Wash. Admin. Code § 246-455-020

Hospital Patient Discharge Reporting of UB-92/UB-04 Data Set Information

For all hospital patient discharges, hospitals must collect and report certain UB-92 or UB-04 data elements to the Department of Health.  This includes such information as:

•         The patient control number
•         The type of bill
•         The Medicare provider number
•         Patient’s first name, middle initial, last name and social security number
•         Patient’s zip code and country code
•         Patient’s date of birth, sex, race and ethnicity
•         Patient’s admission date and hour, type of admission, source of admission, discharge status
•         Statement covers period, revenue code, units of service
•         Total charges and payer identification
•         Principal diagnosis code as well as other diagnosis codes, external cause of injury code and principal procedure code
•         Attending provider identifier, operating physician identifier, other provider identifiers

Hospitals should submit data in the form required by the Department in the CHARS Procedure Manual and CHARS 837 Companion Guide.  The data should be submitted to the Department within 45 days following the end of each calendar month.