CHAPTER He-C 1500 DATA SUBMISSION
AND RELEASE OF HEALTH CARE FACILITY DISCHARGE DATA
Statutory
Authority: RSA 126:27
PART He-C 1501 DATA
SUBMISSION OF HEALTH CARE FACILITY DISCHARGE DATA
He-C
1501.01 Purpose and Scope. This part contains the
procedures and requirements for the
submission of health care facility discharge data
from health care facilities licensed in accordance with RSA 151:2, I(a) and (d)
pursuant to RSA 126:25 and 27.
Source. #4069, eff 6-6-86; ss by #4542, eff 12-12-88;
ss by #5844, eff 7-1-94, EXPIRED: 7-1-00
New. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New. #12139,
INTERIM, eff 3-22-17, EXPIRED: 9-18-17
New. #13369, eff
4-20-22
He-C 1501.02 Definitions.
(a) “Agent”
means a person engaged under contractual agreement with the department for the
performance of services pursuant to RSA 126:25.
(b) “Clinical
data” means the health care, hospital and non-hospital health care facility
data, and all other data collected in
accordance with the rules adopted pursuant to RSA 126:27.
(c) “Commissioner”
means the commissioner of the New Hampshire department of health and human
services or designee.
(d) “Department”
means the New Hampshire department of health and human services.
(e) “Discharge data
set” means a list of data elements that are collected in accordance with He-C
1501.06 for discharges or encounters of patients who receive services from a
healthcare facility.
(f) “Encounter”
means any visit where a medical treatment, evaluation, or management services
are provided, except those at a hospital inpatient department.
(g) “Health
care facility” means, in this part, a hospital-based, public or private,
proprietary or not-for-profit entity providing health services licensed in
accordance with RSA 151:2, I(a) and (d), except offices of primary care
practices and rural health clinics.
(h) “Inpatient
discharges” means records or data from discharges of patients who are admitted
to a health care facility and are coded as “Inpatient”, except when UB-04 Form
Locator 04 “Type of Bill” is equal to 018x, hospital swing beds.
(i) “Insured” means
the person who is subscribing or carrying the primary, secondary, or tertiary
insurance plan for the patient case. This
term includes “insurance subscriber”.
(j) “Patient”
means any person in a data set that is the subject of the activities of the
claim performed by the health care provider.
(k) “Rural health clinics” means a clinic that is located in a rural area designated as a shortage area, is
not a rehabilitation agency or a
facility primarily for the care and treatment of mental diseases,
and meets all other requirements of 42 CFR 405 and 491.
Source. #4069, eff 6-6-86; EXPIRED 6-6-92
New. #5844, eff 7-1-94, EXPIRED: 7-1-00
New. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New. #12139, INTERIM, eff 3-22-17, EXPIRED:
9-18-17
New.
#13369, eff 4-20-22
He-C
1501.03 Licensed Health Care Facilities Required to Submit
Discharge Data Sets. All hospital-based health care facilities
defined in He-C 1501.02(g) shall be required to submit discharge data sets for
all inpatient discharges and outpatient encounters.
Source. #4074, eff 6-27-86; EXPIRED 6-27-92
New. #5844, eff 7-1-94, EXPIRED: 7-1-00
New. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New.
#12139, INTERIM, eff 3-22-17, EXPIRED: 9-18-17
New.
#13369, eff 4-20-22 (formerly He-C 1503.01)
He-C
1501.04 Health Care Data Set Submission Description. Beginning
with discharges occurring on July 1, 2022, and continuing at
least quarterly thereafter, health care facilities shall submit to the
department, or its agent, a completed health care discharge data set for all
patients. Each health care facility shall also ensure submittal of
all health care discharge data processed by any sub-contractor or other third
party on its behalf.
Source. #4074, eff 6-27-86; EXPIRED 6-27-92
New. #5844, eff 7-1-94, EXPIRED: 7-1-00
New. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New.
#12139, INTERIM, eff 3-22-17, EXPIRED: 9-18-17
New.
#13369, eff 4-20-22 (formerly He-C 1503.02)
He-C
1501.05 General Requirements for
Data Set Submission.
(a) Health
care facilities shall submit data to the
department, or its agent, as standard health care discharge or equivalent
encounter information transactions in a format compliant with the National
Uniform Billing Committee’s “Official UB-04 Data Specifications Manual” (2022
Edition), available as noted in Appendix A.
(b) Unless
otherwise specified in He-C 1501.06, the National Uniform Billing Committee’s
“Official UB-04 Data Specifications
Manual” (2022 Edition), available as noted in Appendix A, shall be the code
source to be utilized for discharge data submission.
(c) Unless
otherwise specified in He-C 1501.06, data elements shall be required as defined
by the UB-04 reporting standard in the
National Uniform Billing Committee’s “Official UB-04 Data Specifications
Manual” (2022 Edition), available as noted in Appendix A.
(d) Data
submissions shall be made using the ANSI ASC X12N 837 electronic file format
pursuant to 45 CFR 162.920(a).
(e) Data
submissions shall be made to the department or its agent utilizing a secure
protocol. E-mail attachments and paper submissions shall not be
acceptable.
Source. #4074, eff 6-27-86; EXPIRED 6-27-92
New. #5844, eff 7-1-94, EXPIRED: 7-1-00
New. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New.
#12139, INTERIM, eff 3-22-17, EXPIRED: 9-18-17
New.
#13369, eff 4-20-22 (formerly He-C 1503.03)
He-C
1501.06 Required Data Elements.
(a) The
following elements from the UB-04
reporting standard shall be submitted as follows:
(1) UB-04
Form Locator 01, “billing provider name, address and telephone
number”;
(2) UB-04
Form Locator 02, “pay-to name and address”;
(3) UB-04
Form Locator 03a, “patient control number”;
(4) UB-04
Form Locator 03b, “medical/health record number”;
(5) UB-04
Form Locator 04, “type of bill”;
(6) UB-04
Form Locator 05, “federal tax ID number”;
(7) UB-04
Form Locator 06, “statement covers period from/through”;
(8) UB-04
Form Locator 08, “patient name/identifier”, which shall be divided into
4 distinct components containing:
a. Patient last name;
b. Patient first name;
c. Patient middle name, if
available; and
d. Patient generational
identifier suffix, if available;
(9) UB-04
Form Locator 09, “patient address street, city/town, state, 5-digit zip code,
and country code” which shall be:
a. “YYYYY” 5-digit zip code for other country residents; and
b. “XXXXX” 5-digit zip code for unknown or no fixed address;
(10) UB-04
Form Locator 10, “patient birth date”;
(11) UB-04
Form Locator 11, “patient sex”;
(12)
UB-04 Form Locator 12, “admission/start of care date”;
(13) UB-04
Form Locator 13, “admission hour”;
(14) UB-04
Form Locator 14, “priority (type) of admission or visit”;
(15) UB-04
Form Locator 15, “point of origin for admission or visit”;
(16) UB-04
Form Locator 16, “discharge hour;
(17) UB-04
Form Locator 17, “patient discharge status”;
(18) UB-04
Form Locator 18 through 28, “condition codes”, which shall:
a. Be
submitted as recorded; and
b. Be
collected, recorded, and submitted where applicable for “02” = Patient alleges
the medical condition or injury causing this episode of care is due to the
employment environment or events such as workers' compensation or black lung;
(19) UB-04
Form Locator 31 through 34, “occurrence codes and dates”, which
shall:
a. Be
submitted as recorded; and
b. Be
collected, recorded, and submitted where applicable for 04 =
Accident/employment related;
(20) UB-04 Form Locator 35 and 36, “occurrence
span codes and dates”;
(21) UB-04 Form Locator 38, “insured date of birth,
sex, and address”, if applicable;
(22) UB-04 Form Locator 39 through 41, “value codes and amounts”,
which shall:
a. Be
submitted as recorded; and
b. Be
collected, recorded, and submitted where applicable for:
1. 54
= Newborn Birth Weight in Grams; and
2. P0
= For newborns, mother’s medical record number;
(23) UB-04
Form Locator 42, “revenue codes”;
(24) UB-04
Form Locator 44, “HCPCS or CPT/accommodation rates/HIPPS rate codes”, except
the length limit shall not apply;
(25) UB-04
Form Locator 45, “service dates”;
(26) UB-04
Form Locator 46, “service units”;
(27) UB-04
Form Locator 47, “total charges”;
(28) UB-04
Form Locator 50, “payer name – primary, secondary, tertiary”, except the length
limit shall not apply;
(29) UB-04
Form Locator 51, “health plan identification number – primary, secondary,
tertiary”;
(30) UB-04
Form Locator 56, “national provider identifier – billing provider”;
(31) UB-04
Form Locator 57, “other billing provider identifier”;
