (a). The method of submission, data formats and coding specifications shall be defined in the department’s data submission manual.
2. Hospitals shall send the data to the department within 45 calendar days of the last day of each calendar quarter using the department’s electronic submission system. Calendar quarters shall begin on January 1, April 1, July 1 and October 1 and shall end on March 31, June 30, September 30 and December 31.
3. Upon written request, the department shall provide consultation to a hospital to enable the hospital to submit data according to department specifications.
4. The department may grant an extension of the time limits specified under subd. 2. only when the hospital adequately justifies to the department the hospital’s need for additional time. In this subdivision, “adequate justification” means a delay due to a strike, fire, natural disaster or catastrophic computer failure. A hospital desiring an extension shall submit a request for an extension in writing to the department at least 10 calendar days prior to the date that the data are due. The department may grant an extension for up to 30 calendar days.
5. Each hospital shall submit inpatient data electronically with physical specifications, format and record layout in accordance with the department’s data submission manual.
6.
a. To ensure confidentiality, hospitals using qualified vendors to submit data shall submit to the department an original trading partner agreement that has been signed and notarized by the qualified vendor and the hospital.
b. Hospitals shall be accountable for their qualified vendor’s failure to submit data in the formats required by the department.
(c) Data verification, review and comment procedures. The data verification, review and comment procedures specified in s. DHS 120.11 (1) to (3) shall apply.
(d) Physician verification, review and comment on hospital-submitted claims data. The data verification, review and comment procedures specified in s. DHS 120.11 (1), (2) and (4) shall apply.
(e) Data adjustment methods. The department shall adjust health care charge and mortality information for case mix and severity using commonly acceptable methods and tools designed for administrative claims information to perform adjustments for a class of health care providers.
(f) Waiver from data submission requirements. There shall be no waivers from the data submission requirements under this subsection.
(g) Compliant data submission.
1. To be considered compliant with this chapter, a facility’s data submission shall be all of the following:
a. Submitted to the department electronically, as specified in the data submission manual.
b. Consist of an individual facility data file.
c. Meet the department standard of 10% or fewer records that do not pass the department’s error checking procedures on or before the data submission due date.
2. Facilities that fail to achieve a compliant data submission as required under this subsection may be subject to forfeitures.
(5m) Emergency department data.
(a) Data to be collected. Hospitals shall submit to the department all of the following data for each patient:
1. Federal tax identification number of the hospital.
2. Discharge diagnosis.
3. Referral source.
4. Discharge date.
5. Patient zip code.
6. Patient birth date.
7. Patient gender.
8. Arrival date.
9. Disposition.
10. Source of admission.
11. Patient discharge status.
12. Attending emergency provider specialty.
13. Total charges.
14. Patient county of residence.
15. Primary payer identifier and type.
16. Secondary payer identifier and type.
17. Principal and other diagnosis codes.
18. External cause of injury codes.
19. Principal and other procedure codes.
20. Date of service.
21. Attending emergency provider ID.
22. Consulting provider ID.
23. Consulting provider specialty.
24. Performing provider ID.
25. Performing provider type/specialty.
26. Encrypted case identifier.
27. Insured’s policy number.
28. Diagnosis present at arrival.
29. Type of bill identifying the location of service.
30. Patient race.
31. Patient ethnicity.
(b) Data submission procedures.
1. Each hospital shall electronically submit to the department all data specified in par. (a). The method of submission, data formats and coding specifications shall be defined in the department’s data submission manual.
2. Within 45 calendar days after the last day of each calendar quarter, each hospital shall submit to the department the data specified in par. (a) using the department’s electronic data submission system. Calendar quarters shall begin on January 1, April 1, July 1 and October 1 and shall end on March 31, June 30, September 30 and December 31.
3. Upon written request, the department shall provide consultation to a hospital to enable the hospital to submit data according to department specifications.
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Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.