G. SUPPLEMENTARY INFORMATION CHIA reports all discrepancy detail based on hospital submissions of the FY 2014 Hospital Inpatient Discharge Data Profile Report Final Without Grouper Reports form. – Note: Verification reports are available for review. Please direct requests to the attention of CHIA Public Records by facsimile to 617-727-7662. SUPPLEMENT I. LIST OF TYPE "A" AND TYPE "B" ERRORS TYPE "A" ERRORS Charges (by Revenue Record Type Code) Principal Diagnosis Starting Date Code Period Ending Date Medical Associate Diagnosis Record Number Code (I XIV) – Patient Sex Number of ANDS Patient Birth Principal Procedure Date Code Significant Admission Procedure Code I Date Discharge Significant Procedure Code II Date Significant Procedure Code III-XIV Physical Record Count Primary Source of Payment Patient Record Type 2X Count Status Billing Number Record Type 3X Count Record Type Primary 4X Count Record Type 5X Count Payer Type Primary Record Type 6X Count Payer Type Secondary Total Charges: Special Services Mother’s Medical Record Number Total Charges: Routine Services Revenue Code Total Charges: Ancillaries Total Charges: (ALL CHARGES) Number of Units of Service
G. SUPPLEMENTARY INFORMATION CHIA reports all discrepancy detail based on hospital submissions of the FY 2014 Hospital Inpatient Discharge Data Profile Report – Final Without Grouper Reports form. Note: Verification reports are available for review. Please direct requests to the attention of CHIA Public Records by facsimile to 617-727-7662. SUPPLEMENT I. LIST OF TYPE "A" AND TYPE "B" ERRORS TYPE "A" ERRORS Record Type Starting Date Period Ending Date Medical Record Number Patient Sex Patient Birth Date Admission Date Discharge Date Primary Source of Payment Patient Status Billing Number Primary Payer Type Primary Payer Type Secondary Mother’s Medical Record Number Revenue Code Units of Service Charges (by Revenue Code) Principal Diagnosis Code Associate Diagnosis Code (I – XIV) Number of ANDS Principal Procedure Code Significant Procedure Code I Significant Procedure Code II Significant Procedure Code III-XIV Physical Record Count Record Type 2X Count Record Type 3X Count Record Type 4X Count Record Type 5X Count Record Type 6X Count Total Charges: Special Services Total Charges: Routine Services Total Charges: Ancillaries Total Charges: (ALL CHARGES) Number of
CHIADOC-HDD-UM-Final-FY14-Final-4-2015.docx