SPARCS Frequently Asked Questions (FAQs)

        SPARCS Operations - for all SPARCS questions        

Phone: (518) 473-8144
Fax: (518) 486-3518
   Commerce Account Management Unit (CAMU) - for Health Commerce Accounts   

Phone: (866) 529-1890
HCS Website:
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Categories Menu Audit/Enforcement Process
Q - # Topic Questions & Answers Posted
AP-001 Enforcement Q: I just received a letter from SPARCS regarding missing data from last year's submissions – what happens now?

A: If the missing data mentioned in the letter is submitted by the following month, then no further actions will be taken. If the data is not received by the following month, and you have not received an exception, we will notify your CEO of possible impending enforcement actions which may include a Statement of Deficiencies (SOD), fines or a Medicaid rate reduction.

Categories Menu Contacts
Q - # Topic Questions & Answers Posted
C-001 Contact Q: How can I change my SPARCS Coordinator?

A: There are 3 ways: 1) send an e-mail with your changes to, or 2) call SPARCS Operations at (518) 473-8144, or 3) complete the SPARCS Update Contact Information Form. The forms are available by calling or e-mailing SPARCS Operations.

C-002 Contact Q: What level of access do SPARCS Coordinators have?

A: SPARCS Coordinators have SPARCS Upload Access, along with permission to view patient level data for their facility. They also have basic HCS account access which allows them to view information on the HCS not restricted by specific program areas.

C-003 Contact Q: Can our facility have more than one SPARCS Contact/Coordinator?

A: Each facility can have as many contacts as they wish; however, there is only one SPARCS Coordinator and Backup Coordinator per facility. Any correspondences generated by SPARCS relative to the data collection process will be sent to the Coordinator.

C-004 Contact Q: I contract with a vendor to submit files to SPARCS on our behalf – can I list the vendor as my SPARCS Coordinator?

A: While vendors may be listed as "Other" contacts for your facility, they cannot be assigned to either the SPARCS Coordinator or Backup Coordinator role.

C-005 Contact Q: How do I get e-mail notifications of SPARCS changes?

A: There are two ways - SPARCS Coordinators automatically receive all electronic and paper correspondences. In addition, any contact we list for your facility may opt to receive e-mails from SPARCS. Just call us to request to be added to our e-mail list. We also distribute information to interested parties via our listserv, SPARCS-L. To subscribe to SPARCS-L, go to SPARCS-L and follow the instructions.

Categories Menu Coding Issues
Q - # Topic Questions & Answers Posted
CI-001 NTE01 Q: The Inpatient versus Outpatient Addendum has different information as to what is to be reported in the NTE01?

A: The addenda is correct, the file layout is different for the inpatient and outpatient files.

CI-002 Other Diagnosis POA Indicator, Inpatient Addendum Section 5.44 Q: The Inpatient Addendum indicates the HI01-9 should be either a "Y", "N", "U" or "W" and the SPARCS Inpatient Output Data Dictionary indicates the valid codes are "1", "2", or "9". What is correct?

A: The correct values for 837 submission are "Y", "N", "U", "W", "1", or " " (blank).

CI-003 QTY Segment (Loop 2300, Claim Quantity), Inpatient Addendum Section 5.51 Q: The QTY segment is for reporting the Covered Days and Non-Covered Days quantities. The SPARCS Inpatient Addendum indicates at least two loops are required – one for Covered and one for Non-Covered. If a claim has no Non-Covered Days, what should I report?

A: The Non-Covered Days QTY segment is not required for claims with zero Non-Covered Days.

CI-004 QTY Segment (Loop 2300, Claim Quantity), Inpatient Addendum Section 5.51 Q: The UDS version allowed for Covered and Non-Covered Day quantities to be reported multiple times, once for each payer. Has this changed in the 837?

A: Yes. Covered days are reported only once and apply to the entire claim. The QTY segment can repeat up to 4 times to report Covered, Co-Insured, Life-Time Reserved or Non-Covered days. There is no longer a way to associate Covered and Non-Covered Days for a specific payer.

CI-005 E-Codes Q: Are E-Codes required?

A: Yes. E-Codes are required for both inpatient and outpatient submission in the HI segment. (Note: the E must be an Uppercase letter "E" and all digits entered exactly as shown in the ICD-9-CM coding reference.)

CI-006 Value Codes Q: Is the value code I entered returned to me on the edit report?

A: Yes. The value code is displayed in the "Value" Column of the edit report.

CI-007 Revenue Codes Q: We have been using Revenue code 361 for Minor Surgery on ambulatory surgery cases when reporting to SPARCS in the past, and they have always been accepted. Now, the records we are submitting with Revenue Code 361 are being rejected. Why?

A: The definition of reporting Ambulatory Surgery to SPARCS was changed in February 2011 to use revenue codes and was modified in June 2011 to a shorter list of revenue codes. Currently, 0361 is not classified as a reportable Ambulatory Surgery Code. If you are reporting Ambulatory Surgery claims, you must use the following codes, along with the Procedure Time, 72 hour edit, Method of Anesthesia and the Operating Room Physician.

