The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.

1. (1) Accurate and Consistent Data--Data that has been edited by DSHS and subjected to provider validation and certification.
2. (2) Ambulatory Surgical Care Data--Data for events associated with reporting hospital services, which require surgery to be performed in an operating room on an anesthetized patient.
3. (3) ANSI 837 Institutional Guide--American National Standards Institute, Accredited Standards Committee X12N, 837 Health Care Institutional Claim Implementation Guide.
4. (4) APC--Ambulatory Payment Classification.
5. (5) Attending Physician--The individual licensed under the Medical Practice Act (Occupations Code, Chapter 151) who would normally be expected to certify and recertify the medical necessity of the services rendered during the hospital episode.
6. (6) Audit--An electronic standardized process developed and implemented by DSHS to identify potential errors and mistakes in file structure format or data element content by reviewing data fields for the presence or absence of data and the accuracy and appropriateness of data.
7. (7) Certification File--One or more electronic files (may include reports concerning the data and its compilation process) compiled by DSHS that contain one record for each patient event submitted for each reporting hospital under this subchapter during the reporting quarter and may contain one record for any patient event occurring during one prior reporting quarter for whom additional event claims have been received.
8. (8) Certification Process--The process by which a provider confirms the accuracy and completeness of the certification file required to produce the public use data file as specified in §1301.66 of this title (relating to Certification of Event Data).
9. (9) Charge--The amount billed by a provider for specific procedures or services provided to a patient before any adjustment for contractual allowances, government mandated fee schedules or write offs for charity care, bad debt or administrative courtesy. The term does not include co-payments charged to health maintenance organization enrollees by providers paid by capitation or salary in a health maintenance organization.
10. (10) Clinical Classification Software--A classification system that groups diagnoses and procedures into a limited number of clinically meaningful categories.
11. (11) Comments--The notes or explanations submitted by the reporting hospitals, physicians or other health professionals concerning the provider quality reports or the encounter data for public use as described in the Texas Health and Safety Code, §108.010(c) and (e) and §108.011(g) respectively.
12. (12) Council--The Texas Health Care Information Council, until the abolition of the Council, the Department of State Health Services after abolition of the Council.
13. (13) CPT--Current Procedural Terminology.
14. (14) Data format--The sequence or location of data elements in an electronic record according to prescribed specifications.
15. (15) Discharge--The formal release of a patient by a physician authorized to practice in a reporting hospital ambulatory surgical unit or emergency department; that is, the termination of a period of medical services by death or by disposition to a residence or another health care provider.
16. (16) DSHS--Department of State Health Services, the successor state agency to the Texas Health Care Information Council and the Texas Department of Health.
17. (17) DRG--Diagnosis Related Group.
18. (18) EDI--Electronic Data Interchange--A method of sending data electronically from one computer to another. EDI helps providers and payers maintain a flow of vital information by enabling the transmission of claims and managed care transactions.
19. (19) Electronic Filing--The submission of computer records in machine readable form by modem transfer from one computer to another (EDI) or by recording the records on a nine track magnetic tape, computer diskette or other magnetic media acceptable to DSHS.
20. (20) Emergency Department--Department or room within a reporting hospital as determined by federal or state law for the provision of emergency health care.
21. (21) Emergency Department Data--Events associated with hospital services in an emergency department or emergency room.
22. (22) Error--Data submitted on a event file which are not consistent with the format and data standards contained in this subchapter or with auditing criteria established by DSHS.
23. (23) Ethnicity--The status of patients relative to Hispanic background. Reporting hospitals shall report this data element according to the following ethnic types: Hispanic or Non-Hispanic.
24. (24) Event--The medical screening examination, triage, observation, diagnosis or treatment of a patient within the authority of a reporting hospital.
25. (25) Event claim--A set of computer records as specified in §1301.68 of this title (relating to Event Files--Records, Data Fields and Codes) relating to a specific patient. "Event claim" corresponds to the ANSI 837 Institutional Guide term, "Transaction set."
26. (26) Event file--A computer file as defined in §1301.68 of this title (relating to Event Files--Records, Data Fields and Codes) periodically submitted on or on behalf of a reporting hospital in compliance with the provisions of this subchapter. "Event File" corresponds to the ANSI 837 Institutional Guide terms, "Communication Envelope" or "Interchange Envelope."
27. (27) Executive director--The chief administrative officer of the Council or of the department designated by the Department of State Health Services to perform the functions of the Council.
28. (28) Facility--For the purposes of this subchapter a facility is a reporting hospital.
29. (29) Facility Type Indicators--An indicator that provides information to the data user as to the type of facility or the primary health services delivered at that reporting hospital (e.g., Hospital based ambulatory surgical unit and hospitals with an emergency department or emergency room). A hospital may have more than one indicator.
