reglab/statecodes huggingface dataset:
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 912 - DATA REPORTING REQUIREMENTS › Subchapter B - PENNSYLVANIA UNIFORM CLAIMS AND BILLING FORM SUBMISSION SCHEDULES › GENERAL PROVISIONS › Section 912.24 - Frequency of data submissions

Current through Register Vol. 54, No. 28, July 13, 2024
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.
This section cited in 28 Pa. Code §
													912.22 (relating to data element
						  submission schedules).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 912 - DATA REPORTING REQUIREMENTS › Subchapter B - PENNSYLVANIA UNIFORM CLAIMS AND BILLING FORM SUBMISSION SCHEDULES › EXCEPTIONS › Section 912.31 - Principle

Current through Register Vol. 54, No. 28, July 13, 2024
The Council may, within its discretion and for good
						reason, grant exceptions to sections within this chapter when the policy and
						objectives of this chapter and the act are otherwise met.
The provisions of this §
													912.31 amended under section 5(b)
						  of the Health Care Cost Containment Act (35 P. S. §
														449.5(b)).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 912 - DATA REPORTING REQUIREMENTS › Subchapter B - PENNSYLVANIA UNIFORM CLAIMS AND BILLING FORM SUBMISSION SCHEDULES › EXCEPTIONS › Section 912.32 - Requests for exceptions

Current through Register Vol. 54, No. 28, July 13, 2024
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.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 912 - DATA REPORTING REQUIREMENTS › Subchapter B - PENNSYLVANIA UNIFORM CLAIMS AND BILLING FORM SUBMISSION SCHEDULES › EXCEPTIONS › Section 912.33 - Revocation of exceptions

Current through Register Vol. 54, No. 28, July 13, 2024
(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.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 912 - DATA REPORTING REQUIREMENTS › Subchapter B - PENNSYLVANIA UNIFORM CLAIMS AND BILLING FORM SUBMISSION SCHEDULES › INTERPRETATIONS › Section 912.41 - Definition for major ambulatory service

Current through Register Vol. 54, No. 28, July 13, 2024
(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.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 912 - DATA REPORTING REQUIREMENTS › Subchapter C - FINANCIAL REPORTING REQUIREMENTS › Section 912.61 - Annual audited financial statements

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				  For fiscal years beginning January 1, 1988, and thereafter, a hospital and
				  ambulatory service facility providing covered services shall file annual
				  audited financial statements within 120 days after the close of the fiscal
				  year.
(b) The financial statements
				  shall be certified by an independent certified public accountant who shall
				  render an opinion that the statements have been prepared in accordance with
				  generally accepted accounting principles, and on the financial position,
				  results of operations and changes in financial positions of the hospital as of
				  and for the period then ended.
(c)
				  The certified annual statements shall contain the following:
(1) A balance sheet detailing the assets,
				  liabilities and net worth of the hospital or ambulatory service
				  facility.
(2) A statement of
				  revenue and expenses that fully discloses deductions from revenue according to
				  contractual adjustments and other deductions.
(3) A statement of changes in financial
				  position.
(4) Footnotes to
				  financial statements.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 912 - DATA REPORTING REQUIREMENTS › Subchapter C - FINANCIAL REPORTING REQUIREMENTS › Section 912.62 - Quarterly summary utilization and financial reports

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A hospital and ambulatory care facility
				  providing covered services shall compile data following instructions on report
				  format HC-87-Q1 beginning May 1, 1988.
(b) Quarterly summary utilization and
				  financial reports, due 45 days following each quarter, shall be sent to the
				  Council beginning with the first quarter of 1988. Report formats shall follow
				  the instructions and Form HC-87-Q1.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 912 - DATA REPORTING REQUIREMENTS › Subchapter C - FINANCIAL REPORTING REQUIREMENTS › Section 912.63 - Medicare cost reports and Medical Assistance Form 336

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A provider is required to submit to the
				  Council a copy of its Medicare cost report and Medical Assistance Form 336 at
				  the time they are due to the Department of Welfare or the Health Care Financing
				  Administration or within 120 days of the close of its fiscal year reporting
				  period.
(b) A provider is required
				  to submit the settled Medicare cost report and certified MA 336 Form within 30
				  days of the final settlement.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 912 - DATA REPORTING REQUIREMENTS › Subchapter D - OTHER REQUIREMENTS › Section 912.81 - Provider information

