North Dakota Administrative Code › Title 33 - State Department of Health › Article 33-03 - State Department of Health › Chapter 33-03-23 - Health Care Claims Data › Section 33-03-23-02 - Requests for data

Current through Supplement No. 393, July, 2024
The committee may require data suppliers and agencies of
				  state government to provide certain data and information.
1. The committee shall establish uniform
				formats for the different types of data for use by data suppliers in providing
				hospitalization data, health professional data, nursing home data, health
				maintenance organization data, and other types of data as the committee finds
				necessary.
2. Data required to be
				submitted must be provided to the committee in the format established or, if
				the data supplier requests in writing, in a format which is technically
				equivalent and which supplies all of the necessary information. Third-party
				payers who cannot meet these reporting specifications and third-party payers
				who demonstrate that it is not economically feasible to report in accordance
				with these specifications shall request in writing approval to report the data
				in a specific, alternative form. These requests must be submitted to and
				approved inwriting by the department.
3. Data requests must be specific regarding
				the time period covered, data elements to be provided, and the form and format
				in which the data is to be provided.
4. Hospital data required to be provided must
				be limited to those data elements provided for on the health care financing
				administration form UB-92 (or replacement form) using the current definitions
				developed by the North Dakota uniform billing committee, and, as specified by
				the health care data committee, other data commonly collected in the course of
				billing and obtaining reimbursement of claims.
5. Health professional data required to be
				provided must be limited to those data elements provided for on the health care
				financing administration form 1500 or successor form or other forms specified
				by the health care data committee, and, as specified by that committee other
				data commonly collected in the course of billing and obtaining reimbursement of
				claims.
6. Data must be provided
				within sixty days of the committee's request for data. A fifteen-day extension
				of time for providing data may be granted if the data supplier adequately
				justifies the delay.
7. Prior to
				collecting hospital data or health professional data from any data supplier,
				the data supplier must be provided an exact format for reporting data and an
				explicit description of each data item to be reported. Descriptions of data
				elements shall include specifications in terms of form location, definitions
				and alternate specifications, and definitions for those data suppliers that do
				not maintain the exact UB-92 data as described in the North Dakota uniform
				billing procedures manual, or for data elements not provided for in the
				HCFA-1500 medicare carriers manual (as revised). Those data suppliers that
				maintain similar elements shall report the comparable data elements that they
				maintain and a detailed code structure for each element to the department.
8. Data must be collected at least
				annually but not more often than quarterly from the following data suppliers:
a. Those comprehensive health association of
				North Dakota members, including health maintenance organizations, found by the
				North Dakota commissioner of insurance to be subject to an assessment of one
				percent or more as a participating member of the comprehensive health
				association of North Dakota, and any data supplier whose annual written premium
				is 0.5 percent or more of the total annual written premiums for individual or
				for group medical and major medical policies, as determined by the latest
				survey or census of insurance carriers conducted by the North Dakota
				commissioner of insurance, and any data supplier whose annual written premium
				for hospital-surgical expense coverage is one million dollars or more as
				determined by the latest survey or census of the North Dakota commissioner of
				insurance.
b. The committee may
				request, but may not require, that self-funded group health plans submit claims
				data.
c. State agencies that have
				paid any claims for hospital or health professional services during the
				calendar year, including medicare and medicaid data in the possession of the
				agency.