(1) "Ambulatory Surgical Treatment Center"
shall have the same definition as contained in T.C.A. §
(2) "ASTC" is the acronym for ambulatory
surgical treatment center.
"Claim" shall mean a charge or bill for services rendered, billed to the
patient, to another private individual, or to a third party payer, public or
"Claims Data" shall
mean all data elements collected for all patients for whom an ASTC or ODC
provides services that are entered on any claim form prepared by the ASTC or
ODC and shall always include those required data elements identified in the
subparagraphs listed in rule
, paragraphs (1)
(5) "CMS-1500" shall mean
the claim form "Centers for Medicare & Medicaid Services 1500" or its
shall mean the commissioner of the Tennessee Department of Health.
(7) "Data Element" shall mean any individual
piece of information collected from a patient by an ASTC or ODC during the
process of providing services to that patient for which the ASTC or ODC will
file a claim.
shall mean the Tennessee Department of Health.
(9) "Error" shall mean data that are
incomplete or inconsistent with the specifications in the ASTC Data System
Procedural Manual, the ODC Data System Procedural Manual, or these
(10) "Final Joint Annual
Report" shall mean the most recent Joint Annual Report filed by an ASTC or ODC
where the data contained in the report have been edited, queried, and updated
when appropriate, by the Department.
(11) "JAR" is the acronym for Joint Annual
(12) "ODC" is the acronym
for outpatient diagnostic center.
(13) "Outpatient Diagnostic Center" shall
have the same definition as contained in T.C.A. §
"Personal Identifiers" shall be defined
to include all the identifiers contained in 45 C.F.R. § 164.514
(15) "Processed Data" shall
mean data that have been analyzed by the Department or the Department's
designated data vendor(s) and errors, inconsistencies, and/or incomplete
elements in the data set, if any, have been identified.
(16) "Public" shall mean anyone other than
the Tennessee Department of Health, its vendors, and its contracted
(17) "Record Level Data"
shall mean a set of data that is specific to individual patient
(18) "State" shall mean the
government of the State of Tennessee including all its agencies.
(19) "UB-04" shall mean the CMS Form 1450,
[a.k.a. "the Uniform Hospital Billing Form"], or its successor forms as
established by the National Uniform Billing Committee and the State Uniform
Billing Implementation Committee.
(20) "Vendor" shall mean a third party
entity, approved by the Department, through whom an ASTC or ODC submits its
claims data for the purpose of compilation and editing according to these rules
and the instructions of the Department.
(21) "Verified Data" shall mean data that
have been processed by the Department after the ASTCs or ODCs have had the
opportunity to suggest corrections and/or deletions, and all appropriate
revisions have been made to the data and approved by the Department.