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246-455-010  <<  246-455-020 >>   246-455-040

PDFWAC 246-455-020

Reporting of UB-04 data set information.

(1) Hospitals shall collect and report the following data set elements to the department:
(a) Patient control number
Patient's unique alpha-numeric number assigned by the hospital to facilitate retrieval of individual patient records
(b) Type of bill
(c) National Provider Identifier (UB-04), or department assigned identifier, as applicable
(d) Patient last name (at least the first four letters)
(e) Patient first name (at least the first three letters)
(f) Patient middle initial
(g) Patient Social Security number (at least the last four digits)
(h) Patient zip code (U.S.A.)
(i) Patient country code (outside U.S.A.) International Organization for Standardization (ISO) 3166-1
(j) Patient's date of birth
(k) Sex
(l) Admission date
(m) Type of admission
(n) Point of origin for admission
(o) Patient discharge status
(p) Statement covers period (from - through)
(q) Revenue code
(r) Units of service
(s) Total charges
(t) Payer identification (up to three): Payer identification number per the CHARS procedure manual identifying each payer group from which the hospital may expect some payment of the bill
(u) Principal diagnosis code
(v) Other diagnosis codes
(w) External cause of injury (ECI) code
(x) Principal procedure code
(y) Other procedure code
(z) Attending provider identifier National Provider Identifier according to Centers for Medicare and Medicaid Services (CMS) schedule
(aa) Operating physician identifier National Provider Identifier according to CMS schedule, as applicable
(bb) Other provider identifiers National Provider Identifier according to CMS schedule, as applicable
(cc) Admission hour
(dd) Race - Per minimum Office of Management and Budget (OMB) standards
(ee) Ethnicity - Per minimum OMB standards
(ff) Discharge hour
(gg) Procedure date
(hh) Present on admission status
(ii) Health care provider taxonomy code
(jj) Health care common procedure coding system (HCPCS)
(kk) Service date
(2) The hospital shall report all patient discharge data described in WAC 246-455-010 and 246-455-020 according to UB-04 specifications unless noted otherwise.
[Statutory Authority: RCW 43.70.052, 2014 c 220. WSR 15-19-152, § 246-455-020, filed 9/22/15, effective 10/23/15. Statutory Authority: RCW 43.70.040 and 43.70.052. WSR 07-09-091, § 246-455-020, filed 4/18/07, effective 5/23/07. Statutory Authority: RCW 43.70.040 and [43.]70.170. WSR 03-13-029, § 246-455-020, filed 6/10/03, effective 7/11/03. Statutory Authority: RCW 43.70.040 and chapter 70.170 RCW. WSR 94-12-090, § 246-455-020, filed 6/1/94, effective 7/2/94. Statutory Authority: RCW 43.70.040. WSR 91-02-049 (Order 121), recodified as § 246-455-020, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 70.39 RCW. WSR 87-08-037 (Order 87-02, Resolution No. 87-02), § 261-50-030, filed 3/30/87; WSR 87-04-008 (Order 87-01, Resolution No. 87-01), § 261-50-030, filed 1/23/87. Statutory Authority: RCW 70.39.180. WSR 86-14-081 (Order 86-03, Resolution No. 86-03), § 261-50-030, filed 7/1/86; WSR 85-17-020 (Order 85-05, Resolution No. 85-05), § 261-50-030, filed 8/13/85. Statutory Authority: Chapter 70.39 RCW. WSR 84-20-067 (Order 84-06, Resolution No. 84-06), § 261-50-030, filed 10/1/84.]
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