Subchapter B. PENNSYLVANIA UNIFORM CLAIMS AND BILLING FORM SUBMISSION SCHEDULES
GENERAL PROVISIONS Sec.
912.21. Required data elements.
912.22. Data element submission schedules.
912.23. Form of data submissions and release by Council.
912.24. Frequency of data submissions.
EXCEPTIONS
912.31. Principle.
912.32. Requests for exceptions.
912.33. Revocation of exceptions.
INTERPRETATIONS
912.41. Definition for major ambulatory service.
GENERAL PROVISIONS
§ 912.21. Required data elements.
(a) A health care facility is required to submit the following data elements:
(1) Data elements specified in the act contained in Council Manual HC-87-101, Volume A. (See Appendix A.) A health care facility shall refer to Appendix A to determine specific data elements definitions and formats.
(2) Additional data elements, as defined in Appendix A:
(i) Unusual occurrences.
(A) Nosocomial infections.
(B) Readmissions.
(ii) Patient race.
(b) A hospital is required to submit the following additional data elements:
(1) Patient morbidity. A hospital shall refer to Council Manual HC-87-101, Volume A, Field 21b (See Appendix A) to determine formats.
(2) Patient severity. A hospital shall refer to Council Manual HC-87-101, Volume A, Field 21a (See Appendix A) to determine formats.
Source The provisions of the 912.21 adopted January 29, 1988, effective January 30, 1988, 18 Pa.B. 459; amended April 8, 1988, effective March 1, 1988, 18 Pa.B. 1607. Immediately preceding text appears at serial page (124980).
§ 912.22. Data element submission schedules.
A health care facility shall submit data under the following schedules:
(1) General hospitals with more than 100 licensed beds.
(i) Inpatient data elements. A general hospital is required to submit data elements for inpatient discharges in the first quarter of 1988 by June 30, 1988, and thereafter, under § 912.24 (relating to frequency of data submissions).
(ii) Outpatient data elements. A general hospital is required to submit data elements for outpatient covered services by March 31, 1989, for discharges in the fourth quarter of 1988 and thereafter, under § 912.24.
(iii) Patient morbidity and patient severity data elements. A general hospital is required to submit data elements for patient morbidity and patient severity for inpatients admitted on or following the implementation date, excluding those in specialty units, in accordance with the following schedule:
(A) Region 5. Discharges in the second quarter of 1988 are due on or before September 30, 1988, and thereafter, under § 912.24.
(B) Region 7. Discharges in the third quarter of 1988 are due on or before December 31, 1988, and thereafter, under § 912.24.
(C) Region 1. Discharges in the fourth quarter of 1988 are due on or before March 31, 1989, and thereafter, under § 912.24.
(D) Regions 6 and 8. Discharges in the first quarter of 1989 are due on or before June 30, 1989, and thereafter, under § 912.24.
(E) Regions 2, 3 and 4. Discharges in the second quarter of 1989 are due on or before September 30, 1989, and thereafter, under § 912.24.
(F) Region 9. Discharges in the third quarter of 1989 are due on or before December 31, 1989, and thereafter, under § 912.24.
(2) General hospitals with 100 beds or less and other health care facilities. A general hospital with 100 beds or less or health care facility, excluding a health care facility identified in paragraph (1), are required to submit data elements for inpatient discharges and data elements for outpatient covered services rendered in the fourth quarter of 1988 by March 31, 1989, and thereafter, under § 912.24. The following schedule shall be used for patient morbidity and patient severity:
(i) For inpatient admissions beginning July 1, 1989, a general hospital in Regions 1, 2, 3, 4 and 5 shall submit data for discharges in the third quarter of 1989 on or before December 31, 1989, and thereafter, under § 912.24.
(ii) For inpatient admissions beginning October 1, 1989, a general hospital in Regions 6, 7, 8 and 9 shall submit data for discharges in the fourth quarter of 1989 on or before March 31, 1990, and thereafter, under § 912.24.