(32)
UB-04 Form Locator 58, “insured name – primary, secondary, tertiary”;
(33) UB-04
Form Locator 59, “patient’s relationship to insured – primary, secondary,
tertiary”;
(34) UB-04
Form Locator 64, “document control number”;
(35) UB-04
Form Locator 65, “employer name (of the insured)”, which shall:
a. When
the employer is not known, be recorded as “UNKNOWN”; and
b. When
not employed, be recorded as “NA.”;
(36) UB-04
Form Locator 66, “diagnosis and procedure code qualifier (ICD version
indicator)”;
(37) UB-04
Form Locator 67, “principal diagnosis code and present on admission indicator”
which for the present on admission (POA) element shall only be recorded on
inpatient discharges;
(38) UB-04
Form Locator 67A-Q, “other diagnosis codes and present on admission indicator”
which for the POA element shall only be recorded on inpatient discharges;
(39) UB-04
Form Locator 69, “admitting diagnosis code”;
(40) UB-04
Form Locator 70A-C, “patient’s reason for visit codes”;
(41) UB-04
Form Locator 72A-C, “external cause of injury (ECI) codes and present on
admission indicator”, which shall be reported in order for
every applicable principal and other diagnoses;
(42) UB-04
Form Locator 74, “principal procedure code and date”;
(43) UB-04
Form Locator 74A-E, “other procedure codes and dates”;
(44) UB-04
Form Locator 76, “attending provider name and identifiers”;
(45) UB-04
Form Locator 77, “operating physician name and identifiers”;
(46) UB-04
Form Locator 78 and 79, “other provider (individual) names and identifiers”;
(47) UB-04
Form Locator 80, “remarks”; and
(48) UB-04
Form Locator 81A-D, “code-code field”, which shall:
a. Be
submitted as recorded; and
b. Be
collected, recorded, and submitted for 81 which means race and ethnicity.
(b) The
health care facility shall submit information to the department regarding
primary language spoken as the health care facility has coded it in spreadsheet
format, mapping internal codes to the language.
(c) Whenever
health care facility internal mapping changes occur, the health care facility
shall submit to the department an updated spreadsheet initially required in (b)
above.
(d) The following
shall not be submitted in the discharge data set:
(1) UB-04 Form Locator 04 “Type of Bill” is equal
to 018x (Hospital Swing Beds);
(2) Professional claims, those typically billed
on a CMS 1500 billed under the hospital tax ID number or other tax ID numbers
except the technical component of professional claims and bundled
technical/professional claim lines at critical access hospitals;
(3) Lab specimen only encounters;
(4) Pre-hospital ambulance encounters;
(5) Primary care practices; and
(6) Rural health clinics.
Source. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New.
#12139, INTERIM, eff 3-22-17, EXPIRED: 9-18-17
New.
#13369, eff 4-20-22 (formerly He-C 1503.04)
He-C
1501.07 Transmittal Record. With each submission
of data, a transmittal record shall also be supplied that contains the
following information:
(a) Submitting health care facility name;
(b) Submitting health care facility tax ID
number;
(c) Submitting health care facility Medicare
provider number;
(d) If different from
submitting health care facility, the name and address of the location where
discharges in the submitted records occurred;
(e) File name;
(f) Contact person name;
(g) Contact person telephone number;
(h) Contact
person e-mail address;
(i) Date processed;
(j) Time processed;
(k) Submission
date; and
(l) Explanatory
notes to assist with processing of the file.
Source. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New.
#12139, INTERIM, eff 3-22-17, EXPIRED: 9-18-17
New.
#13369, eff 4-20-22 (formerly He-C 1503.06)
He-C
1501.08 Submission of Test Data.
(a) Each
health care facility shall submit to the department, or its agent, a test data
submission for the purpose of determining compliance with required data
submission standards.
(b) Each test
data submission shall contain one month’s worth of discharges.
(c) Test
data submission shall be required:
(1) Upon
adoption of these rules; and
(2) Whenever
a facility changes systems or processes.
