Requests for data

The committee may require data suppliers and agencies of state government to provide certain data and information. 1. The committee shall establish uniform formats for the different types of data for use by data suppliers in providing hospitalization data, health professional data, nursing home data, health maintenance organization data, and other types of data as the committee finds necessary. 2. Data required to be submitted must be provided to the committee in the format established or, if the data supplier requests in writing, in a format which is technically equivalent and which supplies all of the necessary information. Third-party payers who cannot meet these reporting specifications and third-party payers who demonstrate that it is not economically feasible to report in accordance with these specifications shall request in writing approval to report the data in a specific, alternative form. These requests must be submitted to and approved inwriting by the department. 3. Data requests must be specific regarding the time period covered, data elements to be provided, and the form and format in which the data is to be provided. 4. Hospital data required to be provided must be limited to those data elements provided for on the health care financing administration form UB-92 (or replacement form) using the current definitions developed by the North Dakota uniform billing committee, and, as specified by the health care data committee, other data commonly collected in the course of billing and obtaining reimbursement of claims. 5. Health professional data required to be provided must be limited to those data elements provided for on the health care financing administration form 1500 or successor form or other forms specified by the health care data committee, and, as specified by that committee other data commonly collected in the course of billing and obtaining reimbursement of claims. 6. Data must be provided within sixty days of the committee's request for data. A fifteen-day extension of time for providing data may be granted if the data supplier adequately justifies the delay. 7. Prior to collecting hospital data or health professional data from any data supplier, the data supplier must be provided an exact format for reporting data and an explicit description of each data item to be reported. Descriptions of data elements shall include specifications in terms of form location, definitions and alternate specifications, and definitions for those data suppliers that do not maintain the exact UB-92 data as described in the North Dakota uniform billing procedures manual, or for data elements not provided for in the HCFA-1500 Medicare carriers manual (as revised). Those data suppliers that maintain similar elements shall report the comparable data elements that they maintain and a detailed code structure for each element to the department. 8. Data must be collected at least annually but not more often than quarterly from the following data suppliers: a. Those comprehensive health association of North Dakota members, including health maintenance organizations, found by the North Dakota commissioner of insurance to be subject to an assessment of one percent or more as a participating member of the comprehensive health association of North Dakota, and any data supplier whose annual written premium is 0.5 percent or more of the total annual written premiums for individual or for group medical and major medical policies, as determined by the latest survey or census of insurance carriers conducted by the North Dakota commissioner of insurance, and any data supplier whose annual written premium for hospital-surgical expense coverage is one million dollars or more as determined by the latest survey or census of the North Dakota commissioner of insurance. b. The committee may request, but may not require, that self-funded group health plans submit claims data. c. State agencies that have paid any claims for hospital or health professional services during the calendar year, including Medicare and Medicare data in the possession of the agency. 9. The committee shall require that the data suppliers include a contract identifier number for contracts or plans paid for or subsidized by the North Dakota public employees retirement system or the comprehensive health insurance association of North Dakota and for those employer groups who have requested in writing that the department retain a contract identifier number. 10. The committee shall require that the data suppliers include identification codes for hospitals, health professionals, clinics, and patients. 11. Data must be collected at least annually, but not more often than quarterly, from the department of human services regarding basic care, intermediate care, and skilled nursing care provided in long-term care facilities located in this state. The data must include Medicare and Medicare claims for these facilities as collected by the department of human services. 12. Data must be supplied in the mode of transmission specified by the committee.