28 Pa. Code § 911.1
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Act-The Health Care Cost Containment Act (35 P. S. §§ 449.1-449.19).
Ambulatory service facility-A facility licensed in this Commonwealth, not part of a hospital, which provides medical, diagnostic or surgical treatment to patients not requiring hospitalization. The term includes, but is not limited to, ambulatory surgical facilities, ambulatory imaging or diagnostic centers, birthing centers, freestanding emergency rooms and other facilities providing ambulatory care which charge a separate facility charge. The term does not include the offices of private physicians or dentists, whether for individual or group practice.
Council-The Health Care Cost Containment Council.
Covered services-Health care services or procedures connected with episodes of illness that require either inpatient hospital care or major ambulatory service such as surgical, medical or major radiological procedures, including initial and follow-up outpatient services associated with the episode of illness before, during or after inpatient hospital care or major ambulatory service. The term does not include routine outpatient services connected with episodes of illness that do not require hospitalization or major ambulatory service.
Data source-The term includes, but is not limited to, the following:
External cause code (E code)-The classification of environmental events, circumstances and conditions as the cause of injury, poisoning and other adverse effects. An external cause of injury is an injury which can be assigned an E code. The E code classification should be used as an additional code for more detailed analysis.
Health care facility-The term includes, but is not limited to, the following:
Hispanic/Latino origin or descent-Hispanic/Latino refers to people whose origins are from Spain, Mexico or the Spanish-speaking countries of Central or South America. Origin can be viewed as the ancestry, nationality, lineage or country in which the person or the person's ancestors were born before arrival in the United States.
Hospital-An institution, licensed in this Commonwealth, which is a general, tuberculosis, mental, chronic disease or other type of hospital, or kidney disease treatment center, whether profit or nonprofit, and including those operated by an agency of State or local government.
Major ambulatory service-Surgical or medical procedures. The term includes, but is not limited to, diagnostic and therapeutic radiological procedures, commonly performed in hospitals or ambulatory service facilities, which are not of a type commonly performed or which cannot be safely performed in a physician's office and which require special facilities such as operating rooms or suites or special equipment such as fluoroscopic equipment or computed tomographic scanners, or a postprocedure recovery room or short-term convalescent room.
Patient severity-A measure of severity of illness as defined by the Council using appropriate clinical findings, such as physician examinations, radiology findings, laboratory findings and pathology findings or any other relevant clinical factors.
Pennsylvania Uniform Claims and Billing Form format-The Uniform Hospital Billing Form UB-82/HCFA 1450, and the HCFA 1500, or their successors, as developed by the National Uniform Billing Committee, with additional fields as necessary to provide the data in section 6(c) and (d) of the act (35 P. S. § 449.6(c) and (d)).
Physician-An individual licensed under the statutes of the Commonwealth to practice medicine and surgery within the scope of the Osteopathic Medical Practice Act (63 P. S. §§ 271.1-271.18) or the Medical Practice Act (63 P. S. §§ 422.1-422.45).
Provider-A hospital, or an ambulatory service facility or a physician.
28 Pa. Code § 911.1
The provisions of this § 911.1 amended under the Health Care Cost Containment Act (35 P. S. §§ 449.1-449.19).