30. (30) Geographic identifiers--A set of codes indicating the public health region and county in which the patient resides.
31. (31) HCPCS--HCFA's Common Procedure Coding System (HCFA-Health Care Finance Administrations (Now called Centers for Medicare and Medicaid Services)).
32. (32) HIPPS--Health Insurance Prospective Payment System.
33. (33) Hospital--A public, for-profit, or nonprofit institution licensed as a general or special hospital (25 TAC §133.2(22)(52)), or a hospital owned by the state.
34. (34) ICD--International Classification of Disease.
35. (35) IRB--Institutional Review Board.
36. (36) Operating or Other Physician--The "physician" licensed by the Texas State Board of Medical Examiners, or "other health professional" licensed by the State of Texas who performed the principal procedure or performed the surgical procedure most closely related to the principal diagnosis.
37. (37) Other health professional--A person licensed to provide health care services other than a physician. An individual other than a physician who provides diagnostic or therapeutic procedures to patients. The term encompasses persons licensed under various Texas practice statutes, such as psychologists, chiropractors, dentists, nurse practitioners, nurse midwives, and podiatrists who are authorized by the reporting hospital to examine, observe or treat patients.
38. (38) Panel--Scientific Review Panel.
39. (39) Patient account number--A number assigned to each patient by the hospital, which appears on each computer record in a patient event claim. This number is not consistent for a given patient from one hospital to the next, or from one admission to the next in the same hospital. DSHS will delete or encrypt this number to protect patient confidentiality prior to release of data.
40. (40) Physician--An individual licensed under the laws of this state to practice medicine under the Medical Practice Act, Occupations Code, Chapter 151.
41. (41) Provider--For the purposes of this subchapter, a physician or reporting hospital.
42. (42) Public use data file--A data file composed of event claims which have been altered by the deletion, encryption or other modification of data fields to protect patient and physician confidentiality and to satisfy other restrictions on the release of ambulatory surgical care and emergency department data imposed by statute.
43. (43) Race--A division of patients according to traits that are transmissible by descent and sufficient to characterize them as distinctly human types. Reporting hospitals shall report this data element according to the following racial types: American Indian, Eskimo, or Aleut; Asian or Pacific Islander; Black; White; or Other.
44. (44) Reporting hospital--A public, for-profit, or nonprofit institution licensed or owned by this state as a general or special hospital or a hospital owned by the state that volunteers to participate in the data collection, correction, certification and analysis process specified in this subchapter.
45. (45) Required minimum data set--The list of data elements for which reporting hospitals may submit an event claim for each patient event occurring in the hospital. The required minimum data set is specified in §1301.68(d) of this title (relating to Event Files--Records, Data Fields and Codes) and is only required if the hospital chooses to participate in reporting under this subchapter. This list does not include all the data elements that are required by the ANSI 837 Institutional Guide to submit an acceptable event file. For example: Interchange Control Headers and Trailers, Functional Group Headers and Trailers, Transaction Set Headers and Trailers and Qualifying Codes (which identify or qualify subsequent data elements).
46. (46) Research data file--A customized data file, which includes the data elements in the public use file and may include data elements other than the required minimum data set submitted to DSHS, except those data elements that could reasonably identify a patient or physician.
47. (47) Scientific Review Panel--DSHS' appointees or agent who have experience and expertise in ethics, patient confidentiality, and health care data who review and approve or disapprove requests for data or information other than the public use data.
48. (48) Submission--The transfer of a set of computer records as specified in §1301.68 of this title (relating to Event Files--Records, Data Fields and Codes) that constitutes the event file for one or more reporting hospitals under this subchapter.
49. (49) Submitter--The person or organization, which physically prepares an event file for one or more reporting hospitals and submits them under this subchapter. A submitter may be a hospital or an agent designated by a hospital or its owner.
50. (50) TDH--Texas Department of Health, or its successor agency, the Department of State Health Services.
51. (51) THCIC Identification Number--A string of 6 characters assigned by DSHS to identify hospitals for reporting and tracking purposes.
52. (52) Uniform patient identifier--A unique identifier assigned by DSHS to an individual patient and composed of numeric, alpha, or alphanumeric characters, which remains constant across hospitals and patient events. The relationship of the identifier to the patient-specific data elements used to assign it is confidential.
53. (53) Uniform physician identifier--A unique identifier assigned by the Council to a physician or other health professional who is reported as attending or treating a patient in a hospital and which remains constant across hospitals. The relationship of the identifier to the physician-specific data elements used to assign it is confidential. The uniform physician identifier shall consist of alphanumeric characters.
54. (54) Validation--The process by which a provider verifies the accuracy and completeness of data and corrects any errors identified before certification.

Source Note:The provisions of this §421.61 adopted to be effective August 29, 2004, 29 TexReg 8123; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8842.