UPDATE (2/21/2020): Health Plan Identification
Last October you received the message below following a letter from the TN Department of Health (TDH) requesting a change on the Health Plan ID fields – specifically the primary field, field #168. The TDH wanted to see better data in this field and asked that the field be edited with a fatal error beginning with the Q1-2020 data submissions. THA placed a warning edit on the health plan ID fields for the submission of your Q3 and Q4-19 data. You can read the details in my previous email listed below.
Since then we learned that the Federal Registry rescinded the requirement for health plans to maintain their health plan identification numbers effective December 2019. We had a conversation with the TDH and the state agreed to leave the warning edit on the Primary Health Plan ID (field 168) at this time. The warning edit, # 6204, will not turn into a fatal edit beginning with the Q1-2020 data submissions. We will have further conversation with the state over the coming weeks regarding the health plan ID field edits and will communicate the final outcome.
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On Friday, October 11, 2019, the Tennessee Department of Health (TDH) emailed all licensed Tennessee hospitals a letter requesting improvement of data in all health plan identification fields (primary, secondary and tertiary). Please find that letter HERE. The specific field numbers in reference are 168-170 in your RDDS UB04 record layout; or reference UB-04 form locators 51A-51C. The letter stated that many hospitals are reporting all 9s in these fields which is not acceptable. The TDH is asking all hospitals to begin submitting more viable data for these fields, specifically the PRIMARY health plan ID field, on or before the Q1-2020 discharge data submission which is due to the Remote Discharge Data System (RDDS) no later than May 30, 2020. The TDH further indicated if the health plan identification field – PRIMARY ONLY – does not contain valid identifiers beginning with the Q1-2020 data submission, this field (field # 168) will be edited and considered a fatal error. This could potentially push your facility above the 2% fatal error threshold which will not allow your data to be submitted to the TDH and making you susceptible to penalties as described in the rules of the state law.
Please note: The secondary and tertiary health plan identification fields will remain warning errors beginning with Q1-2020 data submissions. However, you should continue to monitor these fields as well.
In order to prepare for the change set by the TDH, The Tennessee Hospital Association (THA) analyzed the 2018 final data and found the TDH facts to be true, many hospitals are submitting all 9s in the indicated primary health plan identification field. In order to meet the requests of the TDH, THA will redesign the existing warning edits by changing the logic and further making the PRIMARY health plan ID field FATAL beginning with your Q1-2020 data submission. The warning edits that have been set in place for the health plan identification fields (RDDS UB04 record layout field numbers 168-170 or UB FLs 51A-51C) are listed below. These are the warnings you should look for and evaluate in your Q3 and Q4-19 data submissions, particularly edit # 6204.
| Edit No. New for Q3&Q4-19 | Edit Type | Edit Description | Layout Field No. | Layout Field Description | Layout Positions |
| 6204 | Warning | Primary health plan number is missing or invalid | 168 | Payer ID/Health Plan ID – Primary (pg 74 HDDS Manual) | 1452-1466 |
| 6205 | Warning | Secondary health plan number is missing or invalid | 169 | Payer ID/Health Plan ID – Secondary (pg 75 HDDS Manual) | 1467-1481 |
| 6206 | Warning | Tertiary health plan number is missing or invalid | 173 | Payer ID/Health Plan ID – Tertiary (pg 76 HDDS Manual) | 1482-1496 |
In order to prepare for the change set by the TDH, the following fatal edit will be active for the PRIMARY health plan ID field beginning with your Q1-2020 discharge data submission to RDDS due May 30, 2020:
| Edit No. New for Q1-20 | Edit Type | Edit Description | Edit Logic | Layout Field No. | Layout Field Description | Layout Positions |
| 6207 | FATAL | Primary health plan number is missing or invalid | Fatal error when the field contains blanks and the primary payer is not equal to 0, P, Z or blank; or the field contains a string of 9s or zeros. | 168 | Payer ID/Health Plan ID – Primary (pg 74 HDDS Manual) | 1452-1466 |
*Please note, the layout field descriptions and positions can be found in the HDDS manual. If you do not have a copy of the manual, you can find it by logging into RDDS or on our website, THA-HIN.com, by clicking HERE.How can you be prepared?
As you submit your Q3-19 (due November 29, 2019) and Q4-19 (due March 1, 2020) discharge data to RDDS, please carefully review your edit summary and edit detail reports in RDDS and look for the existing warning edits, 6204-6206, with special attention to the PRIMARY health plan ID field (edit 6204). This will help you determine if your data needs attention in these particular fields prior to the Q1-2020 data being submitted by May 30, 2020. If you have a >2% of the 6204 warning applied in your reports as you submit your Q3 and Q4-19 data, keep in mind these will turn to fatal errors beginning with your Q1-2020 data submission, in turn, placing your fatal error rate above the 2% threshold allowed by the TDH.
THA staff will reach out to your hospital(s) over the coming weeks if we found major issues with these fields while analyzing the 2018 data. We want to better prepare you for 2020 data submissions.