DHS 120.13(2)(a)(a) Each freestanding ambulatory surgery center shall electronically submit to the department, as described in the department's data submission manual, all data elements specified in
sub. (1) for all ambulatory patient surgical procedures within 45 calendar days after the end of each calendar quarter. Calendar quarters shall begin on January 1, April 1, July 1 and October 1 and shall end on March 31, June 30, September 30 and December 31. The method of submission, data formats and coding specifications shall be defined in the department's data submission manual.
DHS 120.13(2)(b)
(b) The department may grant an extension of the time limits specified under
par. (a) only when the center adequately justifies to the department the center's need for additional time. In this paragraph, “adequate justification" means a delay due to a strike, fire, natural disaster or catastrophic computer failure. A center desiring an extension shall submit a request for an extension in writing to the department at least 10 calendar days prior to the date that the data are due. The department may grant an extension for up to 30 calendar days.
DHS 120.13(2)(c)
(c) Upon written request, the department shall provide consultation to a freestanding ambulatory surgical center to enable the requesting center to submit ambulatory patient surgical data according to the department's specifications.
DHS 120.13(2)(d)1.1. To ensure confidentiality, centers using qualified vendors to submit data shall provide to the department an original trading partner agreement that has been signed and notarized by the qualified vendor and the ambulatory surgery center.
DHS 120.13(2)(d)2.
2. Centers shall be accountable for their qualified vendor's failure to submit and edit data in the formats required by the department.
DHS 120.13(3)
(3) Freestanding ambulatory surgery center data verification, review and comment procedures. The data verification, review and comment procedures specified in
s. DHS 120.11 (1) to
(3) shall apply.
DHS 120.13(4)
(4) Physician verification, review and comment on freestanding ambulatory surgery center-submitted data. The data verification, review and comment procedures specified in
s. DHS 120.11 (1),
(2) and
(4) shall apply.
DHS 120.13(5)
(5) Data adjustment methods. The department shall adjust health care charge information for case mix and severity using commonly acceptable methods and tools designed for administrative claims information to perform adjustments for a class of health care providers.
DHS 120.13(6)
(6) Waiver from data submission requirements. There shall be no waivers from the data submission requirements under this section.
DHS 120.13(7)(a)(a) To be considered compliant with this chapter, a facility's data submission shall be all of the following:
DHS 120.13(7)(a)1.
1. Submitted to the department electronically, as specified in the data submission manual.
DHS 120.13(7)(a)3.
3. Meet the department standard of 10% or fewer records that do not pass the department's error checking procedures on or before the data submission due date.
DHS 120.13(7)(b)
(b) Facilities that fail to achieve a compliant data submission as required under this subsection may be subject to forfeitures.
DHS 120.13 History
History: Cr.
Register, December, 2000, No. 540, eff. 1-1-01;
CR 01-051: am. (2) (d) 1. and (7) (a) 1.,
Register September 2001 No. 549 eff. 10-1-01;
CR 03-033: am. (2) (a)
Register December 2003 No. 576, eff. 1-1-04.
DHS 120.14
DHS 120.14 Data to be submitted by physician class of provider. DHS 120.14(1)(a)(a)
Data to be collected. Physicians shall submit all of the following data elements:
DHS 120.14(1)(a)8.
8. The first date of illness, if patient has had same or similar illness.
DHS 120.14(1)(b)1.1. Non–exempt physicians shall submit claims information to the department in an electronic format using secure methods specified in a data submission manual provided by the department. Physicians who submit data through a qualified vendor shall require their vendor to comply with the requirements specified in this paragraph. In addition, qualified vendors shall sign a trading partner agreement.
DHS 120.14(1)(b)2.
2. Each physician shall submit his or her data to the department within 30 calendar days following the close of the reporting period. The department shall provide instructions on submission in a data submission manual.
DHS 120.14(1)(b)3.
3. The department may grant an extension of the deadline specified under
subd. 2. only when the physician adequately justifies to the department the physician's need for additional time. In this subdivision, “adequate justification" means a delay due to a strike, fire, natural disaster or catastrophic computer failure. A physician desiring an extension shall submit a request for an extension in writing to the department at least 10 calendar days prior to the date that the data are due. The department may grant an extension for up to 30 calendar days.
DHS 120.14(1)(b)4.a.a. To ensure confidentiality of the data is maintained, physicians using qualified vendors to submit data shall provide to the department an original trading partner agreement that has been signed and notarized by the qualified vendor and the physician.
DHS 120.14(1)(b)4.b.
b. A physician or his or her delegated representative shall be accountable for his or her qualified vendor's failure to submit and edit data in the format required by the department.
DHS 120.14(1)(b)5.
5. A health care provider that is not a hospital or ambulatory surgery center shall, before submitting information required by the department under this chapter, convert any names of an insured's payer or other insured's payer to a payer category code as specified by the department in its data submission manual.
DHS 120.14(1)(b)6.
6. A health care provider or qualified vendor may not submit information that uses any of the following as a patient account number:
DHS 120.14(1)(b)6.a.
a. The patient's social security number or any substantial portion of the patient's social security number.
DHS 120.14(1)(c)1.1. The department shall check the accuracy and completeness of all submitted data.
DHS 120.14(1)(c)2.
2. The department may not retain or release any of the following data elements if the department receives the elements:
