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Data Request for

3MTM ICD-10 Data Analysis - Outpatient

3MTM ICD-10 Data Analysis-Ambulatory will assist you to evaluate the areas within your patient population where additional documentation specificity will be required under ICD-10. Understanding the clinical areas that are most impacted by the switch to ICD-10 will assist you in making further decisions relating to personnel, educational opportunities and process improvement.

Ideally, we would like to receive three months of data.

Data sources: Please submit final bills. This would be the claims that were submitted for payment, usually from your claims management system. The data file may contain claims inpatient, outpatient, Medicare and non-Medicare claims in the same file. We will be able to identify the correct claims for processing. Please use one of the following formats:

Data format: The claims data can be submitted in any of the following formats:

ASC X12N-837 (004010X096)

UB-04 print image

UB-04 print image is defined as an ASCII text file that, if printed, would perfectly overlay the UB-04 form. This file can contain an unlimited number of claims, however, it should be free from other types of data such as report headers or footers. See page 3 for a sample of the UB-04 print image.

Minimum Data Set

If you are unable to supply the 837 or UB-04 file formats, we will also except data in Microsoft Excel® or delimited text file. The Minimum Data Set data must conform to the template show on page 4.

Media: The data can be supplied on any of the following media:

• CD or DVD

• E-mail (encryption required and size limitation, see below)

HIPAA requires that all protected health information be encrypted before being transmitted via the Internet. 3M HIS Consulting Services offers a free encryption tool (CS Encryption) which can be downloaded from

NOTE: There is a 3mb size limitation on data that we can receive as an e-mail attachment. When CS Encryption is used, the data is automatically compressed and then encrypted. This will reduce the size of the data file, but if the encrypted file is larger than 3mb, the data must be submitted to 3M on CD-ROM.

Email the encrypted data to:

HI-3M-CS-DATA@

If you have questions on the data please contact:

George F. Chafin

3M HIS Consulting Services

678-332-3742

gfchafin@

CONFIDENTIALITY -- Patient-Specific Protected Health Information

3M Consulting will retain the confidentiality of and appropriately safeguard any patient-specific information made available to, or generated by, 3M Consulting. Without limitation to the obligations of 3M Consulting otherwise set forth by agreement, or imposed by applicable law, 3M Consulting agrees to comply with the applicable requirements of law relating to protected health information and with respect to any task or other activity 3M Consulting performs, to the extent the Covered Entity, as defined in the final privacy regulations, would be required to comply with such requirements.

3MTM ICD-10 Data Analysis - Outpatient

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Sample UB-04 Print Image

[pic]

3MTM ICD-10 Data Analysis - Outpatient

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Minimum Data Set – Outpatient I-10 Analysis Reporting

The first preference is to receive the UB-04 print image or the X12-837 format. However, if these formats are not available we can accept outpatient data in a Excel or delimited TXT file. The data structure is show below.

Notes:

• All diagnosis codes should contain both the leading and trailing zeros if the zero is normally part of that code. Therefore, in Excel the diagnosis columns must be formatted at Text.

• Columns flagged as “not required” must exist in the template but the column is not required to be populated.

• When supplying a delimited file it should follow industry standard formatting as follows:

Character columns should be enclosed in quotation marks.

Numeric columns should not be enclosed in quotation marks.

The data can also be space delimited to yield a “Fixed Field” format.

If you have any questions please contact:

George Chafin

3M HIS Consulting Services

678-332-3742

gfchafin@

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3MTM ICD-10 Data Analysis - Outpatient

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Minimum Data Set Template – Outpatient I-10 Analysis Reporting

|Column Name |Type | |Column Name |Type |

|Patid |Character | |Secdx48 |Character |

|Patname |Character | |Secdx49 |Character |

|MedRecNo |Character | |CPT1 |Character |

|Admdate |Character | |CPT2 |Character |

|Disdate |Character | |CPT3 |Character |

|DOB |Character | |CPT4 |Character |

|Sex |Character | |CPT5 |Character |

|Pridx |Character | |CPT6 |Character |

|Secdx1 |Character | |CPT7 |Character |

|Secdx2 |Character | |CPT8 |Character |

|Secdx3 |Character | |CPT9 |Character |

|Secdx4 |Character | |CPT10 |Character |

|Secdx5 |Character | |CPT11 |Character |

|Secdx6 |Character | |CPT12 |Character |

|Secdx7 |Character | |CPT13 |Character |

|Secdx8 |Character | |CPT14 |Character |

|Secdx9 |Character | |CPT15 |Character |

|Secdx10 |Character | |CPT16 |Character |

|Secdx11 |Character | |CPT17 |Character |

|Secdx12 |Character | |CPT18 |Character |

|Secdx13 |Character | |CPT19 |Character |

|Secdx14 |Character | |CPT20 |Character |

|Secdx15 |Character | |CPT21 |Character |

|Secdx16 |Character | |CPT22 |Character |

|Secdx17 |Character | |CPT23 |Character |

|Secdx18 |Character | |CPT24 |Character |

|Secdx19 |Character | |CPT25 |Character |

|Secdx20 |Character | |CPT26 |Character |

|Secdx21 |Character | |CPT27 |Character |

|Secdx22 |Character | |CPT28 |Character |

|Secdx23 |Character | |CPT29 |Character |

|Secdx24 |Character | |CPT30 |Character |

|Secdx25 |Character | |CPT31 |Character |

|Secdx26 |Character | |CPT32 |Character |

|Secdx27 |Character | |CPT33 |Character |

|Secdx28 |Character | |CPT34 |Character |

|Secdx29 |Character | |CPT35 |Character |

|Secdx30 |Character | |CPT36 |Character |

|Secdx31 |Character | |CPT37 |Character |

|Secdx32 |Character | |CPT38 |Character |

|Secdx33 |Character | |CPT39 |Character |

|Secdx34 |Character | |CPT40 |Character |

|Secdx35 |Character | |CPT41 |Character |

|Secdx36 |Character | |CPT42 |Character |

|Secdx37 |Character | |CPT43 |Character |

|Secdx38 |Character | |CPT44 |Character |

|Secdx39 |Character | |CPT45 |Character |

|Secdx40 |Character | |CPT46 |Character |

|Secdx41 |Character | |CPT47 |Character |

|Secdx42 |Character | |CPT48 |Character |

|Secdx43 |Character | |CPT49 |Character |

|Secdx44 |Character | |Payor |Character |

|Secdx45 |Character | |CAMPUS |Character |

|Secdx46 |Character | |  |  |

|Secdx47 |Character | |  |  |

3MTM ICD-10 Data Analysis - Outpatient

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Please complete this form and return with the data. If the data is being submitted via e-mail, please include this information in the text of the email.

Hospital name: __________________________________ Medicare Provider No. or NPI ___________________

Your name: __________________________________ Title: ________________________________________

Phone: __________________________________ Email: ________________________________________

No. claims submitted: _________________

Name of system that produced the data:____________________________________________

Date range of claims being submitted: _____________________________________________

For technical assistance, please contact: For administrative assistance, please contact:

George Chafin Susan Gorry

3M HIS Consulting Services 3M HIS Consulting Services

100 Ashford Center North 100 Ashford Center North

Suite 200 Suite 200

Atlanta, GA 30338-4844 Atlanta, GA 30338-4844

678-332-3742 678-332-3744

gfchafin@ sgorry@

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