Information Bulletin, November 2002

Data Submissions
SPARCS Changes
Outpatient Edit
HIPAA Compatibility
Data Quality
Data Submissions

Once again hospitals and vendors should be congratulated for another successful year of data submissions. For data received through the month of October approximately 99% of projected 2001 SPARCS data has been posted to the SPARCS master files. Facilities identified with possible data shortfalls are being contacted by SPARCS staff. We anticipate publishing the 2001 Annual Report with data submitted through the month of November. The ARS publication will note those facilities with a shortfall along with an explanation, which will also be posted on the SPARCS public web site.

There are facilities that currently have data shortfalls because their original or corrected data has not been submitted to SPARCS. Should you have any questions concerning the status of your 2001 data, please do not hesitate to contact the SPARCS Administrative Unit. Just as a reminder, the status of your inpatient and outpatient master file submissions is available on our Audit and Submission History Report page on our public web site.

SPARCS Changes

SPARCS is currently testing the announced 2003 changes to the Ambulatory Surgery system. We encourage providers to send us test files at your earliest convenience. As a reminder, the new requirements will be mandatory for all outpatient surgeries after December 31, 2002. Data submitted for prior years outpatient surgeries will only edit for the new requirements if the new data elements are included in the submission.

The purpose of these changes is part of an incremental plan for the SPARCS system to collect emergency department data prior to September 2003 as mandated by the authorizing state legislation. The new data fields being collected will class the SPARCS outpatient submission requirements with provider information systems and will provide a standard mechanism to identify different outpatient services. The final emergency department specifications are now available on the SPARCS public web site at www.health.state.ny.us/statistics/sparcs/sysdoc/elements_837/table_x12.htm.

We are planning to begin testing the emergency department data submissions sometime before the first of March 2003. Additional details about our testing strategies will be published in future bulletins.

Outpatient Edit

Providers will now be expected to submit e-codes when appropriate on all outpatient submissions to SPARCS as part of the 2003 changes to the SPARCS system. Currently there is a multiple relationship edit for inpatient submissions that requires e-codes be reported when a diagnosis code between the ranges of 800 and 999.99 are reported. We are planning to implement that same edit for outpatient submissions. Any provider interested in discussing this intended edit should contact the SPARCS Administrative Unit.

HIPAA Compatibility

The SPARCS system is now testing HIPAA compatible claim format (837) submissions. It is important to note that SPARCS will continue to support the current version 5 and 6 formats along with the 837 format until further notice. The companion documents detailing the SPARCS inpatient and outpatient requirements mapped to the 837 format are available on the SPARCS public web site at the following URL:

www.health.state.ny.us/statistics/sparcs/sysdoc/ip837.htm
www.health.state.ny.us/statistics/sparcs/sysdoc/op837.htm

Any provider interested in testing 837 formatted submissions should contact the SPARCS Administrative Unit.

Data Quality

Because of the increased use of SPARCS data for a variety of purposes the SPARCS staff continues to research ways to validate the reported inpatient and outpatient data. SPARCS routinely performs data quality checks by generating distribution reports on data items and comparing them to the statewide distribution. For example, a distribution report based on the patient disposition code would show where a patient went upon discharge. If the report showed a facility had no patients being discharged to home, that would indicate a potential problem for that facility. In the past, reports have been created based on disposition code, other diagnosis emergent indicator, e-code reporting patterns, source and type of admissions, race, ethnicity, county code, expected primary reimbursement codes, attending physician license numbers, and the last 4 digits of the unique identifier. With limited staff, notification to the facilities of potential problems based on these reports has not been consistent. Only facilities with significant differences were notified. Even in those cases we do not know the best person to notify of a potential problem. We are soliciting comments from facilities to help us improve our communication with the provider community. We appreciate your input helping us identity the best person in your facility to notify of a potential problem. Because of staff limitations we are also urging facilities to become more familiar with the Health Provider Network (HPN) as a means to routinely share confidential information about the quality of the data reported to SPARCS. Please contact the SPARCS administrative unit with your comments and suggestions.