Author: thahindev

The Tennessee Department of Health (TDH), in collaboration with the Tennessee Hospital Association Health Information Network (THA HIN), has released the 2018 Hospital Discharge Data System (HDDS) User Manual.  You can access the manual by visiting THA-HIN.com or by clicking here.  If you are a registered user for THA RDDS, you may also access the manual upon logging into the RDDS website. 

You will find a historical summary of changes to this manual beginning on page 7.  The changes to the current manual include:

• Conversion to ICD-10 effective October 1, 2015
• Dual coding discontinued for ICD-10 for outpatient claims effective October 1, 2015
• New payer codes effective January 1, 2016
• No longer accepting provider UPIN identifiers effective with the submission of Q1-18 discharge data
• Updated language overall to reflect the Official UB-04 Data Specification Manual published by the National Uniform Billing Committee (NUBC)

The THA Board of Directors met on December 11th, 2015 and approved changes to the THA Data Release Policy that were recommended by the THA Data Policy Committee. These changes were made to more accurately reference sections of the THA HIN Agreement, and to permit THA to release patient names to the Tennessee Department of Health, per the Department’s formal request.

The changes to the content of the policy are highlighted in yellow in this version of the policy.

An un-highlighted version of the full policy is available here.

Please note, changes were made to the format of this document on 2/2/2016, but no other content changes were made.

On June 29, 2015, we sent an email regarding changes in payer codes effective with January 1, 2016 discharge data. This notification serves as a reminder as the New Year is quickly approaching! More specifically, the changes are as follows:

• Current payer codes “B-Blue Cross/Blue Shield (not managed care)” and “H-Blue Cross Managed Care – HMO/PPO/Other Managed Care” have been combined. Both are placed under payer code “B-Blue Cross/Blue Shield.”
  • There are two additions added to payer code B: (1) Blue Network E and (2) Blue Network M.
• Current payer codes “I-Commercial Insurance (not managed care)” and “L-Commercial Managed Care-HMO/PPO/Other Managed Care” have been combined. Both are placed under payer code “L” and renamed to “Commercial – Other.”
• The following payers have been removed from being grouped into payer code “L-Commercial-Other” and have been assigned new payer codes:
  • United Healthcare – payer code 14
  • Cigna – payer code 15
  • Aetna – payer code 16
• A new payer code has been created for the Community Health Alliance (CHA). The payer code assigned is 17.
• Payer code K has been renamed to Medicare Advantage and has three additions: (1) Windsor, (2) CrestPoint and (3) Sterling.
• Payer code “13-Access TN” has been removed.

A few other minor changes were made which reflect updated health plan names, etc. Again, the changes outlined above are effective beginning with January 1, 2016 discharges. A reference document is available for download. The changes listed above and reflected in the Excel document should be applied to all three payer code fields (primary, secondary and tertiary payer codes).

Please share this information with each person in your facility who is involved in state required hospital discharge data reporting activities.

On October 3, 2014, the Tennessee Department of Health (TDH) mailed all licensed Tennessee hospitals a letter reinforcing penalty for failure to report. The TDH will begin enforcing the penalties associated with delinquent reports having a Statement Covers Period through Data on or after January 1, 2015. The implementation of this section of the T.C.A. at this date is in hopes to receive more complete and higher quality data. Hospitals that are currently delinquent on the date of implementation will not be charged for the previously delinquent records, but delinquencies after that date will be assessed the penalties. The letter sent by TDH can be viewed by clicking here.

THA has a process set in place to remind you of quarterly data submission deadlines. This process has not changed and will continue as it has in the past. Below are the quarterly reporting due dates for hospital UB discharge data submission:

• January – March (Q1) discharge data are due to be submitted no later than May 30th.
• April – June (Q2) discharge data are due to be submitted no later than August 29th.
• July – September (Q3) discharge data are due to be submitted no later than November 29th.
• October – December (Q4) discharge data are due to be submitted no later than March 1st of the following year.

Each quarter Nora Sewell, HIN Data Analyst, sends reporting reminders to hospitals, usually no less than a month before a reporting due date. Once the scheduled due date (as outlined above) has passed, Nora notifies the TDH of those hospitals who have not submitted their UB discharge data by the specified scheduled date. In the future, these hospitals could run the risk of being fined for failure to submit discharge data according to schedule.

There are three main characteristics every data system should strive for: timeliness, accuracy and completeness. Please help us keep the data quality and integrity high as it will only serve you, THA member hospitals, the most precise data possible.

Inpatient Replacement Bill Type 0117
As you are aware, bill type 0117 indicates an inpatient replacement bill. If this bill type is submitted to the THA RDDS, the system will search the database for a previous claim by comparing key elements. Once the previous claim has been located, the replacement bill (0117) will overlay the original record and the bill type will be changed from 0117 to 0111.

Please note: If a replacement bill (0117) cannot be linked to a previous bill, the replacement bill will become the database record and the bill type will be changed to 0111.

Outpatient Replacement Bill Type 0137
Similar to the above statement, bill type 0137 indicates an outpatient replacement bill. If this bill type is submitted to the THA RDDS, the system will search the database for a previous claim by comparing key elements. Once the previous claim has been located, the replacement bill (0137) will overlay the original record and the bill type will be changed from 0137 to 0131.

Please note: If a replacement bill (0137) cannot be linked to a previous bill, the replacement bill will become the database record and the bill type will be changed to 0131. Please contact Larissa Lee if you have any questions or need assistance.

The process to submit TEST data through THA RDDS is different from the process used in the past when test data was submitted through HIDI. Please be sure to follow the steps below when submitting TEST data through THA RDDS.

1. Using RDDS, all TEST files should use discharge records that have not yet been submitted. TEST records should have discharge dates later than records already on RDDS for your hospital. In other words, if you have already submitted Q2 data for your hospital and it is within the fatal error threshold (no more than 2%), any TEST data should be for Q3 or later, or even a smaller submission that includes data for one month, (i.e., July data) would be acceptable to submit as a TEST file.
2. Once the TEST file has processed and you have checked it to make sure the change you were making is working properly, you MUST DELETE the Batch (by number) that RDDS assigned to the TEST file when it was submitted.
3. It is also recommended that THA HIN staff be notified in advance if you plan to submit TEST data so we can be aware and communicate this if necessary with the processing system..

Please contact Larissa Lee if you have any questions or need assistance.