North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 14 - Director, Division of Health Service Regulation › Subchapter H - CERTIFICATION OF STATEWIDE DATA PROCESSORS › Section .0100 - CERTIFICATION OF STATEWIDE DATA PROCESSOR › Section 14H .0103 - REQUIREMENTS FOR CERTIFICATION

Current through Register Vol. 39, No. 2, July 15, 2024
A party desiring to be certified as a statewide data
					 processor shall make a written application to the Division that complies with
					 the following requirements:
(1) The
				  applicant must make a satisfactory showing that it is capable of making
				  available annually to the Division, at no charge, a report which compares the
				  35 most frequently reported charges of the hospitals and freestanding
				  ambulatory surgical facilities reporting patient data to the applicant during
				  the calendar year. Each annual report shall be due to the Division within 180
				  days after the end of the calendar year.
(2) The applicant must make a satisfactory
				  showing that it is capable of receiving from hospitals and freestanding
				  ambulatory surgical facilities throughout the State the patient data elements
				  specified in Items (3) through (5) of this Rule.
(3) With regard to patient data concerning
				  inpatients discharged by hospitals, the applicant must make a satisfactory
				  showing that is capable of compiling and maintaining a uniform set of data from
				  the patient data which shall include the following HCFA 1450 (UB-92) data
				  elements for every inpatient discharged regardless of payor:
DATA ELEMENT
DESCRIPTION
(1)
Patient Control Number
Form Locator 3 - As stated in the North Carolina
								HCFA 1450 Manual
(2)
Bill Type
Form Location 4 - As Stated in the North Carolina
								HCFA 1450 Manual
(3)
Provider Identification
(A)
Medicaid Base Provider Number
The number assigned to the provider by Medicaid or
								as assigned by the certified statewide data processor (for batching
								only)
(B)
Federal Tax Number
Form Locator 5 - As stated in the North Carolina
								HCFA 1450 Manual
(4)
Zip Code of Patient Address
Form Locator 13 - Only the zip code portion of this
								field is required. Code as stated in the North Carolina HCFA 1450 Manual
(5)
Patient Birth Date
Form Locator 14 - As stated in the North Carolina
								HCFA 1450 Manual
(6)
Patient Sex
Form Locator 15 - As stated in the North Carolina
								HCFA 1450 Manual
(7)
Admission Date
Form Locator 17 - As stated in the North Carolina
								HCFA 1450 Manual
(8)
Admission Type
Form Locator 19 - As stated in the North Carolina
								HCFA 1450 Manual
(9)
Source of Admission
Form Locator 20 - As stated in the North Carolina
								HCFA 1450 Manual
(10)
Patient Status
Form Locator 22 - As stated in the North Carolina
								HCFA 1450 Manual
(11)
Discharge Date (Statement Covers Period)
Form Locator 6 - As stated in the North Carolina
								HCFA 1450 Manual
(12)
All Revenue Codes and Associate Charges
Forms Locators 42 and 47 - As stated in the North
								Carolina HCFA 1450 Manual
(13)
Payer Identification
Form Locator 50a - Classifications code and
								specific carrier identification code for primary payer
(14)
Certificate/Social Security/Health
Form Locator 60a - As stated in the Insurance
								Claim/Identification Number North Carolina HCFA 1450 Manual
(15)
Insurance Group Number
Form Locator 62a - As stated in the North Carolina
								HCFA 1450 Manual
(16)
Principal Diagnosis
Form Locator 67 - As stated in the North Carolina
								HCFA 1450 Manual
(17)
Other Diagnoses 8
Form Locators 68-75 - As stated in the North
								Carolina HCFA 1450 Manual
(18)
External Cause of Injury Code (E Code)
Form Locator 77 - As stated in the North Carolina
								HCFA 1450 Manual/whenever the principal diagnosis is an injury, poisoning or
								adverse effect
(19)
Principal Procedure and Date
Form Locator 80 - As stated in the North Carolina
								HCFA 1450 Manual
(20)
Other Procedures and Dates
Form Locator 81a-e - As stated in the North
								Carolina HCFA 1450 Manual
(21)
Attending Physician Identification
Form Locator 82 - Only the UPIN is required. Code
								as stated in the North Carolina HCFA 1450 Manual
(22)
Other Physician Identification
Form Locator 83 - Only the UPIN is required. Code
								as stated in the North Carolina HCFA 1450 Manual
(4) With regard to patient data concerning
				  ambulatory surgery patients released from hospitals and freestanding ambulatory
				  surgical facilities, the applicant must make a satisfactory showing that it is
				  capable of compiling and maintaining a uniform set of data from the patient
				  data which shall include the following HCFA 1450 (UB-92) data elements for
				  every ambulatory surgical patient released regardless of payor:
DATA ELEMENT
DESCRIPTION
(1)
Patient Control Number
Form Locator 3 - As stated in the North Carolina
								HCFA 1450 Manual
(2)
Bill Type
Form Locator 4 - As stated in the North Carolina
								HCFA 1450 Manual
(3)
Provider Identification
(A)
Medicaid Base Provider Number
The number assigned to the provider by Medicaid or
								as assigned by the certified statewide data processor (for batching
								only)
(B)
Federal Tax Number
Form Locator 5 - As stated in the North Carolina
								HCFA 1450 Manual
(4)
Zip Code of Patient Address
Form Locator 13 - Only the zip code portion of this
								field is required. Code as stated in the North Carolina HCFA 1450 Manual
(5)
