Wisconsin Legislature: DHS 120.12(5)(c)

DHS 120.12(5)(b)1.1. 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.

DHS 120.12(5)(b)2.2. 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.

DHS 120.12(5)(b)3.3. Upon written request, the department shall provide consultation to a hospital to enable the hospital to submit data according to department specifications.

DHS 120.12(5)(b)4.4. 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.

DHS 120.12(5)(b)5.5. Each hospital shall submit inpatient data electronically with physical specifications, format and record layout in accordance with the department’s data submission manual.

DHS 120.12(5)(b)6.6.

DHS 120.12(5)(b)6.a.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.

DHS 120.12(5)(b)6.b.b. Hospitals shall be accountable for their qualified vendor’s failure to submit data in the formats required by the department.

DHS 120.12(5)(c)(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.

DHS 120.12(5)(d)(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.

DHS 120.12(5)(e)(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.

DHS 120.12(5)(f)(f) Waiver from data submission requirements. There shall be no waivers from the data submission requirements under this subsection.

DHS 120.12(5)(g)(g) Compliant data submission.

DHS 120.12(5)(g)1.1. To be considered compliant with this chapter, a facility’s data submission shall be all of the following:

DHS 120.12(5)(g)1.a.a. Submitted to the department electronically, as specified in the data submission manual.

DHS 120.12(5)(g)1.b.b. Consist of an individual facility data file.

DHS 120.12(5)(g)1.c.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.

DHS 120.12(5)(g)2.2. Facilities that fail to achieve a compliant data submission as required under this subsection may be subject to forfeitures.

DHS 120.12(5m)(5m) Emergency department data.

DHS 120.12(5m)(a)(a) Data to be collected. Hospitals shall submit to the department all of the following data for each patient:

DHS 120.12(5m)(a)1.1. Federal tax identification number of the hospital.

DHS 120.12(5m)(a)2.2. Discharge diagnosis.

DHS 120.12(5m)(a)3.3. Referral source.

DHS 120.12(5m)(a)4.4. Discharge date.

DHS 120.12(5m)(a)5.5. Patient zip code.

DHS 120.12(5m)(a)6.6. Patient birth date.

DHS 120.12(5m)(a)7.7. Patient gender.

DHS 120.12(5m)(a)8.8. Arrival date.

DHS 120.12(5m)(a)9.9. Disposition.

DHS 120.12(5m)(a)10.10. Source of admission.

DHS 120.12(5m)(a)11.11. Patient discharge status.

DHS 120.12(5m)(a)12.12. Attending emergency provider specialty.

DHS 120.12(5m)(a)13.13. Total charges.

DHS 120.12(5m)(a)14.14. Patient county of residence.

DHS 120.12(5m)(a)15.15. Primary payer identifier and type.

DHS 120.12(5m)(a)16.16. Secondary payer identifier and type.

DHS 120.12(5m)(a)17.17. Principal and other diagnosis codes.

DHS 120.12(5m)(a)18.18. External cause of injury codes.

DHS 120.12(5m)(a)19.19. Principal and other procedure codes.

DHS 120.12(5m)(a)20.20. Date of service.

DHS 120.12(5m)(a)21.21. Attending emergency provider ID.

DHS 120.12(5m)(a)22.22. Consulting provider ID.

DHS 120.12(5m)(a)23.23. Consulting provider specialty.

DHS 120.12(5m)(a)24.24. Performing provider ID.

DHS 120.12(5m)(a)25.25. Performing provider type/specialty.

DHS 120.12(5m)(a)26.26. Encrypted case identifier.

DHS 120.12(5m)(a)27.27. Insured’s policy number.

DHS 120.12(5m)(a)28.28. Diagnosis present at arrival.

DHS 120.12(5m)(a)29.29. Type of bill identifying the location of service.

DHS 120.12(5m)(a)30.30. Patient race.

DHS 120.12(5m)(a)31.31. Patient ethnicity.

DHS 120.12(5m)(b)(b) Data submission procedures.

DHS 120.12(5m)(b)1.1. 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.

DHS 120.12(5m)(b)2.2. 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.

DHS 120.12(5m)(b)3.3. Upon written request, the department shall provide consultation to a hospital to enable the hospital to submit data according to department specifications.

DHS 120.12(5m)(b)4.4. The department may grant an extension of the deadline 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 before the date the data are due. The department may grant an extension for up to 30 calendar days.

DHS 120.12(5m)(b)5.5.

DHS 120.12(5m)(b)5.a.a. To ensure confidentiality, hospitals using qualified vendors to submit data shall provide an original trading partner agreement to the department that has been signed by the qualified vendor and the hospital.

DHS 120.12(5m)(b)5.b.b. Hospitals shall be accountable for their qualified vendor’s failure to submit data in the formats and by the due dates specified by the department.

DHS 120.12(5m)(c)(c) Data verification, review and comment procedures. The data verification, review and comment procedures specified in s. DHS 120.11 (1) to (3) shall be used for this subsection.

DHS 120.12(5m)(d)(d) Physician verification, review and comment procedures on hospital-submitted claims data. The data verification, review and comment procedures specified in s. DHS 120.11 (1), (2) and (4) shall be used for this subsection.

DHS 120.12(5m)(e)(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.

DHS 120.12(5m)(f)(f) Waiver from data submission requirements. There shall be no waivers from the data submission requirements under this subsection.

DHS 120.12(5m)(g)(g) Compliant data submission.

DHS 120.12(5m)(g)1.1. To be considered compliant with this chapter, a hospital’s data submission shall be all of the following:

DHS 120.12(5m)(g)1.a.a. Submitted to the department via the department’s electronic data submission system.

DHS 120.12(5m)(g)1.b.b. Consist of an individual hospital data file.

DHS 120.12(5m)(g)1.c.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.