  • SPARCS Reportable Ambulatory Surgery Codes are:
  • 0360, 0362, 0369 General Services, Operating Room Services
  • 0481 Cardiac Cat Lab, Cardiology
  • 0490 General Classification, Ambulatory Surgery
  • 0499 Other Ambulatory Surgical Care, Ambulatory Surgery
  • 0750 General Classification Gastro-Intestinal Services
  • 0790 General Classification, Lithotripsy

You can also visit the following link for more information on Ambulatory Surgery and Expanded Outpatient Data Collection submissions:

Note: Any records submitted not using the above defined Ambulatory Surgery Revenue codes will default to an expanded outpatient submission. If you are using 0361 (OP), your submission will require the following information: Date of Service (DTP03 - 2400), Service Units (SV2 - 2400), and if it is a Medicaid claim, the Value Code and Amount (HI - 2300) is also required.
CI-008 Psychiatric Patients Q: How does SPARCS identify psych patients? Can you confirm they are excluded from the Medicaid HMO numbers in the GME CMI threshold?

A: On the SPARCS Inpatient Output file there are two ways to identify psychiatric patients. They are both calculated data elements. They are: service category and exempt unit. The service category value of "psychiatric" is created using the ICD-9-CM code range 290-319. The exempt unit data element is based upon the DRG calculation; one of the categories is for "psychiatric" patients.

The Medicaid HMO numbers in the GME CMI threshold calculation exclude exempt units. If it is an Acute Psych DRG, it would be included.
CI-009 Hospice Data Q: Does SPARCS collect hospice data? If yes, under what circumstances?

A: Generally, SPARCS does not collect hospice data because these services are certified under Article 36 and SPARCS data is capturing services provided in Article 28 health care facilities. However, SPARCS will allow the submission of care provided to a hospice patient that was provided in an Article 28 facility. These certain circumstances arise where a hospice patient needs acute care services. While patients are enrolled in hospice and using their hospice benefits, there are times that acute care is required. This is generally for pain management which may involve a diagnostic or interventional surgical procedure for the purpose of relieving pain and/or to stabilize an acute care condition that cannot be managed in the home environment. Patients continue to be billed by their hospice provider, and the hospital is reimbursed through an agreement with the hospice provider. While the billing differs from our general hospital population, these are still hospital patients utilizing hospital services. If the hospital generally does not have a hospice inpatient unit (or even scatter beds) for the sole purpose of providing palliative care, then the hospital may submit this data to SPARCS. If the hospital does possess such a service, then these services should be excluded from the SPARCS reporting. Additionally, when reporting hospice care to SPARCS, you must utilize the appropriate revenue code from Appendix I to reflect the appropriate level of care.

Following are examples of circumstances in which SPARCS will accept hospice submissions:

(a) The beds are not separately licensed as hospice beds under Article 36 (beds may be licensed as acute beds, etc.).

(b) The hospital does not bill for hospice services, it is not an approved service of the hospital.

(c) These are patients enrolled in a hospice program who require acute care services.

(d) These patients are not receiving hospice services from the hospital while registered as inpatients of the hospital.

(e) A viable hospice care program is the guarantor for the hospital reimbursement, not Medicare or any other payer.
Categories Menu Data Elements
Q - # Topic Questions & Answers Posted
DE-001a NPI Q: What National Provider Identifications (NPIs) are SPARCS collecting?

A: SPARCS is collecting the facility's NPI. (Note: Not the individual Practitioner's NPI.)

DE-001b NPI Q: My facility has multiple NPI's. Which one should I report?

A: Any one of the NPI's issued to your facility.

DE-001c NPI Q: I don't have the NPI? What would I report?

A: Report the PFI with the XX qualifier, or report the Employer's Identification Number with 24 as the qualifier. The NPI is entered in the NM1 Service Provider Name (Loop 2010AA) in segment NM109 for both inpatient and outpatient submission.

DE-002a Type of Bill Q: How do I report the Type of Bill?

A: This is a composite element, the first 2 positions are for the type of facility and the bill classification. The letter "A" is used as a separator, and the third position designates the type of transaction.

Example of Type of Bill=131 (new claim from a hospital for outpatient services):

DE-003a Patient Race Q: The SPARCS Input Data Dictionary indicates that Patient Race is reported in the NTE segment of the 2300 Loop and in the DMG segments of the 2010BA or 2010CA Loops. Does this have to be reported in both the NTE segment and the DMG segment?

A: No. Reporting Patient Race is dependent on what version of the 837 you are reporting. If you are reporting in 4010, Patient Race is placed in the NTE segment. In 4050, it is submitted in the DMG segment.

DE-003b Patient Race/Ethnicity Q: Our facility recently had a case where the patient was dead on arrival (DOA). This made it difficult to determine the race/ethnicity of the deceased patient. We are using the DMG segment (5010R) to report Race/Ethnicity, but there is no corresponding code for "Unknown". What should we do?

