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Data submission and collection - 35 Pa. Stat. Ann. § 449.6

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The health care cost containment council is authorized to collect and providers must submit all data required under this section. The council may adopt data adjustment methodologies to adjust for severity of illness. The council must also publish a list of 35 conditions, treatments, and procedures for which providers must submit data.  The council must also establish a Uniform Claims and Billing form through which data sources must utilize.  Providers must submit the following data about each covered service to the health care cost containment council, which will collect the data using electronic data processing:

  • Identifying information about the patient, including a unique identifier and the patient’s date of birth, sex, race, and zip code;
  • Date of admission and date of discharge;
  • Principal and secondary diagnoses;
  • Principal procedure and up to three secondary procedures;
  • Total charges of and actual payments to the facility, segregated into major categories;
  • Charges of and actual payments to each professional rendering service relating to an incident of hospitalization or treatment in an ambulatory service facility;
  • Patient discharge status; and
  • Provider service effectiveness and provider quality data measures.

Providers must submit the following additional data to the council:

  • Audited annual financial reports of all hospitals and ambulatory service facilities providing covered services;
  • Medicare cost report for Medical Assistance; and
  • Additional data, including data about specific diagnoses and procedures that can be used in reports about:
    • Mortality rates;
    • Rates of infection;
    • Morbidity rates;
    • Readmission rates; and
    • Rate of incidence of post-discharge professional care.

The council must allow data sources to review and correct the information it has submitted within a reasonable time.  Additionally, data sources may be able to provide a written explanation for data that may be misinterpreted or misleading.  The council must verify the patient safety indicator for the submitted data for accuracy, and may allow hospitals to make changes to the data during the verification period. 


Current as of June 2015