Source. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New.
#12139, INTERIM, eff 3-22-17, EXPIRED: 9-18-17
New.
#13369, eff 4-20-22 (formerly He-C 1503.07)
He-C
1501.09 Submission Periods.
(a) The
submission period for health care facilities submission of data sets shall be
monthly or quarterly.
(b) Monthly data
set submissions shall be made no later than 2 months after the end of each data
submission period, as follows:
(1) March
31, for those patients discharged in January;
(2) April
30, for those patients discharged in February;
(3) May
31, for those patients discharged in March;
(4) June 30, for those patients discharged in
April;
(5) July 31, for those patients discharged in
May;
(6) August 31, for those patients discharged in
June;
(7) September 30, for those patients discharged
in July;
(8) October 31, for those patients discharged in
August;
(9) November 30, for those patients discharged in
September;
(10) December 31, for those patients discharged in
October;
(11) January 31, for those patients discharged in
November; and
(12) February 28, for those patients discharged in
December.
(c) Quarterly data
set submissions shall be made no later than 2 months after the end of each data
submission period, as follows:
(1) May
31, for those patients discharged between January 1 and March 31;
(2) August
31, for those patients discharged between April 1 and June 30;
(3) November
30, for those patients discharged between July 1 and September 30; and
(4) February 28, for those patients discharged
between October 1 and December 31.
(d) Health care
facilities shall notify the department or its agent, in writing, when
additional time is required to file a submission.
Source. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New.
#12139, INTERIM, eff 3-22-17, EXPIRED: 9-18-17
New.
#13369, eff 4-20-22 (formerly He-C 1503.08)
He-C
1501.10 Non-Compliant Data Submission.
(a) Each
health care facility shall be notified when data
submissions do not meet the standards described in this rule, including the
specific file and the data elements that do not meet the standards.
(b) Each
health care facility notified of a non-compliant data submission shall respond
within 30 days of the notification by
making the changes necessary to meet the standards and resubmit the entire data
submission.
Source. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New.
#12139, INTERIM, eff 3-22-17, EXPIRED: 9-18-17
New.
#13369, eff 4-20-22 (formerly He-C 1503.12)
PARTS He-C 1502 –
He-C 1549 – RESERVED
PART He-C
1550 SUBMISSION OF HEALTH CARE FACILITY
FINANCIAL DATA
Statutory
Authority: RSA 126:27, I-III, V
He-C 1550.01 Purpose and Scope. This part contains the requirements for the
submission of health care facility financial information from
nursing homes, acute care hospitals, residential care facilities, specialty
hospitals, or other health care facilities licensed under RSA 151.
Source. # 9781, eff 1-1-11, EXPIRED: 1-1-19
New. #12723, INTERIM, eff 2-14-19, EXPIRES:
8-13-19
He-C 1550.02 Definitions.
(a)
“Certified financial statements” means the
annual financial statements that have been subject to an independent audit in
accordance with generally accepted auditing standards, including a certificate
of audit or the independent auditor report that expresses an opinion as to whether or not the accompanying financial statements are
presented fairly in accordance with generally accepted accounting
principles.
(b)
“Commissioner” means the commissioner of the New
Hampshire department of health and human services or his or her designee.
(c)
“Confidential financial information” means any financial information
filed either by a hospital or nursing home in accordance with data disclosure
under RSA 126:25:.
(1) That has not yet been revealed to persons other than:
a. Employees, agents, or attorneys of the
hospital;
b. Persons or entities with which the hospital
is jointly participating in an effort to obtain
financing; and
c. Persons or entities to which the hospital has
applied for financing;
(2) That would, if revealed, substantially,
predictably, and adversely affect the ability of the hospital or its affiliated
interests to obtain financing on reasonable terms in competition with others
seeking similar types of capital; and
(3) That could lawfully be concealed under
applicable laws governing financial transactions.
(d)
“Department” means the New Hampshire department of health and human
services.
(e)
“Financial statements” means documents including, but not limited, to a
balance sheet, a statement of operations, a cash flow statement, and notes to
financial statements, and, if applicable, consolidating and supplemental
financial schedules.
