ARSD 44:66:02:03. Required patient data to be reported

Each hospital required to report charge information pursuant to SDCL 34-12E-11 shall provide the following information from the UB-04 form: (1) Record type; (2) Hospital number; (3) Patient control number; (4) Date of birth; (5) Sex; (6) Admission date; (7) Principal diagnosis; (8) Admitting diagnosis; (9) Principal procedure; (10) Discharge date; (11) Patient status; and (12) Total charges. For the purposes of this section, "UB-04 form" is a standardized form from the Centers for Medicare and Medicaid Services used to electronically submit claims for health care received in an institutional setting.