1. A. Schedule for reporting: Beginning with the first quarter of 2013 (January 1-March 31), all licensed non-federal general and specialty inpatient health care facilities in New Mexico shall submit the reporting period discharges to the division on a quarterly basis the data required by this rule, in accordance with the following schedule:

   Reporting period Report due to the division (95% discharges) Division returns integrity and validation errors Final corrected report due to the division (100% discharges) January 1-March 31 May 31 June 15 June 30 April 1-June 30 August 30 September 15 September 30 July 1-September 30 November 30 December 15 December 31 October 1-December 31 February 28 of the following year March 15 of the following year March 31 of the following year

   Reporting period

   Report due to the division (95% discharges)

   Division returns integrity and validation errors

   Final corrected report due to the division (100% discharges)

   January 1-March 31

   May 31

   June 15

   June 30

   April 1-June 30

   August 30

   September 15

   September 30

   July 1-September 30

   November 30

   December 15

   December 31

   October 1-December 31

   February 28 of the following year

   March 15 of the following year

   March 31 of the following year

2. B. Pursuant to the electronic reporting requirements in 7.1.27.10 NMAC, submit the data as a fixed-width ASCII text (flat) file. Follow the record layout specifications, provided by the division, for field placement and lengths (field lengths are maximum values and shall contain blank spaces as fillers for values less than the maximum length).

3. C. Data required to be reported: All licensed non-federal general and specialty inpatient health care facilities in New Mexico shall report to the division the following data elements, in the record layout provided by the division. Required data items:

   (1) New Mexico state license number, left justified;

   (2) medicare provider number, left justified;

   (3) provider zip code (five or nine digits), left justified;

   (4) admission hour (military time);

   (5) patient’s admission date (mmddyyyy);

   (6) point of origin (1 to 9, a, d, e, and f);

   (7) type of admission (1 to 4, 9);

   (8) patient’s ems ambulance run number, left justified;

   (9) traffic crash report number, left justified;

   (10) accident state (two-digit code), left justified;

   (11) patient’s medical record number, left justified;

   (12) patient’s medicaid id number;

   (13) patient’s control number, left justified;

   (14) birth weight (grams);

   (15) attending physician NPI (assigned by medicare);

   (16) operating physician NPI (assigned by medicare);

   (17) discharge hour (military time);

   (18) patient’s discharge date (mmddyyyy);

   (19) patient’s status (01 to 99);

   (20) primary payer category (1 to 10, 88), right justified;

   (21) primary payer identification name, left justified;

   (22) primary payer type (1 to 3, 88), right justified;

   (23) secondary payer category (1 to 10, 88), right justified;

   (24) secondary payer identification name, left justified;

   (25) secondary payer type (1 to 3, 88), right justified;

   (26) tertiary payer category (1 to 10, 88), right justified;

   (27) tertiary payer identification name, left justified;

   (28) tertiary payer type (1 to 3, 88), right justified;

   (29) 1st condition code, left justified;

   (30) 2nd condition code, left justified;

   (31) 3rd condition code, left justified;

   (32) 4th condition code, left justified;

   (33) 5th condition code, left justified;

   (34) 6th condition code, left justified;

   (35) 7th condition code, left justified;

   (36) 8th condition code, left justified;

   (37) 9th condition code, left justified;

   (38) 10th condition code, left justified;

   (39) 11th condition code, left justified;

   (40) 1st revenue code, left justified;

   (41) 1st revenue code description, left justified;

   (42) 1st revenue code service date (mmddyyyy), left justified;

   (43) 1st revenue code service units, right justified;

   (44) 1st revenue code line item charges, right justified;

   (45) 1st revenue code non-covered charges, right justified;

   (46) 2nd revenue code, left justified;

   (47) 2nd revenue code description, left justified;

   (48) 2nd revenue code service date (mmddyyyy), left justified;

   (49) 2nd revenue code service units, right justified;

   (50) 2nd revenue code line item charges, right justified;

   (51) 2nd revenue code non-covered charges, right justified;

   (52) 3rd revenue code description, left justified;

   (53) 3rd revenue code service date (mmddyyyy), left justified;

   (54) 3rd revenue code service units, right justified;

   (55) 3rd revenue code line item charges, right justified;

   (56) 3rd revenue code non-covered charges, right justified;

   (57) 4th revenue code, left justified;

   (58) 4th revenue code description, left justified;

   (59) 4th revenue code service date (mmddyyyy), left justified;