Patient Birth Date
Form Locator 14 - As stated in the North Carolina
								HCFA 1450 Manual
(6)
Patient Sex
Form Locator 15 - As stated in the North Carolina
								HCFA 1450 Manual
(7)
Admission Date
Form Locator 17 - As stated in the North Carolina
								HCFA 1450 Manual
(8)
Admission Type
Form Locator 19 - As stated in the North Carolina
								HCFA 1450 Manual
(9)
Source of Admission
Form Locator 20 - As stated in the North Carolina
								HCFA 1450 Manual
(10)
Patient Status
Form Locator 22 - As stated in the North Carolina
								HCFA 1450 Manual
(11)
Discharge Date (Statement Covers Period)
Form Locator 6 - As stated in the North Carolina
								HCFA 1450 Manual
(12)
All Revenue Codes and Associated Charges
Form Locators 42 and 47 - As stated in the North
								Carolina HCFA 1450 Manual
(13)
Payer Identification
Form Locator 50a - Classification code and specific
								carrier identification
(14)
Certificate/Social Security/Health
Form Locator 60a - As stated in the Insurance
								Claim/Identification Number North Carolina HCFA 1450 Manual
(15)
Insurance Group Number
Form Locator 62a - As stated in the North Carolina
								HCFA 1450 Manual
(16)
Principal Diagnosis
Form Locator 67 - As stated in the North Carolina
								HCFA 1450 Manual
(17)
Other Diagnoses
8 Form Locators 68-75 - As stated in the North
								Carolina HCFA 1450 Manual
(18)
External Cause of Injury Code (E-Code)
Form Locator 77 - As stated in the North Carolina
								HCFA 1450 Manual/whenever the principal diagnosis is an injury, poisoning or
								adverse effect
(19)
Principal Procedure and Date
Form Locator 80 - As stated in the North Carolina
								HCFA 1450 Manual
(20)
Other Procedures and Dates
Form Locators 81a-e - As stated in the North
								Carolina HCFA 1450 Manual
(21)
Attending Physician Identification
Form Locator 82 - Only the UPIN is required. (Code
								as stated in the North Carolina HCFA 1450 Manual
(22)
Other Physician Identification
Form Locator 83 - Only the UPIN is required. Code
								as stated in the North Carolina HCFA 1450 Manual
(5) With regard to patient data concerning
				  ambulatory surgery patients released from hospitals and freestanding ambulatory
				  surgical facilities, the application must make a satisfactory showing that it
				  is capable of compiling and maintaining a uniform set of data from the patient
				  data which shall include the following HCFA 1500 data elements for every
				  ambulatory surgical patient released regardless of payor:
(1)
Payer Identification
(2)
Insured's ID Number
(3)
Patient's Date of Birth
(4)
Gender of Patient
(5)
Zip Code of Patient Address
(6)
Diagnosis or Nature of Illness or Injury
								(1-4)
(7)
Dates of Service
(8)
Place of Service
(9)
Type of Service
(10)
Procedures, Services, and Supplies (including
								modifiers if applicable)
(11)
Charges
(12)
Days or Units
(13)
Federal Tax ID
(14)
Patient's Account Number
(15)
Total Charge
(16)
Attending Physician's UPIN Number
(17)
Medicaid Base Provider Number or Number Assigned by
								Certified Statewide Data Processor
(6) The applicant must make a satisfactory
				  showing that it is capable of examining the patient data it receives for
				  accuracy, informing the hospital or freestanding ambulatory surgical facility
				  submitting the patient data of all potential errors in the patient data which
				  are discovered as a result of the examination for accuracy, and correcting the
				  patient data as directed by the hospital or freestanding ambulatory surgical
				  facility. An applicant shall be deemed to have satisfactorily shown that it is
				  capable of examining patient data for accuracy if the applicant has made a
				  satisfactory showing that it is capable of designating a record as an error
				  record when:
(a) A record reported on a HCFA
				  1450 (UB-92) form contains an invalid or all-blank field for any of the
				  following HCFA 1450 (UB-92) data elements: Patient Control Number, Bill Type,
				  Federal Tax I.D., Zip Code, Date of Birth, Sex, Admission Date, Admission Type,
				  Source of Admission, Patient Status, Statement Covers Period, Revenue Codes and
				  Charges, Primary Payer, Principal Diagnosis, Attending Physician
				  Identification.
(b) A record
				  reported on a HCFA 1500 form contains an invalid or all-blank field for any of
				  the following HCFA 1500 data elements: Payor Identification, Insured's I.D.
				  Number, Federal Tax I.D., Zip Code, Date of Birth, Sex, Dates of Service, Place
				  of Service, Type of Service, Procedures Defined with CPT-HCPCS Code with
				  Modifiers, Principal Diagnosis Codes, Principal and Secondary Surgical
				  Procedure, Patient's Account Number, Attending Physician
				  Identification.
(c) The sum
				  indicated by the data element concerning total charges does not equal the sum
				  of all other charges reported on the record.
(d) An inpatient record reported on a HCFA
				  1450 (UB-92) contains any of the following data elements which contain an
				  invalid code: Other Diagnoses, Principal Procedure Code and Date, Other
				  Procedure Codes and Dates, External Cause of Injury Code, Other Physician
				  Identification (if a procedure was performed).
(e) An ambulatory surgical patient record
				  reported on a HCFA 1450 (UB-92) form contains any of the following data
				  elements which contain an invalid code: Other Diagnoses, Other Procedure Codes
				  and Dates, External Cause of Injury Code.