Wisconsin Legislature: DHS 120.14(3)(a)10.

1. Physicians practicing anytime during calendar year 1998 and submitting claims electronically to any payer shall continue to submit their practice data to the department electronically.

2. Physicians beginning practice in Wisconsin after calendar year 1998 who have the capacity to submit claims data electronically as evidenced by electronic submission to payers shall submit data to the department electronically.

a. The department may grant up to four 6-month exceptions to the requirements in subd. 1. or 2. to physician practices that request an exception to the submission requirements and submit an affidavit as evidence of lost capacity to submit data electronically.

b. The department shall cancel the exception to the submission requirements after 6 months unless the physician requests another exception in writing.

c. If the department discovers evidence of electronic submission of health care claims data within the exception period, the department shall not grant additional exceptions.

4. The department shall report all exceptions granted by the department under subd. 3. to the board.

5. The department may grant an exception to the requirements in subd. 1. or 2. to a physician who submits an affidavit of financial hardship and supporting evidence demonstrating financial inability to comply with the requirements.

(2) Physician self-report.

(a) Data to be collected.

1. ‘Health care plan affiliation and updates.’ Physicians shall report new affiliations with health care plans and terminations with health care plans to the department within 30 calendar days of the change.

2. ‘Hospital privileges update.’ Physicians shall report hospital privilege changes to the department within 30 days of the hospital’s granting of the privileges or the discontinuance of the privileges.

(b) Data submission procedures. Physicians shall report the information in par. (a) to the department through the department’s internet submission system. Physicians without access to the internet shall fax or mail their changes to the department.

Note: For the purposes of par. (b), the Department’s address is Bureau of Health Information and Policy, P. O. Box 2659, Madison, Wisconsin 53701-2659, or deliver the communications to Room 372, 1 W. Wilson Street, Madison, Wisconsin. The Bureau of Health Information and Policy’s fax number is 608-264-9881.

(c) Data verification, review and comment procedures. The department shall, within 15 working days, send an acknowledgement to the reporting physician verifying the self-report and inviting the physician to submit corrected data within 10 working days.

(d) Data adjustment methods. There shall be no adjustment methods for data submitted under this subsection.

(e) Waiver from data submission requirements. There shall be no waivers from the data submission requirements under this subsection.

(3) Physician survey.

(a) Data to be collected. The department shall collect all of the following types of workforce and practice information:

1. Name of the physician and address or addresses of main practice or employment.

2. Active status information.

3. License or certification status, including date of initial licensure or certification, credential suspensions or revocations.

4. Medical education and training information.

5. Specialty, board certification and recertification information.

6. Teaching focus information, if applicable.

7. Practice information, including practice name, location, phone number, hours spent at location and provision of obstetrical, pediatric or prenatal care.

8. Whether the physician renders services to medicare and medical assistance patients and, if applicable, whether the physician has signed a medicare participation agreement indicating that she or he accepts assignment on all medicare patients.

9. Whether the physician participates in a voluntary partnercare program specified under s. 71.55 (10), Stats., under which assignment is accepted for low-income elderly.

Note: Section 71.55 (10), Stats., was repealed by 2003 Wis. Act 33.

10. Date, state and county of most recent residency.

11. Current names and addresses of facilities at which the physician has been granted privileges.

12. The usual and customary charges for office visits, routine tests and diagnostic workups, preventive measures and frequently occurring procedures, as specified by the department.

13. Health plan affiliations.

(b) Data submission procedures.

1. Physicians shall return the survey to the department within 30 days of receiving it. Receipt of data is presumed within 5 days of the date the notice was mailed.

2. The department may grant an extension of a deadline specified in subd. 1. for submission of information only when the physician adequately justifies to the department the physician’s need for additional time. In this subdivision, “adequate justification’’ means a delay due to a labor strike, fire, natural disaster or catastrophic computer failure. A physician 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. Physicians who have been granted an extension by the department shall submit their data directly to the department.

Note: Physicians who are required to send their information directly to the department should use the following address: Bureau of Health Information and Policy, P. O. Box 2659, Madison, Wisconsin 53701-2659, or deliver the communications to Room 372, 1 W. Wilson Street, Madison, Wisconsin.

(c) Data verification, review and comment procedures. Physicians shall verify or correct information contained on their survey. The department shall verify questionable information by contacting the applicable physician.

(d) Data adjustment methods. There shall be no adjustment methods for data submitted under this subsection.

(e) Waiver from data submission requirements. There shall be no waivers from the data submission requirements under this subsection.

History: Cr. Register, December, 2000, No. 540, eff. 1-1-01; CR 01-051: am. (1) (b) 4. a., Register September 2001 No. 549 eff. 10-1-01; CR 03-033: am. (1) (b) 1., 2., 4. b., 5. and 6. (intro.), (c) 2. (intro.), 4. b., 5. (intro.) and b., (e) 1. and 4., renum. (1) (c) 3. to be (1) (c) 4m. and am., r. (1) (c) 4. c. Register December 2003 No. 576, eff. 1-1-04.

DHS 120.15 Data to be submitted by other classes of health care providers.

(1) Applicability. This section applies to all of the following classes of health care providers:

(a) Dentists licensed under ch. 447, Stats.