   (60) 4th revenue code service units, right justified;

   (61) 4th revenue code line item charges, right justified;

   (62) 4th revenue code non-covered charges, right justified;

   (63) 5th revenue code, left justified;

   (64) 5th revenue code description, left justified;

   (65) 5th revenue code service date (mmddyyyy), left justified;

   (66) 5th revenue code service units, right justified;

   (67) 5th revenue code line item charges, right justified;

   (68) 5th revenue code non-covered charges, right justified;

   (69) 6th revenue code, left justified;

   (70) 6th revenue code description, left justified;

   (71) 6th revenue code service date (mmddyyyy), left justified;

   (72) 6th revenue code service units, right justified;

   (73) 6th revenue code line item charges, right justified;

   (74) 6th revenue code non-covered charges, right justified;

   (75) 7th revenue code, left justified;

   (76) 7th revenue code description, left justified;

   (77) 7th revenue code service date (mmddyyyy), left justified;

   (78) 7th revenue code service units, right justified;

   (79) 7th revenue code line item charges, right justified;

   (80) 7th revenue code non-covered charges, right justified;

   (81) 8th revenue code, left justified;

   (82) 8th revenue code description, left justified;

   (83) 8th revenue code service date (mmddyyyy), left justified;

   (84) 8th revenue code service units, right justified;

   (85) 8th revenue code line item charges, right justified;

   (86) 8th revenue code non-covered charges, right justified;

   (87) 9th revenue code, left justified;

   (88) 9th revenue code description, left justified;

   (89) 9th revenue code service date (mmddyyyy), left justified;

   (90) 9th revenue code service units, right justified;

   (91) 9th revenue code line item charges, right justified;

   (92) 9th revenue code non-covered charges, right justified;

   (93) 10th revenue code, left justified;

   (94) 10th revenue code description, left justified;

   (95) 10th revenue code service date (mmddyyyy), left justified;

   (96) 10th revenue code service units, right justified;

   (97) 10th revenue code line item charges, right justified;

   (98) 10th revenue code non-covered charges, right justified;

   (99) 11th revenue code, left justified;

   (100) 11th revenue code description, left justified;

   (101) 11th revenue code service date (mmddyyyy), left justified;

   (102) 11th revenue code service units, right justified;

   (103) 11th revenue code line item charges, right justified;

   (104) 11th revenue code non-covered charges, right justified;

   (105) 12th revenue code, left justified;

   (106) 12th revenue code description, left justified;

   (107) 12th revenue code service date (mmddyyyy), left justified;

   (108) 12th revenue code service units, right justified;

   (109) 12th revenue code line item charges, right justified;

   (110) 12th revenue code non-covered charges, right justified;

   (111) 13th revenue code, left justified;

   (112) 13th revenue code description, left justified;

   (113) 13th revenue code service date (mmddyyyy), left justified;

   (114) 13th revenue code service units, right justified;

   (115) 13th revenue code line item charges, right justified;

   (116) 13th revenue code non-covered charges, right justified;

   (117) 14th revenue code, left justified;

   (118) 14th revenue code description, left justified;

   (119) 14th revenue code service date (mmddyyyy), left justified;

   (120) 14th revenue code service units, right justified;

   (121) 14th revenue code line item charges, right justified;

   (122) 14th revenue code non-covered charges, right justified;

   (123) 15th revenue code, left justified;

   (124) 15th revenue code description, left justified;

   (125) 15th revenue code service date (mmddyyyy), left justified;

   (126) 15th revenue code service units, right justified;

   (127) 15th revenue code line item charges, right justified;

   (128) 15th revenue code non-covered charges, right justified;

   (129) 16th revenue code, left justified;

   (130) 16th revenue code description, left justified;

   (131) 16th revenue code service date (mmddyyyy), left justified;

   (132) 16th revenue code service units, right justified;

   (133) 16th revenue code line item charges, right justified;

   (134) 16th revenue code non-covered charges, right justified;

   (135) 17th revenue code, left justified;

   (136) 17th revenue code description, left justified;

   (137) 17th revenue code service date (mmddyyyy), left justified;

   (138) 17th revenue code service units, right justified;

   (139) 17th revenue code line item charges, right justified;

   (140) 17th revenue code non-covered charges, right justified;

   (141) 18th revenue code, left justified;

   (142) 18th revenue code description, left justified;

   (143) 18th revenue code service date (mmddyyyy), left justified;

   (144) 18th revenue code service units, right justified;