Current through Register Vol. 54, No. 28, July 13, 2024
A provider shall submit the following information annually
					 on a form designed by the Council and in accordance with a submission schedule
					 developed by the Council.
(1)
Physicians on staff.
A health care facility shall submit a
				  listing of hospital-based and nonhospital-based physicians on the active,
				  associate, courtesy and consulting medical staff. The listing shall include
				  physician name, Pennsylvania license number and clinical specialty. The listing
				  shall indicate whether the physician is Board-certified in the listed
				  specialties.
(2)
Medicare
				  assignment.
A physician shall indicate whether the physician accepts
				  Medicare assignment as full payment for services.
(3)
Medical Assistance
				  participation.
A physician shall indicate whether the physician is
				  registered as a provider with the Commonwealth's Medical Assistance Program. If
				  the physician is registered, the number assigned by the Medical Assistance
				  Program shall be listed.
(4)
Accreditation, certification and licensure.
A provider shall
				  submit information concerning accreditation, certification and licensure of the
				  facility by the Commonwealth; the Joint Commission on the Accreditation of
				  Health Care Organizations, the American Osteopathic Association, or certified
				  for Medicare Conditions of Participation; and the Commission on the
				  Accreditation of Rehabilitation Facilities. The information shall include the
				  accrediting/certifying/licensing agency, the type of
				  accreditation/certification/licensure and the term, including the expiration
				  date.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 913 - PAYOR DATA REPORTING REQUIREMENTS › Subchapter A - GENERAL PROVISIONS › Section 913.1 - Legal base and purpose

Current through Register Vol. 54, No. 28, July 13, 2024
(a) This chapter
				  is promulgated by the Council under section 6 of the Health Care Cost
				  Containment Act (35 P. S. §
											449.6).
(b) This chapter establishes data elements,
				  submission schedules and data element formats for the collection of the data
				  elements from payors as specified in section 6 of the act.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 913 - PAYOR DATA REPORTING REQUIREMENTS › Subchapter A - GENERAL PROVISIONS › Section 913.2 - Affected parties

Current through Register Vol. 54, No. 28, July 13, 2024
This chapter applies to payors for covered services
					 rendered in health care facilities licensed by the
					 Commonwealth.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 913 - PAYOR DATA REPORTING REQUIREMENTS › Subchapter B - DATA SUBMISSION SCHEDULES › Section 913.21 - Required data elements

Current through Register Vol. 54, No. 28, July 13, 2024
A payor is required to submit data elements specified in
					 the act contained in Council Manual HC-87-101, Volume B. See Appendix A. Payors
					 shall refer to Appendix A to determine specific data element
					 definitions.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 913 - PAYOR DATA REPORTING REQUIREMENTS › Subchapter B - DATA SUBMISSION SCHEDULES › Section 913.22 - Data element submission formats

Current through Register Vol. 54, No. 28, July 13, 2024
A payor shall submit data elements to the Council according
					 to computer tape format specifications contained in Council Manual HC-87-101,
					 Volume B (Appendix A) on nine track labeled 1600 or 6250 BPI (density) tape or
					 computer diskette approved by the Council.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 913 - PAYOR DATA REPORTING REQUIREMENTS › Subchapter B - DATA SUBMISSION SCHEDULES › Section 913.23 - Data element submission schedules

Current through Register Vol. 54, No. 28, July 13, 2024
A payor shall submit data according to the following
					 schedules:
(1)
Inpatient
				  data.
A payor shall submit data elements for inpatient discharges
				  beginning with discharges which occurred during the first quarter of 1988. This
				  data shall be submitted on or before September 30, 1988 and thereafter, under
				  §
										913.24 (relating to frequency of
				  data submissions).
(2)
Outpatient data.
A payor shall submit data elements for
				  outpatient services rendered beginning with the fourth quarter of 1988. This
				  data shall be submitted on or before June 30, 1989 and thereafter, under §
				  913.24.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 913 - PAYOR DATA REPORTING REQUIREMENTS › Subchapter B - DATA SUBMISSION SCHEDULES › Section 913.24 - Frequency of data submissions