(iii) For inpatient admissions beginning January 1, 1990, special hospitals and specialty units shall submit data for discharges in the first quarter of 1990 on or before June 30, 1990, and thereafter, under § 912.24.
Source The provisions of this § 912.22 adopted January 29, 1988, effective January 30, 1988, 18 Pa.B. 459; amended April 8, 1988, effective March 1, 1988, 18 Pa.B. 1607; amended December 2, 1988, effective upon publication and applies retroactively to January 30, 1988, 18 Pa.B. 5351. Immediately preceding text appears at serial pages (127084) to (127085).
§ 912.23. Form of data submissions and release by Council.
Data elements required to be submitted under this subchapter shall be submitted on nine-track labeled 1600 or 6250 BPI (density) tape or computer diskette approved by the Council, according to computer tape format specification contained in Appendix A.
Source The provisions of this § 912.23 adopted January 29, 1988, effective January 30, 1988, 18 Pa.B. 459.
§ 912.24. Frequency of data submissions.
Data elements required to be submitted under this subchapter shall be submitted on a quarterly basis by the last day of the third month following the close of the quarter. Data elements for inpatient discharges and outpatient services rendered in calendar quarters ending March 31, June 30, September 30 and December 31, shall be submitted by June 30, September 30, December 31 and March 31.
Source The provisions of this § 912.24 adopted January 29, 1988, effective January 30, 1988, 18 Pa.B. 459.
Cross References This section cited in 28 Pa. Code § 912.22 (relating to data element submission schedules).
EXCEPTIONS
§ 912.31. Principle.
The Council may, within its discretion and for good reason, grant exceptions to sections within this chapterwhen the policy and objectives of this chapter and the act are otherwise met.
Authority The provisions of this § 912.31 amended under section 5(b) of the Health Care Cost Containment Act (35 P. S. § 449.5(b)).
Source The provisions of this § 912.31 adopted January 29, 1988, effective January 30, 1988, 18 Pa.B. 459; amended April 8, 1988, effective March 1, 1988, 18 Pa.B. 1607; amended October 1, 1999, effective October 2, 1999, 29 Pa.B. 5094. Immediately preceding text appears at serial page (242565).
§ 912.32. Requests for exceptions.
Requests for exceptions shall be made in writing addressed to the Executive Director. A request shall be specific to the section in this chapter to which the request applies and shall state in detail the reasons for the request. A request for an exception shall be received and deemed as complete 90 days prior to the appropriate submission date for which the request applies. The Council will act within 60 days of receipt of a complete request. A majority vote by the Council is necessary to grant an exception. Disapproval of the exception request at the Council level shall be deemed to represent disapproval of the request. Applicants will be notified in writing of the action taken by the Council.
Source The provisions of this § 912.32 adopted January 29, 1988, effective January 30, 1988, 18 Pa.B. 459.
§ 912.33. Revocation of exceptions.
(a) An exception granted under this chapter may be revoked by the Council. Notice of revocation will be in writing and will include the reason for the action of the Council and a specific date upon which the exception will be terminated.
(b) In revoking an exception, the Council will provide for a reasonable time between the date of written notice of revocation and the date of termination of an exception for the health care facility to come into compliance with this chapter. Failure by the facility to comply after the specified date may result in enforcement proceedings.
(c) If a facility wishes to request a reconsideration of a denial or revocation of an exception, it shall do so in writing within 30 days of receipt of the adverse notification.
Source The provisions of this § 912.33 adopted January 29, 1988, effective January 30, 1988, 18 Pa.B. 459.
INTERPRETATIONS
§ 912.41. Definition for major ambulatory service.
(a) The Council may issue interpretations of this subchapter which apply to the question of which major ambulatory services are considered to be covered services and submission and modifications to schedules of data pertaining to them.
(b) Interpretations issued under this section will be subject to modification by the Council in an adjudicative proceeding based on the particular facts and circumstances relevant to a service.
Source The provisions of this § 912.41 adopted January 29, 1988, effective January 30, 1988, 18 Pa.B. 459.
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