   (145) 18th revenue code line item charges, right justified;

   (146) 18th revenue code non-covered charges, right justified;

   (147) 19th revenue code, left justified;

   (148) 19th revenue code description, left justified;

   (149) 19th revenue code service date (mmddyyyy), left justified;

   (150) 19th revenue code service units, right justified;

   (151) 19th revenue code line item charges, right justified;

   (152) 19th revenue code non-covered charges, right justified;

   (153) 20th revenue code, left justified;

   (154) 20th revenue code description, left justified;

   (155) 20th revenue code service date (mmddyyyy), left justified;

   (156) 20th revenue code service units, right justified;

   (157) 20th revenue code line item charges, right justified;

   (158) 20th revenue code non-covered charges, right justified;

   (159) 21st revenue code, left justified;

   (160) 21st revenue code description, left justified;

   (161) 21st revenue code service date (mmddyyyy), left justified;

   (162) 21st revenue code service units, right justified;

   (163) 21st revenue code line item charges, right justified;

   (164) 21st revenue code non-covered charges, right justified;

   (165) 22nd revenue code, left justified;

   (166) 22nd revenue code description, left justified;

   (167) 22nd revenue code service date (mmddyyyy), left justified;

   (168) 22nd revenue code service units, right justified;

   (169) 22nd revenue code line item charges, right justified;

   (170) 22nd revenue code non-covered charges, right justified;

   (171) patient’s last name, left justified;

   (172) patient’s middle initial;

   (173) patient’s social security number;

   (174) patient’s street address, left justified;

   (175) patient’s city, left justified;

   (176) patient’s county, left justified;

   (177) patient’s state, left justified;

   (178) patient’s zip code (five or nine digits), left justified;

   (179) patient’s date of birth (mmddyyyy);

   (180) patient’s race-multiple (r1 to r7. r9);

   (181) patient’s ethnicity (e1, e2, e6, e7);

   (182) patient’s tribal affiliation-up to five (t1 to t22, t100, t200, t300);

   (183) sex of patient (m, f, u);

   (184) patient’s phone number, left justified;

   (185) patient’s admitting diagnosis code, left justified;

   (186) patient’s principal diagnosis code, left justified;

   (187) patient’s 2nd diagnosis code, left justified;

   (188) patient’s 3rd diagnosis code, left justified;

   (189) patient’s 4th diagnosis code, left justified;

   (190) patient’s 5th diagnosis code, left justified;

   (191) patient’s 6th diagnosis code, left justified;

   (192) patient’s 7th diagnosis code, left justified;

   (193) patient’s 8th diagnosis code, left justified;

   (194) patient’s 9th diagnosis code, left justified;

   (195) patient’s 10th diagnosis code, left justified;

   (196) patient’s 11th diagnosis code, left justified;

   (197) patient’s 12th diagnosis code, left justified;

   (198) patient’s 13th diagnosis code, left justified;

   (199) patient’s 14th diagnosis code, left justified;

   (200) patient’s 15th diagnosis code, left justified;

   (201) patient’s 16th diagnosis code, left justified;

   (202) patient’s 17th diagnosis code, left justified;

   (203) patient’s 18th diagnosis code, left justified;

   (204) patient’s admitting diagnosis code qualifier (9, 0, 1), left justified;

   (205) patient’s principal diagnosis code qualifier (9, 0, 1), left justified;

   (206) patient’s 2nd diagnosis code qualifier (9, 0, 1), left justified;

   (207) patient’s 3rd diagnosis code qualifier (9, 0, 1), left justified;

   (208) patient’s 4th diagnosis code qualifier (9, 0, 1), left justified;

   (209) patient’s 5th diagnosis code qualifier (9, 0, 1), left justified;

   (210) patient’s 6th diagnosis code qualifier (9, 0, 1), left justified;

   (211) patient’s 7th diagnosis code qualifier (9, 0, 1), left justified;

   (212) patient’s 8th diagnosis code qualifier (9, 0, 1), left justified;

   (213) patient’s 9th diagnosis code qualifier (9, 0, 1), left justified;

   (214) patient’s 10th diagnosis code qualifier (9, 0, 1), left justified;

   (215) patient’s 11th diagnosis code qualifier (9, 0, 1), left justified;

   (216) patient’s 12th diagnosis code qualifier (9, 0, 1), left justified;

   (217) patient’s 13th diagnosis code qualifier (9, 0, 1), left justified;

   (218) patient’s 14th diagnosis code qualifier (9, 0, 1), left justified;