Current through Register Vol. 54, No. 28, July 13, 2024
Data elements required to be submitted under this
					 subchapter shall be submitted on a quarterly basis. The data elements will be
					 due to the Council by the last day of the 6th month following the close of the
					 quarter.
This section cited in 28 Pa. Code §
												913.23 (relating to data element
						submission formats).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 913 - PAYOR DATA REPORTING REQUIREMENTS › Subchapter C - EXCEPTIONS › Section 913.31 - Principle

Current through Register Vol. 54, No. 28, July 13, 2024
The Council may, within its discretion and for good reason,
					 grant exceptions to sections within this chapter when the policy and objectives
					 of this chapter and the act are otherwise met.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 913 - PAYOR DATA REPORTING REQUIREMENTS › Subchapter C - EXCEPTIONS › Section 913.32 - Requests for exceptions

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A
				  request for an exception shall be made in writing 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. Except as
				  provided for in subsection (b), 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 the 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.
(b) A request for an exception for the first
				  reporting period, that is, data due to the Council by September 30, 1988, shall
				  be received and deemed as complete by the Council by 5 p.m. on August 15, 1988.
				  The Council will act within 30 days of the completed request.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 913 - PAYOR DATA REPORTING REQUIREMENTS › Subchapter C - EXCEPTIONS › Section 913.33 - Revocation of exceptions

Current through Register Vol. 54, No. 28, July 13, 2024
(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 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 payor to come into compliance with this chapter. Failure by the payor to
				  comply after the specified date may result in enforcement
				  proceedings.
(c) If a payor 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.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 913 - PAYOR DATA REPORTING REQUIREMENTS › Subchapter D - INTERPRETATIONS › Section 913.41 - Definition for major ambulatory service

Current through Register Vol. 54, No. 28, July 13, 2024
(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.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 913 - PAYOR DATA REPORTING REQUIREMENTS › Subchapter D - INTERPRETATIONS › Appendix B - FORMAT OF DICTIONARY FOR THE IDENTIFICATION OF PHYSICIANS AND FACILITIES

Current through Register Vol. 54, No. 28, July 13, 2024
DATA ELEMENT
DATA
								ELEMENT DESCRIPTION
POSITION
PICTURE
FORMAT
FROM
TO
1
Record Type
1
9(1)
1 = Physician Identifier record 2 = Facility Identifier record
2
Identifier Type
2
9(1)
1 = Tax I.D. Number 2 = Medicare I.D. Number/Social Security Number 3
								= Unique Number for Physician (only)
3
Identifier
								Number
3
20
X(17)
Number identifying the
								physician or facility. Left justify. Blank fill right.
4
Physician/Facility
								Name
21
65
X(45)
The Name of the facility or
								the name of the physician. If name of the physician, place in order as follows:
								Last name followed by a space, first name followed by a space, middle initial.
								Blank fill right.
5
Physician/Facility
								Address
66
150
X(85)
Left justify. Blank fill
								right. (Include street address, city, state, zip.)
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 915 - DATA ACCESS CRITERIA AND PROCEDURE › GENERAL PROVISIONS › Section 915.1 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
This chapter establishes criteria and procedures for access
					 to Council data under sections 4, 5, 7 and 10 of the act (35 P. S. §§
											449.4,
					 449.5,
					 449.7 and
					 449.10).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 915 - DATA ACCESS CRITERIA AND PROCEDURE › GENERAL PROVISIONS › Section 915.4 - Entities with access

Current through Register Vol. 54, No. 28, July 13, 2024
Data will be available from the Council, in accordance with
					 this chapter, to purchasers and other parties.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 915 - DATA ACCESS CRITERIA AND PROCEDURE › CONFIDENTIALITY PROTECTIONS › Section 915.21 - Classes of data collected by the Council

