DHS 120.12(5)(a)10. 10. Source of admission.

DHS 120.12(5)(a)11. 11. Patient discharge status.

DHS 120.12(5)(a)12. 12. Condition codes.

DHS 120.12(5)(a)13. 13. Adjusted total charges and components of those charges.

DHS 120.12(5)(a)14. 14. Leave days.

DHS 120.12(5)(a)15. 15. Primary payer identifier and type.

DHS 120.12(5)(a)16. 16. Secondary payer identifier and type.

DHS 120.12(5)(a)17. 17. Principal and other diagnosis codes.

DHS 120.12(5)(a)18. 18. External cause of injury codes.

DHS 120.12(5)(a)19. 19. Principal and other procedure codes.

DHS 120.12(5)(a)20. 20. Date of principal procedure.

DHS 120.12(5)(a)21. 21. Attending physician license number.

DHS 120.12(5)(a)22. 22. Other physician license number, if applicable.

DHS 120.12(5)(a)23. 23. Patient race.

DHS 120.12(5)(a)24. 24. Patient ethnicity.

DHS 120.12(5)(a)25. 25. Type of bill identifying the location of service.

DHS 120.12(5)(a)26. 26. Encrypted case identifier.

DHS 120.12(5)(a)27. 27. Insured’s policy number.

DHS 120.12(5)(a)28. 28. Diagnosis present at admission.

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

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.