Data to be submitted by physician class of provider – Wis. Admin. Code DHS §120-14

Data to be submitted by physicians to DHS

The Department of Health Services requires physicians to submit certain kinds of data to them on a regular basis.  Physicians are required to submit a list of claims data elements for each patient, including patient’s condition, birth date, payer information, diagnosis, information about service provided, charges, billing information, etc.  The regulation then sets forth detailed requirements for the submission of this data, including deadlines, methods of protecting confidentiality of data, prohibition against submitting patient's social security number or another identifying number.

The regulation requires DHS to check the accuracy and completeness of all data, and prohibits DHS from retaining or releasing any identifying data elements submitted to them like a patient's name, address, signature, phone number, employer name, etc.  DHS is required to create a final data profile and send it to the physician for corrections and review.  The regulation lists a couple of exemptions from these data submission requirements.

In addition to the claim data, physicians are required to submit physician self-reports, which includes information about new affiliations with health care plans and hospital privileges changes.  DHS is also required to collect certain workforce and practice information (such as licensing information, specialty, board certification, facilities where physician has privileges, usual charges, etc) from physicians as part of a physician survey.