Current through Register Vol. 54, No. 28, July 13, 2024
For purposes of this chapter, the data collected by the
					 Council have been classified into three categories:
(1) Nondisclosable data which includes the
				  data set forth in Appendix A.
(2)
				  Protected data which includes the data set forth in Appendix B.
(3) Nonprotected data which includes the data
				  as set forth in Appendix C.
This section cited in 28 Pa. Code §
												915.2 (relating to principles
						governing data access).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 915 - DATA ACCESS CRITERIA AND PROCEDURE › CONFIDENTIALITY PROTECTIONS › Section 915.22 - Release of nondisclosable data

Current through Register Vol. 54, No. 28, July 13, 2024
Nondisclosable data, as set forth in Appendix A, will not
					 be released by the Council to a party, except to the original data source as
					 provided for under §
										915.51(b)
					 (relating to procedures for access to Council data by data
					 sources).
This section cited in 28 Pa. Code §
												915.2 (relating to principles
						governing data access).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 915 - DATA ACCESS CRITERIA AND PROCEDURE › CONFIDENTIALITY PROTECTIONS › Section 915.23 - Release of protected data

Current through Register Vol. 54, No. 28, July 13, 2024
Protected data, as set forth in Appendix B, will only be
					 released upon approval by the Council and if the release is in accordance with
					 the following criteria and under the following conditions:
(1) Data will be released only if there are a
				  minimum of ten cases in a cell, except for data which is a monetary figure.
				  Cells with less than ten cases will be suppressed.
(2) If there are less than ten cases in a
				  cell, the Council may create categories or may aggregate data to provide some
				  detail on the data element to the data requester.
(3) The following data may be released only
				  to a purchaser and only for those individuals for whom the purchaser provided
				  covered health care services:
(i) Estimated
				  responsibility.
(ii) Prior
				  payments-payor and patient.
(iii)
				  Estimated amount due.
(iv) Payor
				  group number.
(v) Employer
				  name.
(vi) Primary payor
				  payments.
(vii) Other
				  payments.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 915 - DATA ACCESS CRITERIA AND PROCEDURE › CONFIDENTIALITY PROTECTIONS › Section 915.24 - Release of nonprotected data

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				  Nonprotected data, as set forth in Appendix C, will be released upon request
				  and approval by the Council except as provided for in subsection (b).
(b) The Council may prohibit the release of
				  disaggregated data on sensitive medical conditions, procedures and diagnoses
				  such as, but not limited to, substance abuse, mental diseases and disorders,
				  acquired immunodeficiency syndrome and related conditions and pregnancy
				  terminations, to ensure that the patient confidentiality safeguards contained
				  in the act and this chapter are not violated.
This section cited in 28 Pa. Code §
												915.2 (relating to principles
						governing data access).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 915 - DATA ACCESS CRITERIA AND PROCEDURE › CONFIDENTIALITY PROTECTIONS › Section 915.25 - Unauthorized use of or access to Council data

Current through Register Vol. 54, No. 28, July 13, 2024
(a) If a person inadvertently or by Council
				  error gains access to data that violates the safeguards in section 10 of the
				  act (35 P. S. §
											449.10), the
				  data shall be returned, without duplication, to the Council with proper notice.
				  If the data have been duplicated, duplications shall also be returned to the
				  Council.
(b) A person who knowingly
				  releases Council data violating the patient confidentiality, actual payments,
				  discount data or raw data safeguards in section 10 of the act to an
				  unauthorized person commits a misdemeanor of the first degree and shall, upon
				  conviction, be sentenced to pay a fine of $10,000 or to imprisonment of not
				  more than 5 years, or both. An unauthorized person who knowingly receives or
				  possesses the data commits a misdemeanor of the first degree.
(c) Sale by a recipient or exchange or
				  publication by a recipient, other than a purchaser, of raw Council data to
				  other parties without the express written consent of, and under terms approved
				  by, the Council shall be unauthorized use of Council data. Unauthorized use of
				  Council data constitutes a misdemeanor of the first degree and, upon
				  conviction, that person shall be sentenced to pay a fine of $10,000 or to
				  imprisonment for not more than 5 years, or both. This restriction does not
				  apply to data published by the Council in reports.
This section cited in 28 Pa. Code §
												915.2 (relating to principles
						governing data access).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 915 - DATA ACCESS CRITERIA AND PROCEDURE › PROCEDURES FOR ACCESSING COUNCIL DATA › Section 915.31 - Procedure for requesting access to Council data

