N.J. Admin. Code § 8:31B-2.5

Current through Register Vol. 56, No. 9, May 6, 2024

Section 8:31B-2.5 - Health data submissions to the Department

(a) A data intermediary shall be selected as follows:

1. A data intermediary is the data processor approved by the Department responsible for collecting, editing, generating selected reports, and submitting the UB data to the Department.

2. A single data intermediary shall be chosen and shall be responsible for all patients regardless of payor class. In the event that it becomes necessary to approve additional data processors, the Department will promulgate an approved list of data processors.

(b) Contractual arrangements between the hospital and the data intermediary shall include the following:

1. The contractual arrangements between a hospital and its data intermediary shall include:

i. Provisions for compliance with the data submission time limits specified in 8:31B-2.4(b);

ii. Provisions for permitting delays in such submissions to the intermediary when circumstances require;

iii. Provisions for resolution of any resulting disputes.

2. Provisions must not affect the ability of the intermediary to comply with the timing requirements set forth in (g) below.

(c) The contractual arrangements shall provide for the quality control measures needed to ensure accurate and reliable data submission by the hospital.

(d) To assess the accuracy and reliability of the data provided to the Department, the Department shall periodically audit selected records in the hospital.

(e) Data shall be edited as follows:

1. The data received by the intermediary from the hospital must be edited prior to submission to the Department, in accordance with the current contract between the Department and the data intermediary.

2. Problems detected by these edits shall be corrected by the data intermediary and the hospital.

3. The hospital shall submit information required by the data intermediary for edit correction within two working days of the request.

(f) Reports shall be produced as follows:

1. The data intermediary shall produce, for the Department and each hospital, a set of periodic reports that will accurately represent the data submitted by each hospital, in accordance with the current contract between the Department and the data intermediary.

2. In addition, hospitals may designate an additional organization, known as a data reporter, to assist in the verification of the accuracy and reliability of the data submitted to the data intermediary. The Department shall direct the data intermediary, selected under (a) above, to release a hospital's data to the reporter only upon receipt of a current signed agreement between the hospital and the data reporter. This agreement shall be updated annually, and shall:

i. Indicate the hospital's designation of a data reporter;

ii. Provide protection of confidential data consistent with Department procedures; and

iii. Allow subsequent re-release of the data by the reporter only when the procedures set by the Department have been followed.

3. These reports are to be used by the hospitals, in conjunction with any other information provided by their data collector or the Department, to verify the accuracy and reliability of the data submitted.

4. The ultimate responsibility for the completeness and accuracy of the UB data submitted to the Department rests with the hospital.

5. Upon request of a payer, the final UB information shall be provided to the payer, for its own cases, by the UB Intermediary.

(g) Data shall be submitted to the Department as follows:

1. Those data elements required to be submitted to the Department by each hospital through the data intermediary are described in detail in the addendum to the UB guidelines. Instructions are available from the Department for formatting the UB data elements into an electronic format for reporting to the Department using the HIPAA-compatible Health Care Service: Data Reporting 837 Version 5010 electronic format. These instructions are known as the New Jersey ANSI ASC X12 Addendum Guide, incorporated herein by reference. The New Jersey ANSI ASC X12 Addendum Guide can be obtained from Program Manager, Health Care Quality Assessment Program, PO Box 360, Trenton, NJ 08625-0360.

2. These required data, edited pursuant to (e) above, shall be submitted to the Department by the data intermediary in a computer-processable format and medium, specified by the current contract between the Department and the data intermediary, within 5 days of the end of each calendar month.

3. Each submission is to include the data on all discharges billed during the previous calendar month.

4. Records not received by the Department (including corrections of fatal errors and records with missing or incorrect information) within the time frames specified, shall be subject to a penalty of $ 1.00 per record per day. The Department shall provide notice of 30 days of its intent to close the data base. The data base shall be closed no sooner than 90 days following the end of the calendar year and no additional cases shall be added after that time.

5. All data submitted to the Department will be edited upon receipt by the data intermediary and any problems detected shall be corrected by the data intermediary with any necessary assistance from the hospital.

(h) All protected health information submitted to the data intermediary pursuant to this regulation is subject to Standards for Privacy of Individually Identifiable Health Information, 45 CFR Part 160 and Part 164.

(i) The intermediary(ies) shall charge the hospitals a maximum amount of $ 1.45 per discharge to process hospital UB data.

N.J. Admin. Code § 8:31B-2.5

Amended by 50 N.J.R. 1494(a), effective 7/2/2018