Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 421 - HEALTH CARE INFORMATION › Subchapter D - COLLECTION AND RELEASE OF OUTPATIENT SURGICAL AND RADIOLOGICAL PROCEDURES AT HOSPITALS AND AMBULATORY SURGICAL CENTERS › Section 421.67 - Event Files-Records, Data Fields and Codes

Current through Reg. 49, No. 28; July 12, 2024
(a) Facilities shall submit event files, electronically in the file format
											  for outpatient bills defined by the American National Standards Institute (ANSI), commonly known as the ANSI
											  ASC X12N form 837 Health Care Claims transaction for institutional claims or ANSI ASC X12N form 837 Health
											  Care Claims transaction for professional claims. ANSI updates these formats from time to time by issuing new
											  versions and the United States Department of Health and Human Services adopts regulations regarding HIPAA
											  that update the version allowed for claim submissions.
(b) DSHS
											  will make detailed specifications for these data elements available to submitters and to the
											  public.
(c) In addition to the data elements contained in the
											  ANSI 837 Institutional Guide and the ANSI 837 Professional Guide, DSHS has specified the location where each
											  of the following data elements in this subsection shall be reported in the ANSI 837 Institutional Guide
											  format and the ANSI 837 Professional Guide format. Data element content, format and locations may change as
											  state legislative requirements, or federal legislative or regulation requirements change (i.e., HIPAA).
(1) Patient race - This data element shall be reported at Loop 2300 in the
											  K3 segment as the second numeric value in this data segment. Acceptable codes are 1 = American
											  Indian/Eskimo/Aleut, 2 = Asian or, Pacific Islander, 3 = Black, 4 = White and 5 = Other Race. In order to
											  obtain this data, the facility staff retrieves the patient's response from a written form or asks the
											  patient, or the person speaking for the patient to classify the patient. If the patient, or person speaking
											  for the patient, declines to answer, the facility staff is to use its best judgment to make the correct
											  classification based on available data.
(2) Patient ethnicity -
											  This data element shall be reported at Loop 2300 in the segment K3 as the first numeric value. Acceptable
											  codes are 1 = Hispanic or Latino Origin and 2 = Not of Hispanic or Latino Origin. In order to obtain this
											  data, the facility staff retrieves the patient's response from a written form or asks the patient, or the
											  person speaking for the patient to classify the patient. If the patient, or person speaking for the patient,
											  declines to answer, the facility staff is to use its best judgment to make the correct classification based
											  on available data.
(3) Other E-codes - These additional E-codes
											  (maximum of 9 other E-codes, a total of 10 E-codes may be submitted) shall be reported (if applicable) in the
											  following ANSI 837 Institutional Guide locations: Loop 2300, segments, HI05-2, HI06-2, HI07-2, HI08-2,
											  HI09-2, HI10-2, HI11-2 and HI12-2. (The first E-code is generally reported in Loop 2300 segment HI04-2).
											  E-codes may be submitted in the ANSI 837 Professional Guide in the following locations Loop 2300, data
											  fields: HI02-2, HI03-2, HI04-2, HI05-2, HI06-2, HI07-2 or HI08-2 if applicable preceded by "BN" qualifying
											  code in the respective data field HI02-1, HI03-1, HI04-1, HI05-1, HI06-1, HI07-1 or HI08-1.
(4) THCIC Identification Number - This data element shall be submitted in
											  data segment REF02 (Secondary Identification Number) of one of the following Loops where the patient received
											  the event services:
(A) Loop 2010AA associated with the "Billing Provider";
											  or
(B) Loop 2010AB associated with the "Pay-to provider";
											  or
(C) Loop 2310E (ANSI 837 Institutional Guide) or Loop 2310D
											  (ANSI 837 Professional Guide) associated with the "Service Facility Provider".