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A request for access to data, including
				  computer-to-computer access, shall be made in writing to the Executive Director
				  of the Council on a form prescribed by the Council. This form will require:
(1) The name of the party requesting the
				  data.
(2) The name, title, address
				  and telephone number of the contact person for the request.
(3) A description of the information to which
				  access is requested, including a description of the desired tape format and
				  list of data elements.
(4)
				  Information on the purpose or intended use of the data.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 915 - DATA ACCESS CRITERIA AND PROCEDURE › PROCEDURES FOR ACCESSING COUNCIL DATA › Section 915.32 - Approval of request for Council data

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Upon receipt of a completed form
				  requesting access to Council data, including computer-to-computer access, the
				  Executive Director will forward the request to the Council which will make a
				  determination to grant or deny the request.
(b) In making the determination to grant the
				  request, the Council is to be satisfied that:
(i) The limitations on data access contained
				  in the act will not be compromised.
(ii) This chapter's provisions regarding
				  confidentiality will not be compromised.
(iii) The data will be used for the legal and
				  statutory purposes as specified in the act.
(iv) Other criteria for the release of the
				  data are met.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 915 - DATA ACCESS CRITERIA AND PROCEDURE › PROCEDURES FOR ACCESSING COUNCIL DATA › Section 915.33 - Appeal of denial of request for data

Current through Register Vol. 54, No. 28, July 13, 2024
(a) If a request for data is denied by the
				  Council, a notice detailing the reasons for the denial will be forwarded to the
				  requester.
(b) If the Council
				  delegates the approval or denial of a request for access to Council data to the
				  Executive Director and the Executive Director denies a request for data, the
				  Executive Director will forward notice of the denial and the reasons for the
				  denial to the requester. Upon request by the party denied access, the Executive
				  Director will forward the request to the members of the Council for their
				  consideration. If the Council subsequently denies the request for data, the
				  Council will forward notice of the denial and the reasons for the denial to the
				  requester.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 915 - DATA ACCESS CRITERIA AND PROCEDURE › PROCEDURES FOR OBTAINING SPECIAL REPORTS › Section 915.41 - Procedure for requesting special reports to be prepared by Council

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A request for
				  special reports shall be made in writing to the Executive Director of the
				  Council on a form prescribed by the Council. This form will require:
(1) The name of party requesting the
				  data.
(2) The name, title, address
				  and telephone number of the contact person for the request.
(3) A description of the information to be
				  contained in the special report, including the time period, a description of
				  desired tables, charts, analysis and report format, as applicable.
(4) The purpose or intended use of the
				  report.
(5) The date when the
				  report is to be completed.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 915 - DATA ACCESS CRITERIA AND PROCEDURE › PROCEDURES FOR OBTAINING SPECIAL REPORTS › Section 915.42 - Approval of request for a special report

Current through Register Vol. 54, No. 28, July 13, 2024
Upon receipt of a completed form requesting a special
					 report, the Council will review the request and determine whether the report
					 can be provided by the Council. In making the determination, the Council will
					 consider the utility of the report, the staff resources necessary to complete
					 the report, the purpose of the report with respect to the mandates contained in
					 the act, the time frame in which the report is requested to be produced and
					 other criteria developed by the Council.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 915 - DATA ACCESS CRITERIA AND PROCEDURE › MISCELLANEOUS PROVISIONS › Section 915.51 - Procedures for access to Council data by data sources

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Hospitals, health care facilities,
				  third-party payors and other data sources shall have access to Council data
				  following the same procedures for access and under the same conditions of
				  confidentiality protections as other requesters.
(b) Notwithstanding the provisions of §
										915.23(3)
				  (relating to release of protected data), a data source that has submitted data
				  elements to the Council has the right to access data elements which have been
				  submitted to the Council under Chapters 912 and 913 (relating to data reporting
				  requirements; and payor data reporting requirements).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 915 - DATA ACCESS CRITERIA AND PROCEDURE › MISCELLANEOUS PROVISIONS › Section 915.52 - Fees charged for Council data and special reports

