Section 590-241-2 - Hospital Inpatient and Outpatient Service Data Sets Filing DescriptionEach hospital shall file with the MHDO or its designee a completed hospital inpatient data set and a completed hospital outpatient data set for every service provided to each patient. A completed hospital data set includes professional and facility services as defined in the appendices.
A.General Requirements(1)Codes(a)Code Sources. The code sources listed and described in Appendix A are to be utilized with the inpatient and outpatient data file submissions.(b)Specific and Unique Coding. Except for location of service codes and provider number, specific or unique coding systems shall not be permitted as part of the inpatient and outpatient data submissions.(c)External Cause Codes. External Cause Codes shall be assigned for all initial treatments of an injury, poisoning, or adverse effect of drugs. If a patient is transferred to another facility for continued treatment, this facility shall also assign the appropriate External Cause Code.(2)Definitions for Required Data Elements. Unless otherwise specified, the definitions for the required data elements described in Appendix B-1 and Appendix C-1 are the same as those provided in the most current National Uniform Billing Data Element Specifications as developed by the National Uniform Billing Committee and approved by the State of Maine Uniform Billing Committee.(3)Inpatient Data Filing. Data for all inpatient services of the hospital must be submitted based on the discharge date and filed under the MHDO provider code assigned to that hospital.(4)Outpatient Data Filing. Data for all outpatient services of the hospital and all services provided by specialty groups or primary care practices must be filed in one or more outpatient data streams under the MHDO provider code assigned to that hospital. Every encounter that is populated with a designated subset of Place of Service codes must include a Location of Service code, internally created by the Hospital. Also, each hospital shall submit annually an updated Location of Service crosswalk, which includes unique location of service code, full location name, address, city, state, and zip code for those locations only.(5)Adjustment Charges. Adjustment charges and negative values are not to be reported in inpatient and outpatient data sets. The adjustment charges are reconciled to the individual line item for which the adjustment applies.B.Detailed File Specifications(1)Filled Fields. All fields shall be filled where applicable. Non-applicable text fields shall be space filled. Non-applicable numeric fields shall be zero filled and shall not include decimal points.(2)Position. All text fields are to be left justified. All numeric fields are to be right justified.(3)Individual Elements and Mapping. Individual data elements, data types, field lengths, and mapping locators (UB-04, CMS 1500, ANSI X12N 837) for each file type are presented in the following appendices:(a)(i) Inpatient Data Specifications - Appendix B-1(ii) Inpatient Data Mapping to National Standards Formats - Appendix B-2(b)(i) Outpatient Data Specifications - Appendix C-1(ii) Outpatient Data Mapping to National Standards Formats - Appendix C-290-590 C.M.R. ch. 241, § 2