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Gap Assist

The Health Care Service: Data Reporting Guide (HCSDRG), an ASC X12 specification based on the HIPAA adopted Health Care Claim: Institutional (837), supports state and federal public health reporting requirements. The source of the data content is from the ASC X12 standards, UB-04, the National Committee on Vital and Health Statistics core data set, as well as some state specific public health reporting requirements. The Gap Assist tool, jointly developed with Washington Publishing Company, with support from the Centers for Disease Control and Prevention/National Center for Health Statistics, provides a metadata perspective on the format and content attributes of each data element supported by the HCSDRG. The Gap Assist tool also provides a view across multiple versions of the ASC X12 standards and a map to the various standards previously named.

To assist in the understanding of how ASC X12 messaging works for this public health reporting function, the following mini-X12 tutorial is provided.

The structure of an ASC X12 transaction is designed to minimize reporting redundancies. A case in point is the reporting of the patient information. If the patient is also the health insurance subscriber that patient information is reported where the subscriber information is reported and no where else. If the patient is not the subscriber there is another location in this ASC X12 specification for that patient information to be entered.

For simplicity the Gap Assist tool only points to the place where the Patient Information would be reported if the patient was not the subscriber. Further explanations of this are available by purchasing the Health Care Service: Data Reporting guide from ASC X12: http://store.x12.org.

A recent change also provides a link from the data elements supported in the HCSDRG and an additional set of metadata for each data element contained in the United States Health Information Knowledgebase (USHIK). This includes a data element definition, as well as other information about each data element, such as field length and data type. The USHIK is an on-line, publicly accessible registry and repository of healthcare-related data, metadata and standards. USHIK is funded and directed by the Agency for Healthcare Research and Quality (AHRQ) with management support in partnership with the Centers for Medicare & Medicaid Services (CMS).