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The Council will charge requesters an
				  amount sufficient to cover the costs associated with providing access to
				  Council data, including computer-to-computer access, including, but not limited
				  to, computer time, cost of materials and staff time. Subsequent requests for
				  the same information will require a fee sufficient to cover only the costs of
				  duplicating the original access. Fee quotes will be provided to requesters in
				  advance of the special request being processed. Special requests will be
				  completed only upon an agreement by the requester to pay the quoted
				  fee.
(b) The Council will charge
				  requesters an amount sufficient to cover preparation and provision of special
				  reports, including, but not limited to, computer time, staff time, cost of
				  materials, and the like. Subsequent requests for the same information will pay
				  a fee only to cover the provision of the report. The Council may waive the fee
				  if the Council determines that the special report is of great public interest.
				  The Council will not charge a fee for reports to be provided under the
				  act.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 915 - DATA ACCESS CRITERIA AND PROCEDURE › MISCELLANEOUS PROVISIONS › Appendix A - NONDISCLOSABLE DATA

Current through Register Vol. 54, No. 28, July 13, 2024
Field Number
Data
								Element Name
FRM
PRM
1
3
Uniform Patient I. D.
2
4
Patient Birthdate (MDY of MY)
4
-
Patient Zip Code (6 through 9
								digits)
5
6
Date of Admission (MDY)
6
7
Date of Discharge (MDY)
8a, b
8
Principle Procedure Date
9a1-9c2
-
Secondary Procedure
								Date
23
17
Patient Control Number
29a-c
20
Certificate/Social
								Security Number/Health Insurance Claim/I. D. Number
FRM-Facility Reporting Manual
PRM-Payor Reporting Manual
This appendix cited in 28 Pa. Code §
												915.3 (relating to definitions);
						28 Pa. Code §
												915.21 (relating to classes of
						data collected by the Council); and 28 Pa. Code §
												915.22 (relating to release of
						nondisclosable data).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 915 - DATA ACCESS CRITERIA AND PROCEDURE › MISCELLANEOUS PROVISIONS › Appendix B - PROTECTED DATA

Current through Register Vol. 54, No. 28, July 13, 2024
Field Number
Data Element Name
FRM
PRM
(2*)
(4*)
Year of Birth/Age
3
5
Patient Sex
4
-
Patient Zip Code (first 5 digits)
14e 1-4
-
Estimated Responsibility
14f 1-4
-
Prior Payments-Payor and
							 Patient
14g 1-4
-
Estimated Amount Due
19
16
Payor Group Number
21e
21
Reserve Field
28a-c
19
Patients' Relationship to
							 Insured
32
-
Employer Name
35
-
Patient Race
-
14
Primary Payor Payments
-
15
Other Payments
*
*
Proxy Patient Identifier
* constructed data element using submitted data
					 elements
FRM-Facility Reporting Manual
PRM-Payor Reporting Manual
This appendix cited in 28 Pa. Code §
												915.3 (relating to definitions);
						28 Pa. Code §
												915.21 (relating to classes of
						data collected by the Council); and 28 Pa. Code §
												915.23 (relating to release of
						protected data).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 915 - DATA ACCESS CRITERIA AND PROCEDURE › MISCELLANEOUS PROVISIONS › Appendix C - NONPROTECTED DATA

