DHS 120.12(6)(b)2.2. ‘Data elements collected.’ Hospitals shall report information on specific ambulatory patient surgical procedures required under subd. 1. from a hospital outpatient department or a hospital-affiliated ambulatory surgical center. The following data elements shall be submitted for each surgical procedure:
DHS 120.12(6)(b)2.a.a. Federal tax identification number of the hospital.
DHS 120.12(6)(b)2.b.b. Patient control number.
DHS 120.12(6)(b)2.c.c. Patient medical record or chart number.
DHS 120.12(6)(b)2.d.d. Date of principal procedure.
DHS 120.12(6)(b)2.e.e. Patient zip code.
DHS 120.12(6)(b)2.f.f. Patient birth date.
DHS 120.12(6)(b)2.g.g. Patient gender.
DHS 120.12(6)(b)2.h.h. Adjusted total charges and components of those charges.
DHS 120.12(6)(b)2.i.i. Primary payer identifier and type.
DHS 120.12(6)(b)2.j.j. Secondary payer identifier and type.
DHS 120.12(6)(b)2.k.k. Principal and other diagnosis codes.
DHS 120.12(6)(b)2.L.L. External cause of injury codes.
DHS 120.12(6)(b)2.m.m. Principal and other procedure codes.
DHS 120.12(6)(b)2.n.n. Attending physician license number, if applicable.
DHS 120.12(6)(b)2.o.o. Other physician license number.
DHS 120.12(6)(b)2.p.p. Patient race.
DHS 120.12(6)(b)2.q.q. Patient ethnicity.
DHS 120.12(6)(b)2.r.r. Type of bill.
DHS 120.12(6)(b)2.s.s. Encrypted case identifier.
DHS 120.12(6)(b)2.t.t. Insured’s policy number.
DHS 120.12(6)(c)(c) Data submission procedures.
DHS 120.12(6)(c)1.1. Each hospital shall submit to the department all data described in par. (a). The method of submission shall be defined in the department’s data submission manual.
DHS 120.12(6)(c)2.2. Within 45 calendar days after the end of each calendar quarter, each hospital shall submit to the department the surgical data specified in par. (a) for all ambulatory patient surgical procedures using the department’s electronic submission system. The department’s electronic submission system shall be described in the department’s data submission manual. 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(6)(c)3.3. 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(6)(c)4.4. Each hospital shall submit ambulatory patient surgical data electronically with physical specifications, format and record layout in accordance with the department’s data submission manual.
DHS 120.12(6)(c)5.5. Upon written request, the department shall provide consultation to a hospital to enable the requesting hospital to submit ambulatory patient surgical data according to the department’s specifications.
DHS 120.12(6)(c)6.6.
DHS 120.12(6)(c)6.a.a. To ensure confidentiality, hospitals using qualified vendors to submit data shall provide to the department an original trading partner agreement that has been signed and notarized by the qualified vendor and the hospital.