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Data Element Name USHIK 004050 005010 006020
Submitter Information
Submitter Name USHIK Yes: 004050 Yes: 005010 Yes: 006020
Submitter Identifier USHIK Yes: 004050 Yes: 005010 Yes: 006020
Submitter Fax USHIK Yes: 004050 Yes: 005010 Yes: 006020
Submitter Telephone USHIK Yes: 004050 Yes: 005010 Yes: 006020
Processing Date USHIK Yes: 004050 Yes: 005010 Yes: 006020
Input/Tape Supplier Number (TSN) USHIK Yes: 004050 Yes: 005010 Yes: 006020
Receiver Information
Receiver Name USHIK Yes: 004050 Yes: 005010 Yes: 006020
Receiver Identification USHIK Yes: 004050 Yes: 005010 Yes: 006020
Provider Information
Service Provider Name USHIK Yes: 004050 Yes: 005010 Yes: 006020
Service Provider Identification Number USHIK Yes: 004050 Yes: 005010 Yes: 006020
Patient Information
Patient's Last Name USHIK Yes: 004050 Yes: 005010 Yes: 006020
Patient's First Name USHIK Yes: 004050 Yes: 005010 Yes: 006020
Patient's Middle Name USHIK Yes: 004050 Yes: 005010 Yes: 006020
Patient's Control Number USHIK Yes: 004050 Yes: 005010 Yes: 006020
Medical Record Number USHIK Yes: 004050 Yes: 005010 Yes: 006020
Unique Personal Identifier/Social Security Number USHIK Yes: 004050 Yes: 005010 Yes: 006020
Patient's Marital Status USHIK No: 004050 Yes: 005010 Yes: 006020
Patient's Race USHIK Yes: 004050 Yes: 005010 Yes: 006020
Patient's Ethnicity USHIK Yes: 004050 Yes: 005010 Yes: 006020
Patient's Preferred Language Spoken USHIK No: 004050 No: 005010 Yes: 006020
Patient's Address Line - 1 USHIK Yes: 004050 Yes: 005010 Yes: 006020
Patient's Address Line - 2 USHIK Yes: 004050 Yes: 005010 Yes: 006020
Patient's City USHIK Yes: 004050 Yes: 005010 Yes: 006020
Patient's County Code USHIK Yes: 004050 Yes: 005010 Yes: 006020
Patient's State USHIK Yes: 004050 Yes: 005010 Yes: 006020
Patient's Postal Service Zip Code and Extension Code USHIK Yes: 004050 Yes: 005010 Yes: 006020
Patient's Sex USHIK Yes: 004050 Yes: 005010 Yes: 006020
Patient's Birth Date USHIK Yes: 004050 Yes: 005010 Yes: 006020
Newborn Birth Weight USHIK USHIK Yes: 004050 Yes: 005010 Yes: 006020
Mother's Medical Record Number for Newborn Child Mother's Medical Record Number for Newborn Child Yes: 004050 Yes: 005010 Yes: 006020
Expected Patient Responsibility USHIK Yes: 004050 Yes: 005010 No: 006020
Claim Information
Priority (Type) of Admission or Visit USHIK Yes: 004050 Yes: 005010 Yes: 006020
Point of Origin for Admission or Visit USHIK Yes: 004050 Yes: 005010 Yes: 006020
Admission Date/Start of Care USHIK Yes: 004050 Yes: 005010 Yes: 006020
Admission Hour USHIK Yes: 004050 Yes: 005010 Yes: 006020
Original Claim Creation Date USHIK No: 004050 No: 005010 Yes: 006020
Statement Covers Period - From Date USHIK Yes: 004050 Yes: 005010 Yes: 006020
Statement Covers Period - Thru Date USHIK Yes: 004050 Yes: 005010 Yes: 006020
Service Date USHIK Yes: 004050 Yes: 005010 Yes: 006020
Discharge Date - Derived from Statement From Date & Type of Bill USHIK Yes: 004050 Yes: 005010 Yes: 006020
Discharge Hour USHIK Yes: 004050 Yes: 005010 Yes: 006020
Patient Status or Disposition USHIK Yes: 004050 Yes: 005010 Yes: 006020
Facility Type Code USHIK Yes: 004050 Yes: 005010 Yes: 006020
Claim Frequency Code USHIK Yes: 004050 Yes: 005010 Yes: 006020
Accident Related Codes & Dates USHIK USHIK Yes: 004050 Yes: 005010 Yes: 006020
Auto Accident State USHIK No: 004050 Yes: 005010 Yes: 006020
North American Industry Codes USHIK No: 004050 No: 005010 Yes: 006020
ALC Span Dates USHIK USHIK Yes: 004050 Yes: 005010 Yes: 006020
LOA Span Dates USHIK USHIK Yes: 004050 Yes: 005010 Yes: 006020
Do Not Resuscitate Indicator USHIK Yes: 004050 Yes: 005010 Yes: 006020
Homeless Patient Indicator USHIK Yes: 004050 Yes: 005010 Yes: 006020
Non-US Resident Patient Indicator USHIK Yes: 004050 Yes: 005010 Yes: 006020
Readmission Code USHIK Yes: 004050 Yes: 005010 Yes: 006020
Medicaid Special Program (PHC) Indicator USHIK Yes: 004050 Yes: 005010 Yes: 006020
Medicaid Special Program (SFP) Indicator USHIK Yes: 004050 Yes: 005010 Yes: 006020