Current through Register Vol. 54, No. 28, July 13, 2024
Field Number
Data Element
							 Name
FRM
PRM
(5/6*)
-
Length of Stay
(5/6*)
-
Day of Week, Admit
(5/6*)
-
Day of Week, Dchg.
7a
-
Principal Diagnosis Code
7b-e
-
Secondary Diagnosis Codes
(8*)
-
Day of Week of Procedure
(8*)
-
Pre-operative LOS
8a, b
8
Principal Procedure Code
9a1-9c2
-
Secondary Procedure Code
10
9
Uniform Identifier for Health
							 Care Facility
11
10
Attending Physician ID
12
10
Operating Physician ID
13a1-13w1
-
Revenue Description
13a2-13w2
-
Revenue Code
13a3-13w3
12
Units of Service
13a4-13w4
13
Total Charges (by
							 Revenue Code Category)
13a5-13w5
-
Noncovered Charges (by
							 Revenue Category)
14b1-3
-
Payor Identification
14c1-3
-
Deductible Amount
14d1-3
-
Co-Insurance Amount
17
-
Uniform Identifier of Primary
							 Payor
18
-
Zip code of Facility
20
-
Patient Discharge Status
21a
-
Patient Severity upon Admission
21b
-
Patient Morbidity
21c
-
Unusual Occurrence-Nosocomial
							 Infections
21d
-
Unusual
							 Occurrence-Readmission
22
-
Type of Bill
24
-
Diagnosis Related Group
25
18
Procedure Coding Method Used
26
-
Type of Admission
27
-
Source of Admission
30
-
Principal and other Diagnoses
							 Descriptions
31
-
Principal and other Procedure
							 Descriptions
33a, b
-
Employment Information
34a, b
-
Employment Status Code
-
2
Place of Service
-
11
Type of Professional Service
* constructed data element using submitted data
					 elements
FRM-Facility Reporting Manual
PRM-Payor Reporting Manual
This appendix cited in 28 Pa. Code §
												915.3 (relating to definitions);
						28 Pa. Code §
												915.21 (relating to classes of
						data collected by the Council); and 28 Pa. Code §
												915.24 (relating to release of
						nonprotected data).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter A - Reserved › Section 1001.1 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.1 amended under the
						  Do-Not-Resuscitate Act, 20 Pa.C.S. Chapter 54; reserved under the Emergency
						  Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter A - Reserved › Section 1001.2 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.2 amended under the
						  Do-Not-Resuscitate Act, 20 Pa.C.S. Chapter 54; reserved under the Emergency
						  Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter A - Reserved › Section 1001.3 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.3 amended under the
						  Do-Not-Resuscitate Act, 20 Pa.C.S. Chapter 54; reserved under the Emergency
						  Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter A - Reserved › Section 1001.4 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.4 amended under the
						  Do-Not-Resuscitate Act, 20 Pa.C.S. Chapter 54; reserved under the Emergency
						  Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter A - Reserved › Section 1001.5 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.5 amended under the
						  Do-Not-Resuscitate Act, 20 Pa.C.S. Chapter 54; reserved under the Emergency
						  Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter A - Reserved › Section 1001.6 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.6 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter A - Reserved › Section 1001.7 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.7 adopted October 13, 2000,
						  effective October 14, 2000, 30 Pa.B. 5363; reserved October 11, 2013, effective
						  October 12, 2013, 43 Pa.B. 6093.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter B - Reserved › Section 1001.21 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.21 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter B - Reserved › Section 1001.22 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.22 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter B - Reserved › Section 1001.23 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.23 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter B - Reserved › Section 1001.24 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.24 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter B - Reserved › Section 1001.25 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.25 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter B - Reserved › Section 1001.26 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.26 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter B - Reserved › Section 1001.27 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.27 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter B - Reserved › Section 1001.28 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.28 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter C - Reserved › Section 1001.41 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.41 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter C - Reserved › Section 1001.42 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.42 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter D - Reserved › Section 1001.61 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.61 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter D - Reserved › Section 1001.62 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.62 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter D - Reserved › Section 1001.65 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.65 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter E - Reserved › Section 1001.81 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.81 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter E - Reserved › Section 1001.82 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.82 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter E - Reserved › Section 1001.83 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.83 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter E - Reserved › Section 1001.84 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.84 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter F - Reserved › Section 1001.101 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.101 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter G - Reserved › Section 1001.121 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.121 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter G - Reserved › Section 1001.122 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.122 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter G - Reserved › Section 1001.123 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.123 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter G - Reserved › Section 1001.124 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.124 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter G - Reserved › Section 1001.125 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.125 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VII - Emergency Medical Services › Subpart A - EMS System › Chapter 1001 - RESERVED › Subchapter H - Reserved › Section 1001.141 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
													1001.141 reserved under the
						  Emergency Medical Services System Act,
						  35 Pa.C.S. §§
														8101-8157.