| (a) Each facility in operation for all or any of the
reporting periods described in §421.63 of this title (relating
to Schedule for Filing Event Files) shall submit to DSHS event claims
as specified in §421.67 of this title (relating to Event Files--Records,
Data Fields and Codes) on all patient events in which the patient
received one or more of the surgical procedures or radiological services
covered by the revenue codes or surgical and radiological categories
specified in §421.67(f) or (g) of this title. All facilities
that are exempt under the Health and Safety Code, Chapter 108, but
choose to participate in reporting under this subchapter, shall comply
with the requirements in this subchapter. To the extent the medical
screening examination, triage, observation, diagnosis or treatment
is made by a health professional, other than a physician, data elements
specified in §421.67(d)(25) - (30) or (e)(19) of this title shall
be filled accordingly or data elements in §421.67(d)(26) or (29)
in the modified ANSI 837 Institutional Guide or §421.67(e)(20)
in the modified ANSI 837 Professional Guide shall be marked with one
of DSHS approved temporary "Physician" or "Other health professional"
code numbers and data elements in §421.67(d)(25)(A) - (C) or
(28)(A) - (C) in the ANSI 837 Institutional Guide format or §421.67(e)(19)(A)
- (C) in the ANSI 837 Professional Guide format may be left blank.
(b) All patient events in which the patient received
one or more of the surgical procedures or radiological services covered
by the revenue codes or surgical and radiological categories specified
in §421.67(f) or §421.67(g) of this title shall be reported
by the facility that prepares one or more bills for patient services.
(1) The facility shall submit an event claim corresponding
to each bill containing the data elements required by §421.67
of this title. For all patients who received one or more of the surgical
procedures or radiological services covered by the revenue codes or
surgical and radiological categories specified in §421.67(f)
or §421.67(g) of this title for which the facility does not prepare
a bill for patient services, the facility shall submit an event claim
containing the required minimum data set.
(2) For all patients that are covered by 42 USC §290dd-2
and 42 CFR Part 2.1, a hospital or ambulatory surgical center shall
submit a discharge claim containing the required data elements specified
by §421.67 of this title. The hospital or ambulatory surgical
center shall replace the patient identifying information with the
default values specified in §421.67(h) of this title or submit
the patient identifying information if release of patient identifying
information is authorized in writing by the patient or patient's guardian.
(c) Each facility shall submit event files by electronic
filing unless the facility receives an exemption letter from DSHS.
(d) Each facility shall submit event claims and event
files in the format specified in §421.67 of this title.
(e) Each facility shall submit event files, data certifications
and other required information to DSHS or its agents at physical or
telephonic addresses specified by DSHS. DSHS shall notify all facilities
and submitters in writing and by publication in the Texas Register at least 30 calendar days
before any change in the addresses.
(f) Each facility may submit event files, or may designate
an agent to submit the event files. If a facility designates an agent,
it shall inform DSHS of the designation in writing at least 30 calendar
days prior to the agent's submission of any discharge report. The
facility shall inform DSHS in writing at least 30 calendar days prior
to changing agents or making the submissions itself.
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| Source Note: The provisions of this §421.62 adopted to be effective August 29, 2004, 29 TexReg 8123; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8842; amended to be effective February 26, 2009, 33 TexReg 9694; amended to be effective October 31, 2011, 36 TexReg 5214; amended to be effective December 18, 2014, 39 TexReg 7582; amended to be effective January 30, 2019, 44 TexReg 429 |