Medicaid Special Program (FP) Indicator USHIK Yes: 004050 Yes: 005010 Yes: 006020
Medicaid Special Program (DIS) Indicator USHIK Yes: 004050 Yes: 005010 Yes: 006020
Workers' Compensation Indicator and Amount USHIK USHIK Yes: 004050 Yes: 005010 Yes: 006020
No Fault Indicator and Amount USHIK USHIK Yes: 004050 Yes: 005010 Yes: 006020
Medicaid Surplus, Catastrophic, Recurring Monthly Amount USHIK USHIK Yes: 004050 Yes: 005010 Yes: 006020
Blood Furnished Indicator and Amount USHIK USHIK Yes: 004050 Yes: 005010 Yes: 006020
Standard Occupation Classification System Codes USHIK No: 004050 No: 005010 Yes: 006020
Insurance Information
Source of Payment Code USHIK Yes: 004050 Yes: 005010 Yes: 006020
Payer Identification USHIK Yes: 004050 Yes: 005010 Yes: 006020
Policy Number USHIK Yes: 004050 Yes: 005010 Yes: 006020
Covered Days USHIK USHIK Yes: 004050 Yes: 005010 Yes: 006020
Non-Covered Days USHIK USHIK Yes: 004050 Yes: 005010 Yes: 006020
Payer Estimated Amount Due USHIK Yes: 004050 Yes: 005010 No: 006020
Payer Prior Payment USHIK Yes: 004050 Yes: 005010 Yes: 006020
Source of Payment Typology USHIK No: 004050 No: 005010 Yes: 006020
Service Line Information
UB-92 Accommodation Code USHIK Yes: 004050 Yes: 005010 Yes: 006020
Accommodations Rate USHIK Yes: 004050 Yes: 005010 Yes: 006020
Accommodations Days USHIK Yes: 004050 Yes: 005010 Yes: 006020
Accommodations Total Charges USHIK Yes: 004050 Yes: 005010 Yes: 006020
Accommodations Total Non-Covered Charges USHIK Yes: 004050 Yes: 005010 Yes: 006020
Ancillary Revenue Code USHIK Yes: 004050 Yes: 005010 Yes: 006020
Ancillary Units of Service USHIK Yes: 004050 Yes: 005010 Yes: 006020
Ancillary Total Charges USHIK Yes: 004050 Yes: 005010 Yes: 006020
Ancillary Total Non-Covered Charges USHIK Yes: 004050 Yes: 005010 Yes: 006020
Total Charges USHIK Yes: 004050 Yes: 005010 Yes: 006020
Procedure Code - HCPCS or CPT4 USHIK Yes: 004050 Yes: 005010 Yes: 006020
Modifier 1 (HCPC & CPT4) USHIK Yes: 004050 Yes: 005010 Yes: 006020
Modifier 2 (HCPC & CPT4) USHIK Yes: 004050 Yes: 005010 Yes: 006020
Modifier 3 (HCPC & CPT4) USHIK No: 004050 Yes: 005010 Yes: 006020
Modifier 4 (HCPC & CPT4) USHIK No: 004050 Yes: 005010 Yes: 006020
Drug Information - Line Level Detail
National Drug Code USHIK No: 004050 Yes: 005010 Yes: 006020
National Drug Unit Count USHIK No: 004050 Yes: 005010 Yes: 006020
Prescription or Compound Drug Association Number USHIK No: 004050 Yes: 005010 Yes: 006020
Physician Information - Line Level Detail
Operating Physician License Number USHIK No: 004050 Yes: 005010 Yes: 006020
Other Operating Physician License Number USHIK No: 004050 Yes: 005010 Yes: 006020
Medical Information
Principal Diagnosis Code USHIK Yes: 004050 Yes: 005010 Yes: 006020
Principal Diagnosis Present on Admission Indicator USHIK No: 004050 Yes: 005010 Yes: 006020
Other Diagnosis Code USHIK Yes: 004050 Yes: 005010 Yes: 006020
Other Diagnosis Present on Admission Indicator USHIK Yes: 004050 Yes: 005010 Yes: 006020
Principal Procedure Code USHIK Yes: 004050 Yes: 005010 Yes: 006020
Principal Procedure Date USHIK Yes: 004050 Yes: 005010 Yes: 006020
Other Procedure Code USHIK Yes: 004050 Yes: 005010 Yes: 006020
Other Procedure Date USHIK Yes: 004050 Yes: 005010 Yes: 006020
Admitting Diagnosis Code USHIK Yes: 004050 Yes: 005010 Yes: 006020
Patient's Reason for Visit USHIK Yes: 004050 Yes: 005010 Yes: 006020
External Cause-of-Injury Code USHIK Yes: 004050 Yes: 005010 Yes: 006020
External Cause-of-Injury Present on Admission Indicator USHIK No: 004050 Yes: 005010 Yes: 006020
Diagnosis Related Group USHIK No: 004050 Yes: 005010 Yes: 006020
Physician Information
Attending Provider License Number USHIK Yes: 004050 Yes: 005010 Yes: 006020
Operating Physician License Number USHIK Yes: 004050 Yes: 005010 Yes: 006020
Other Operating Physician License Number USHIK No: 004050 Yes: 005010 Yes: 006020
Rendering Provider License Number USHIK No: 004050 Yes: 005010 Yes: 006020
Other Physician License Number Obsolete since 004050 Yes: 004050 No: 005010 No: 006020
Referring Provider License Number USHIK Yes: 004050 Yes: 005010 Yes: 006020