Utah Admin. Code R428-10-5 - Data Element Reporting

(1) Tables 2 and 3 list the required data elements. Each hospital shall collect and report all data elements shown in Table 2. Each hospital shall report data elements shown in Table 3 whenever the information is a part of the hospital's patient record. Hospitals shall base data submissions on the specifications in the Submittal Manual for Inpatient Data.

(2) Each hospital shall collect patient social security number as a required data element on the hospital discharge record and report the patient social security number with the complete discharge record according to the submittal schedule.

(3) The Office shall adopt an encryption method for the patient social security number by creating a record linkage number as the control number.

(4) Each hospital shall submit the reported data elements on encrypted electronic media acceptable to the Office or send electronically through the Utah Health Information Network or another compatible electronic data interchange network or other secure upload or secure email method.

(5) The Office shall accept data that complies with data standards established in Rule R590-164, Uniform Health Billing Rule.

TABLE (2) LEVEL 1 DATA ELEMENTS CATEGORY NAME

Provider

1. Provider identifier (hospital name) Patient

2. Patient control number

3. Patient's medical record number

4. Patient Social Security Number

5. Patient name

6. Patient's address, city, state, zip

7. Patient's date of birth

8. Patient's gender Service

9. Admission date

10. Type of admission/visit

11. Point of origin for admission or visit

12. Patient's discharge status

13. Statement covers period

14. Condition codes (do not resuscitate, homeless, others) Charge

15. Service line

16. Revenue codes

17. HCPCS Procedure codes including modifiers

18. Unit or basis for measurement code

19. Service units/days

20. Total charges by revenue code Payer

21. Payer's identification

22. Patient's relationship to insured Diagnosis and Treatment

23. Diagnosis version qualifier

24. Principal diagnosis with present on admission

25. Other diagnosis codes with present on admission

26. Admitting diagnosis code

27. Patient's reason for visit codes

28. External cause of injury codes (E-code) with present on admission

29. Principal ICD procedure code

30. Other ICD procedure codes

31. Date of principal procedure Physician

32. Attending provider primary ID

33. Operating physician primary ID

34. Other operating physician primary ID

35. Rendering physician primary ID

36. Referring provider primary ID Other

37. Type of bill

TABLE (3) LEVEL 2 DATA ELEMENTS CATEGORY NAME

Patient

1. Patient marital status

2. Patient race and ethnicity Employer

3. Employer name Charge

4. Prior payments

5. Estimated amount due Payer

6. Insured names

7. Certificate/Social Security Number/Health Insurance Claim/Identification Number

8. Insured group names Physician

9. Attending provider secondary ID

10. Attending provider specialty information

11. Operating physician secondary ID

12. Operating physician specialty information

13. Other operating physician secondary ID

14. Other operating physic. specialty information

15. Rendering physician secondary ID

16. Rendering physician specialty information

17. Referring provider secondary ID

18. Referring provider specialty information

19. Resident ID

20. Resident ID Type

Notes

Utah Admin. Code R428-10-5