DHS 120.14(1)(a)34. 34. Physician’s and supplier’s billing name.

DHS 120.14(1)(a)35. 35. Physician’s and supplier’s billing address.

DHS 120.14(1)(a)36. 36. Billing physician’s identification number.

DHS 120.14(1)(a)37. 37. Performing physician’s identification number.

DHS 120.14(1)(b) (b) Data submission procedures.

DHS 120.14(1)(b)1. 1. Non–exempt physicians shall submit claims information to the department in an electronic format using secure methods specified in a data submission manual provided by the department. Physicians who submit data through a qualified vendor shall require their vendor to comply with the requirements specified in this paragraph. In addition, qualified vendors shall sign a trading partner agreement.

DHS 120.14(1)(b)2. 2. Each physician shall submit his or her data to the department within 30 calendar days following the close of the reporting period. The department shall provide instructions on submission in a data submission manual.

DHS 120.14(1)(b)3. 3. The department may grant an extension of the deadline specified under subd. 2. 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 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.

DHS 120.14(1)(b)4. 4.

DHS 120.14(1)(b)4.a. a. To ensure confidentiality of the data is maintained, physicians 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 physician.

DHS 120.14(1)(b)4.b. b. A physician or his or her delegated representative shall be accountable for his or her qualified vendor’s failure to submit and edit data in the format required by the department.

DHS 120.14(1)(b)5. 5. A health care provider that is not a hospital or ambulatory surgery center shall, before submitting information required by the department under this chapter, convert any names of an insured’s payer or other insured’s payer to a payer category code as specified by the department in its data submission manual.

DHS 120.14(1)(b)6. 6. A health care provider or qualified vendor may not submit information that uses any of the following as a patient account number:

DHS 120.14(1)(b)6.a. a. The patient’s social security number or any substantial portion of the patient’s social security number.

DHS 120.14(1)(b)6.b. b. A number that is related to another patient identifying number.

DHS 120.14(1)(c) (c) Data verification, review and comment procedures.

DHS 120.14(1)(c)1. 1. The department shall check the accuracy and completeness of all submitted data.

DHS 120.14(1)(c)2. 2. The department may not retain or release any of the following data elements if the department receives the elements:

DHS 120.14(1)(c)2.a. a. The patient’s name and street address.

DHS 120.14(1)(c)2.b. b. The insured’s name, street address and telephone number.

DHS 120.14(1)(c)2.c. c. Any other insured’s name, employer or school name and date of birth.

DHS 120.14(1)(c)2.d. d. The signature of the patient or other authorized signature.

DHS 120.14(1)(c)2.e. e. The signature of the insured or other authorized signature.

DHS 120.14(1)(c)2.f. f. The signature of the physician.

DHS 120.14(1)(c)2.g. g. The patient’s account number, after use only as verification of data by the department.

DHS 120.14(1)(c)2.h. h. The patient’s telephone number.

DHS 120.14(1)(c)2.i. i. The insured’s employer’s name or school name.

DHS 120.14(1)(c)2.j. j. Data regarding insureds other than the patient, other than the payer category code under par. (b) 5.

DHS 120.14(1)(c)2.k. k. The patient’s employer’s name or school name.