(f)
“Health care facility” means a public or private,
proprietary or not-for-profit entity or institution providing health services
licensed under RSA 151:2 including, but not limited to:
(1) Hospitals and infirmaries;
(2) Home health care providers;
(3) Laboratories performing tests or analyses of
human samples;
(4) Facilities or portions of a facility
operating as an outpatient rehabilitation clinic, ambulatory surgical center,
hospice, emergency medical care center, drop-in or walk-in care center,
dialysis center, birthing center, or other entity where health care associated
with illness, injury, deformity, infirmity, or other physical disability is
provided;
(5) Residential care facilities; and
(6) Adult day care programs.
(g)
“Medicare cost report” means the annual cost report, specific to a
facility type, that Medicare requires all Medicare-certified facilities to file
with a Medicare fiscal intermediary.
(h) “Settled” means that a medicare cost report has been adjusted after review or
audit by the medicare fiscal intermediary.
Source. # 9781, eff 1-1-11, EXPIRED: 1-1-19
New. #12723, INTERIM, eff 2-14-19, EXPIRES:
8-13-19
He-C 1550.03 General Requirements for Financial Data
Submission.
(a)
All health care facilities defined in He-C
1550.02(f) shall be required to file financial data with the department or its
agent.
(b)
Financial data shall be submitted annually
to the department:
(1) Within 4 months following the end of the
health care facility’s fiscal year, in accordance with He-C 1550.04(a);
(2) Within 30 days
following the request of the department, in accordance with He-C 1550.04(b),
which shall be no sooner than 4 months following the end of the health care
facility’s fiscal year; or
(3) In the case of the medicare
cost report, within 30 days of submission to the medicare
fiscal intermediary and within 30 days of receipt of a settled cost report from
the medicare fiscal intermediary, in accordance with
He-C 1550.04(i).
(c)
Financial data may be submitted in either paper format or electronic
format, provided that all electronic submissions shall be in pdf format or
another read-only format that maintains the documents’ security and integrity.
(d)
Provisions of this rule shall not void any
contractual requirements for filing financial statements by health care
facilities.
(e)
Contractual requirements shall not void provisions of these rules.
Source. # 9781, eff 1-1-11, EXPIRED: 1-1-19
New. #12723, INTERIM, eff 2-14-19, EXPIRES:
8-13-19
He-C 1550.04 Required Financial Data.
(a)
Each health care facility receiving payments of $500,000 or more of
state or federal funds in the health care facility’s previous fiscal
year shall file with the department certified financial statements within 4
months following the end of the health care facility’s fiscal year.
(b)
Each health care facility receiving payments of less than $500,000 of
state or federal funds in the health care facility’s previous fiscal
year shall, at the written request of the department, file certified financial
statements within 30 days of the request.
(c)
If a health care facility is not required by either state or federal
statute to obtain a certification of audit of its financial statements, and
elects not to obtain such certification of audit, the health care facility
shall file with the department:
(1) Uncertified financial statements according to
the timeframes described in (a) and (b) above; and
(2) A certificate of authenticity which attests
that the financial statements are correct in all material respects and is
signed by an officer of the corporation, partner, or owner under penalty of
unsworn falsification.
(d)
A health care facility which is part of a consolidated financial
statement may file the certified consolidated financial statements if it
includes the consolidating schedules as supplemental information.
(e)
A health care facility which is part of a consolidated financial
statement, but whose certified consolidated financial statements do not contain
the consolidating schedules as supplemental information, shall file with the
department uncertified financial statements for the individual health care
facility and a certificate of authenticity in accordance with (c)(1) and (2)
above.
(f) Filings shall be accompanied by a
letter from the health care facility noting the type of ownership, the name of
the owner, and the number and type of licensed bed capacity.
(g)
Upon written request by the department, a health care facility shall
provide additional information regarding the fiscal condition of the facility
within 30 days of the request or by some other date as specified in the
request.
(h)
A health care facility shall be permitted to disclose additional
information to explain or clarify the financial data submitted.
(i) The following shall apply to health care
facilities that participate in the medicare program
and are required to file an annual medicare cost
report with a medicare fiscal intermediary:
(1) Such facilities shall submit to the
department a copy of the medicare cost report as
filed and as settled; and
(2) Any health care facility that files a medicaid cost report shall be exempt from the submission
requirement in (1) above, but shall be required to
submit the medicare cost report as filed and as
settled upon department request.