   (219) patient’s 15th diagnosis code qualifier (9, 0, 1), left justified;

   (220) patient’s 16th diagnosis code qualifier (9, 0, 1), left justified;

   (221) patient’s 17th diagnosis code qualifier (9, 0, 1), left justified;

   (222) patient’s 18th diagnosis code qualifier (9, 0, 1), left justified;

   (223) 1st e-code, left justified, (required);

   (224) 2nd e-code, left justified;

   (225) 3rd e-code, left justified;

   (226) patient’s admitting diagnosis, present on admission, left justified;

   (227) patient’s principal diagnosis, present on admission, left justified;

   (228) patient’s 2nd diagnosis, present on admission, left justified ;

   (229) patient’s 3rd diagnosis, present on admission, left justified ;

   (230) patient’s 4th diagnosis, present on admission, left justified ;

   (231) patient’s 5th diagnosis, present on admission, left justified ;

   (232) patient’s 6th diagnosis, present on admission, left justified ;

   (233) patient’s 7th diagnosis, present on admission, left justified ;

   (234) patient’s 8th diagnosis, present on admission, left justified ;

   (235) patient’s 9th diagnosis, present on admission, left justified ;

   (236) patient’s 10th diagnosis, present on admission, left justified ;

   (237) patient’s 11th diagnosis, present on admission, left justified ;

   (238) patient’s 12th diagnosis, present on admission, left justified ;

   (239) patient’s 13th diagnosis, present on admission, left justified ;

   (240) patient’s 14th diagnosis, present on admission, left justified ;

   (241) patient’s 15th diagnosis, present on admission, left justified ;

   (242) patient’s 16th diagnosis, present on admission, left justified ;

   (243) patient’s 17th diagnosis, present on admission, left justified ;

   (244) patient’s 18th diagnosis, present on admission, left justified ;

   (245) patient’s diagnosis related group (DRG) code ;

   (246) patient’s principal procedure code, left justified;

   (247) patient’s 2nd procedure code, left justified;

   (248) patient’s 3rd procedure code, left justified;

   (249) patient’s 4th procedure code, left justified;

   (250) patient’s 5th procedure code, left justified;

   (251) patient’s 6th procedure code, left justified;

   (252) patient’s 2nd procedure code, left justified;

   (253) patient’s 3rd procedure code, left justified;

   (254) patient’s 4th procedure code, left justified;

   (255) patient’s 5th procedure code, left justified;

   (256) patient’s 6th procedure code, left justified;

   (257) patient’s principal procedure code qualifier (9, 0, 1), left justified;

   (258) patient’s 2nd procedure code qualifier (9, 0, 1), left justified;

   (259) patient’s 3rd procedure code qualifier (9, 0, 1), left justified;

   (260) patient’s 4th procedure code qualifier (9, 0, 1), left justified;

   (261) patient’s 5th procedure code qualifier (9, 0, 1), left justified;

   (262) patient’s 6th procedure code qualifier (9, 0, 1), left justified;

   (263) patient’s 2nd procedure code qualifier (9, 0, 1), left justified;

   (264) patient’s 3rd procedure code qualifier (9, 0, 1), left justified;

   (265) patient’s 4th procedure code qualifier (9, 0, 1), left justified;

   (266) patient’s 5th procedure code qualifier (9, 0, 1), left justified;

   (267) patient’s 6th procedure code qualifier (9, 0, 1), left justified;

4. D. Data reporting requirements for New Mexico human services department's medicaid system: The New Mexico human service department’s medicaid system shall provide all data listed by cooperative agreement between the division and the human services department, pursuant to the reporting schedule contained in Subsection A of 7.1.27.10 NMAC.
5. E. Data reporting requirements for the medicare (part A) fiscal intermediary: The medicare (part A) fiscal intermediary shall provide all data mutually agreed upon in accordance with law between the division and the fiscal intermediary, pursuant to the reporting schedule contained in Subsection A of 7.1.27.9 NMAC.
6. F. Annual financial statements: All licensed non-federal general and specialty inpatient health care facilities shall submit annual audited financial statements to the division. If the owners of such facilities obtain one audit covering more than one facility, combined annual audited financial statements may be submitted in compliance with this section. Facilities reporting in combined annual audited financial statements must also submit annual unaudited, individual facility financial statements to the division. These reports shall be submitted no later than the end of the calendar year following the statement year.

[7.1.27.9 NMAC - N, 12/31/2012]