Hospital Manual

Hospitals and FASCs, herein referred to as (“facilities”) submit data in a modified HIPAA Complaint 837 claims file format. Data collection is based on valid HIPAA ASC X12 837I and 837P transactions (including 837R – Reporting) electronic data interface reporting (EDI) format.

This section defines the types of data collected from hospitals and ASCs and what fields are assigned by WHAIC and what fields are required on the claim file for each hospital stay or ASC visit to create a record for each patient seen.

This section contains the WHAIC discharge data files specifications or limitations for the following types of patient records sent by the facility:

• Inpatient admit through discharge data from hospitals (INP)
• Emergency department data from hospitals (ER/ED)
• Ambulatory / outpatient surgery data from hospitals (OPS)
• Other hospital outpatient (OHO), & provider-based billing /location (PBB/L) data
• Data from freestanding ambulatory surgery centers (ASC or FASC)

Information such as patient name and demographics will be masked with encryption or census block group identifiers. Clinical information about the services rendered (e.g., diagnoses, procedures performed, length of stay), billing information (e.g., expected payer category, amount charged), and the facility identity must be included.

All you need is an email address and password. All data submitters, editors and other WIpop users are required to register for access to WIpop through the secure Portal. WIpop is a roles-based system in which designations are assigned and decided by the facility.

All facilities are required to have at least one person to serve in the role of Primary Contact. The primary contact oversees the submission of quarterly discharge data process, receives notification of newly registered WIpop users, and has access to quarterly reports. More than one primary contact encouraged.

General Business Rules for 837 Processes that all facilities are required to follow. These guidelines are intended to facilitate the processing of the file and minimize the number of edits.

Contents contained in this section:

• Mapping rules apply to Encrypted Case ID, Unique Case ID, Race, Ethnicity, Payers and Language.
• Business Rules and Limitations apply to acceptance of specific Type of Bill, Revenue Codes and Diagnosis Codes related to Cause of Injury.

This section provides additional detail about the file submission and specific characteristics about the file and file expectations. This section is necessary to help the technical advisor, vendor or developer create the custom 837 claim file and format it according to WHAIC specifications. Use of these guidelines, will allow the file to process accurately, efficiently and with minimal edits.

Section 5.A provides claim file specifications of the following HIPAA 5010 inbound transactions:

•  837 Institutional Health Care Claim – ASC X12N 837 (005010X223A2) | Download Sample 837 I File
•  837 Professional Health Care Claim – ASC X12N 837 (005010X222A1) | Download Sample 837 P File
•  837 Reporting Health Care Services – ASC X12N 837 (005010X225A2) | Download Sample 837 R File

This section contains details related to the facilities responsibility to complete the data submission in a timely fashion, reasons for batch failures, defined custom edits, correcting edits, and completing the validation and affirmation process. Facilities must comply with the data submission timelines as defined by the Wisconsin Statute and WHAIC calendar. Failure to comply with Wisconsin Statutes or the data submission deadlines may result in a formal letter of non-compliance issues.

This section contains the listing of facilities, data dictionary, FAQ’s and supporting file guidance and details related to the Uniform Billing requirements.

1. Facility List (3-Digit IDs)
2. Race & Ethnicity Codes
   1. FAQ on Collecting Patient Race, Ethnicity & Language
3. Language Codes
4. Expected Source of Payment and 837 Payer Mapping
   1. Claim Filing Indicator Codes
   2. Payer ID / NAIC # Sources
5. Type of Bill / Bill Type
6. Place of Service
7. WIpop Coding Guidelines
   1. ICD-10-CM Guidelines for Coding and Reporting
   2. Present on Admission (POA) Indicator Codes
   3. Revenue Codes
8. Point of Origin for Admission or Visit
   1. Priority (Type) of Admission or Visit
   2. Code Structure for Newborns
9. Patient Discharge Status Codes
10. WIpop Edit Codes and Descriptions
11. WIpop Roles and Registration
12. 837 File Handler ("Black Box") Interface
    • Black Box Program and Instructions | Instructions to create UCID/ECID
13. Data Dictionary
14. Manual Data Entry Instructions
15. Marital Status Codes
16. FAQ
17. Terms, Acronyms and Definitions
18. Changes to Document