(j)
The department shall make requests in (b), (g), and (i)(2)
under the following circumstances:
(1) The department is requested to conduct a
fiscal analysis by a department subdivision, a legislative committee, or the
governor’s office; and
(2) The department’s request is directed towards
an entire license class, a geographical subset of that license class, or some
other subset for which a more targeted fiscal analysis is requested.
Source. # 9781, eff 1-1-11, EXPIRED: 1-1-19
New. #12723, INTERIM, eff 2-14-19, EXPIRES:
8-13-19
He-C 1550.05 Request for Extension of Filing Deadlines.
(a)
Health care facilities shall submit a request for an extension of the
filing deadline in He-C 1550.04 (a), (b), or (g) above as follows:
(1) Requests shall be made in writing;
(2) Requests shall be sent to the commissioner;
(3) Requests shall be received no later than 20
days prior to the filing deadline; and
(4) Requests shall include the following:
a. Contact information;
b. Reason for requesting the extension; and
c. New deadline.
(b)
The commissioner shall grant an extension of the filing deadline if:
(1) The request meets the requirements in (a)
above; and
(2) It is determined by the commissioner that the
health care facility has demonstrated good cause for an extension.
(c)
Good cause in (b)(2) means any circumstance beyond the health care
facility’s control that prevents that facility from taking a
required action, including:
(1) Death of the person, or in the person’s
immediate family, who is responsible for preparing the facility’s fiscal
information;
(2) Personal injury or serious illness of the
person responsible for preparing the facility’s fiscal information, or that
person’s immediate family member; or
(3) An unforeseeable situation with the
facility’s audit firm that delays the audit beyond the 4-month period required
in He-C 1550.03(b)(1) or (2).
Source. # 9781, eff 1-1-11, EXPIRED: 1-1-19
New. #12723, INTERIM, eff 2-14-19, EXPIRES:
8-13-19
He-C 1550.06 Penalties.
(a)
Failure of a health care facility to provide to the department the
financial data required in He-C 1550.04 above by the filing deadline, or by the
filing deadline as extended pursuant to He-C 1550.05 above, shall result in the
imposition of daily penalties in accordance with RSA 126:29.
(b)
Pursuant to RSA 126:29, any amount of penalty imposed by the department
shall not be allowed as a reimbursable cost item and shall not be recoverable
from any category of payment source or patient.
Source. # 9781, eff 1-1-11, EXPIRED: 1-1-19
New. #12723, INTERIM, eff 2-14-19, EXPIRES:
8-13-19
He-C 1550.07 Release of Information.
(a)
In accordance with RSA 126:28 and He-C 1550.02(c), all financial
information required to be filed by this part shall be considered confidential
financial information and shall not be made available to the public upon
request.
(b)
The department shall use the financial information submitted by any or
all health care facilities in its analyses of the
financial condition of any or all of the health care
facilities.
(c)
Except as otherwise provided by law, the department may publicly release
the results of such analyses founded in (b) above
except that all confidential financial data shall be disguised, de-identified,
or aggregated in such a way that does not allow for the identification
the individual health care facility.
Source. # 9781, eff 1-1-11, EXPIRED: 1-1-19
New. #12723, INTERIM, eff 2-14-19, EXPIRES:
8-13-19
(1)
Official UB-04 Data Specifications Manual
SOURCE: National Uniform Billing Data Element
Specifications
AVAILABLE FROM:
National Uniform
Billing Committee
http://www.nubc.org/
ABSTRACT: A variety of code definitions for many of the
fields included in the health care data submission requirements.
(2) Current Procedural Terminology (CPT) Codes
(Data Element: MC055)
SOURCE: Physicians' Current Procedural Terminology
(CPT) Manual
AVAILABLE FROM:
Order Department
American Medical
Association
ABSTRACT: A listing of
descriptive terms and identifying codes for reporting medical services and
procedures performed by physicians.
(3) Health Care Common Procedural Coding
System
SOURCE: Health Care Common Procedural Coding System
AVAILABLE FROM:
www.cms.gov/medicare/hcpcs.htm
Centers for Medicare
and Medicaid Services
Center for Health
Plans and Providers
CCPP/DCPC
C5-08-27
ABSTRACT: HCPCS is the Centers for Medicare and
Medicaid Services (CMS) coding scheme to group procedures performed for payment
to providers.