(b) Chiropractors licensed under ch. 446, Stats.

(2) Data to be collected.

(a) In this subsection, “board” means the certifying body for a medical specialty.

(b) For each of the providers specified in sub. (1), the department shall collect all of the following types of workforce and practice information:

1. Name of the provider and address or addresses of main practice or employment.

2. Date of birth.

3. License or certification status, if applicable, including date of initial licensure or certification, credential suspensions or revocations.

4. Specialty, board certification and recertification information, if applicable.

5. Post-secondary education and training.

6. Whether the provider renders services to medicare and medical assistance patients and, if applicable, whether the provider has signed a medicare participation agreement indicating that she or he accepts assignment on all medicare patients.

7. Whether the provider participates in a voluntary partnercare program specified under s. 71.55 (10), Stats., under which assignment is accepted for low-income elderly.

Note: Section 71.55 (10), Stats., was repealed by 2003 Wis. Act 33.

8. Current names and addresses of facilities at which the provider has been granted privileges, if applicable.

9. The usual and customary charges for office visits, routine tests and preventive measures and frequently occurring procedures, as specified by the department.

10. Participation in health maintenance organizations, preferred provider organizations and independent practice arrangements.

11. Practice name, location, phone number and hours spent at location.

12. Type of degree or certification.

13. Date degree or certification granted.

14. Date, state and county of most recent residency.

(c) If the data specified in par. (b) is not available from the department of safety and professional services, or is not available for the desired time interval or in the required format, the department shall require the health care provider to submit that information directly to the department or its designee in a format prescribed by the department.

(d) The department shall consult with each applicable health care provider group specified in sub. (1), through a technical advisory committee or trade association, before the department collects data directly from members of that health care provider group.

(3) Data submission procedures.

(a) The department shall require that information specified in sub. (2) be submitted to the department at least once every 3 years according to a schedule developed by the department. The department may require that the requested information be submitted on an annual or biennial basis according to a schedule developed by the department.

(b) The department may grant an extension of a deadline specified in par. (a) for submission of health care provider information only when the health care provider adequately justifies to the department the health care provider’s need for additional time. In this paragraph, “adequate justification” means a delay due to a labor strike, fire, natural disaster or catastrophic computer failure. A health care provider 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. Health care providers who have been granted an extension by the department shall submit their data directly to the department.

Note: Health care providers who are required to send their information directly to the department should use the following address: Bureau of Health Information and Policy, P. O. Box 2659, Madison, Wisconsin 53701-2659, or deliver the communications to Room 372, 1 W. Wilson Street, Madison, Wisconsin.

(4) Data verification, review and comment procedures. Health care providers specified in sub. (1) shall verify or correct information contained on their survey. The department shall verify questionable data by contacting the applicable health care provider.

(5) Data adjustment methods. There shall be no adjustment methods for data submitted under this section.

(6) Waiver from data submission requirements. There shall be no waivers from the data submission requirements under this section.

Note: With the exception of s. DHS 120.15, under s. 153.78 (2), Stats., and s. DHS 120.10 (3) (b), the department may assess fines on health care providers that do not submit the data specified in this subchapter on a timely basis. Health care providers may be subject to a fine of $100 per day per type of data that has not been submitted to the Department under this subchapter.

History: Cr. Register, December, 2000, No. 540, eff. 1-1-01; correction in (2) (c) made under s. 13.92 (4) (b) 6., Stats., Register February 2012 No. 674.

DHS 120.16 Data to be submitted by health care plans.

(1) Applicability. This section applies to health care plans that either voluntarily submit health care plan data directly to the department or submit it to the department through the data collection of other state agencies.

(2) Data to be collected. The department shall collect all of the following types of data from each participating health care plan or through a designated state agency:

(a) Financial data. Information regarding the financial status of the health care plan secured under the authority of the commissioner of insurance.

(b) Market conduct. Information regarding the conduct of the health care plan in the marketplace secured under the authority of the commissioner of insurance.

(c) Quality indicators. Measures of quality of care provided by the health care plan from the office of the commissioner of insurance.

Note: Quality indicators include Health Plan Employer Data and Information (HEDIS) measures and Consumer Assessment of Health Plans (CAHPS) patient satisfaction measures.

(d) Grievances and complaints data. Measures of grievances and complaints filed by enrollees of the health care plan from the office of the commissioner of insurance and the department of employee trust funds.

(3) Data submission procedures. State agencies specified in sub. (2) shall forward to the department information specified in sub. (2) in electronic files on an annual basis. The information shall be in a format that has been agreed upon by the department and the state agencies.

(4) Data verification, review and comment procedures. Each of the state agencies specified in sub. (2) shall verify that the information provided to the department has been reviewed and meets the agency’s standards for release to the public.

(5) Data adjustment methods. The department shall include caveats regarding the information the department releases to the public, when needed, to assist consumers in understanding the differences in populations served by the health care plans. Caveats may include references to large populations, such as commercial, medical assistance or medicare populations.

History: Cr. Register, December, 2000, No. 540, eff. 1-1-01.

Subchapter IV — Standard Reports

DHS 120.20 General provisions.