(4) Centers for Medicare and Medicaid Services
National Provider Identifier
SOURCE: National Provider System
AVAILABLE FROM:
Centers for Medicare
and Medicaid Services
Office of Information
Services
Security and Standards
Group
Director, Division of
Health Care Information Systems
ABSTRACT: The Centers for Medicare and Medicaid
Services is developing the National Provider
Identifiers, which is proposed as the standard unique identifier for each
health care provider under the Health Insurance Portability and Accountability
Act of 1996.
(5) International Classification of Diseases
Clinical Mod (ICD-9-CM) (and when available ICD-10-CM)
SOURCE: International Classification of Diseases, 9th
Revision, Clinical Modification (ICD-9-CM) (and when available ICD10-CM)
AVAILABLE FROM:
Commission of
Professional and Hospital Activities
ABSTRACT: The International Classification of Diseases,
9th Revision, Clinical Modification, describes the classification of morbidity
and mortality information for statistical purposes and for the indexing of
hospital records by disease and operations.
(6) States and Outlying Areas of the
SOURCE: National Zip Code and Post Office Directory
AVAILABLE FROM:
ABSTRACT: Provides names, abbreviations, and codes for
the 50 states, the
(7) X12 Directories
SOURCE: X12.3 Data Element Directory; X12.22 Segment
Directory
AVAILABLE FROM:
Data Interchange
Standards Association, Inc. (DISA)
ABSTRACT: The data element directory contains the
format and descriptions of data elements used to construct X12 segments. It also contains code lists associated with
these data elements. The segment
director contains the format and definitions of the data segments used to
construct the X12 transaction sets. This
source also contains the Standards for the Classification of Federal Data on
Race and Ethnicity Code Source: ASC X12 External Code Source 859 (Health
Information and Surveillance Systems Board).
(8) ZIP Code
SOURCE: National Zip Code and Post Office Directory,
Publication 65, The USPS Domestic Mail Manual
AVAILABLE FROM:
New Orders
Superintendent of
Documents
ABSTRACT: The ZIP Code is a geographic identifier of
areas within the
APPENDIX
A: Incorporation by Reference Information
|
Rule |
Title |
Publisher; How to Obtain; and
Cost |
|
He-C 1501.05(a), (b), and (c) |
National Uniform Billing Committee’s,
“Official UB-04 Data Specifications Manual” (2022 Edition) |
Publisher: National Uniform Billing
Committee Cost: $530-$4,176 based on number of users The incorporated document is available at: https://ams.aha.org/eweb/dynamicpage.aspx?webcode=listproduct&ptc_code=coding%20and%20billing |
APPENDIX B
|
Rule |
Specific State Statute the Rule
Implements |
|
|
|
|
He-C 1501 |
RSA 126:25; RSA
126:27 |
|
He-C 1501.01 |
RSA 126:25, RSA
126:27 |
|
He-C 1502.01 |
RSA 126:25 |
|
He-C 1503.01-
1503.13 |
RSA 126:25 |
|
He-C 1504.01 |
RSA 126:25; RSA
125:28; 45 CFR 46 |
|
He-C 1504.02 |
RSA 126:28; 45
CFR 46 |
|
He-C 1504.03 |
RSA 126:28; 45
CFR 46 |
|
He-C 1504.04 |
RSA 126:28; 45
CFR 46 |
|
He-C 1504.05 |
RSA 91-A:10; RSA
126:28; 45 CFR 46 |
|
He-C 1504.06 |
RSA 126:30 |
|
He-C 1504.07 |
RSA 126:30 |
|
He-C 1504.08 |
45 CFR 46; RSA
126:30 |
|
He-C 1504.09 |
45 CFR 46 |
|
|
|
|
He-C 1550.01 |
RSA
126:25 |
|
He-C 1550.02 |
RSA 126:25 |
|
He-C 1550.03 |
RSA 126:25, I(a) |
|
He-C 1550.04 |
RSA 126:25,
I(a)-(c) |
|
He-C 1550.05 |
RSA 126:25 |
|
He-C 1550.06 |
RSA
126:29 |
|
He-C 1550.07 |
RSA
126:28; RSA
151-C:2, XI |