A: Unfortunately, the codes used to report race in the DMG segment do not have "unknown". This coding structure was established by the national ASC 837-X12 standards committee for state reporting in the Data Reporting Guide for the 837. SPARCS is therefore recommending that in extreme cases where the race/ethnicity of the patient cannot be determined that facilities report such cases under the NTE (4050R) segment. Please take note that the codes/values used to report under the DMG (5010R) are not the same, and do not appear in the same order as they do in the NTE segment, thus it is essential that each facility review the listed codes prior to submission and create a crosswalk of these codes.
DE-003c Race and Ethnicity Q: I am getting errors for the NTE segment in an Inpatient file with the following format: 005010X225. The error is 2300NTE2000 - RACE CODE. I thought in the 5010 format race and ethnicity was reported in the DMG segment. This is the location on our file. Why is this occurring?

A: Unfortunately, the same error message is used for both segment locations. You are correct in that the race and ethnicity for version 5010 is reported under the DMG segment. Technically, SPARCS still allows Race & Ethnicity to be reported in both the NTE and DMG segments on the X12-837 5010 format file. Thus all errors messages for race & ethnicity, for either the DMG segment or the NTE segment will receive the same error message that will require correction.
DE-004a License Number Q: The first two positions of the Physicians License Number indicate the category of license held by the health care professional. Is this really necessary to report?

A: Yes. The two-digit code is required for reporting Physician License Numbers. Records will error out if this information is not provided.

DE-004b License Number Q: I have a physician ID with a letter "A" in front, how should I submit it?

A: Drop the letter and remember to add the 2 digit type code from Appendix J.

DE-004c Physician License Q: I recently submitted an outpatient submission to SPARCS. I received nine error messages on one of our physician's license number. Per the error message the license is invalid, which is usually due to an incorrect prefix. However, I checked the physician's number in our physician dictionary and he is set up correctly. He is an MD with double zeros (00) in front of his license number. He has been in our system a long time and nothing has been changed. Can you please let me know what is wrong with this license?

A: Just to clarify, there are technically two edits on the license numbers submitted to SPARCS. The first edit is referred to as a "physician pre-edit" on the Health Commerce System (HCS); this edit applies when the prefix of the submitted license number indicates that the provider is a physician (prefix '00'). The "pre-edit" requires that ninety percent of all records submitted with a physician prefix must pass this edit before the file is uploaded to the Mainframe edit program. The "pre-edit" is verifying the actual license number against the NYS Education Department's current list of registered NYS physicians. If less than 90% of your physician license numbers are incorrect, your file will not be uploaded to the Mainframe.

The second edit on the mainframe is for all license types; the edit is checking for numeric values in the appropriate range for each license type.

In this example, you received a pre-edit report indicating that the physician license number is incorrect. Some investigation is needed to determine if: the license number was not registered/renewed at the time of your submission, or the license became "invalid" and the physician should not be practicing or you simply used the wrong prefix ('00') for this provider. Also, the physician could have had a "limited" license (prefix '40') and has since obtained a "permanent" license number from NYS ('00'). You must investigate the cause for each error. As you can see, invalid licenses can occur for a number of reasons.

If a submission fails due to an incorrect physician's license number, we recommend verifying the validity of the license via the NYS Department of Education - Office of the Professions' website at the following link: This is website is updated weekly. You can also review Appendix J from the SPARCS website ( to determine which prefix is needed for the provider's license number.
DE-004d Attending Provider's License Q: When submitting our outpatient services we noticed that our facility receives many referrals whose patients require additional care such as physical therapy, nutrition counseling, etc. In such cases we do not utilize a physician to provide these services, but rely on trained, licensed personnel to perform these functions. Some of these providers are not typically in our provider master file for billing. We are utilizing the referring physician information for submitting the required "Attending Provider License Number". Is this how we should report such claims?

A: Yes and No. Ideally, you should report the actual license number of the person rendering care to the patient to SPARCS. If your facility does not have the provider license numbers for billing purposes in your system, your may report the referring physician license number. Keep in mind that your facility is still obligated to make sure a patient is seen by a NYS licensed provider. Your facility must monitor the care provided to patients.

The submission of your SPARCS file and the data contained within that submission is used by the NYS Department of Health to monitor each facility. SPARCS will begin to monitor the reporting of provider license numbers on Outpatient Services in the future. Specifically starting with monitoring license number submitted for visits with revenue code:
  • 051X Outpatient Clinic visit

The expectation is that these clinic visits should have a licensed physician providing care. Please see the listed provider types in Appendix J of the SPARCS' website ( You may utilize the license code (range: 90000000 - 90999999) for Other Licensed Health Care Professional from Appendix J.
DE-005a Source of Payment Typology Q: When is the new Source of Payment Typology required?

A: The SPARCS system will be able to accept these new data elements on July 1, 2009. You should start reporting the new payment typology in July 2009. You must submit a production file by December 31, 2009 containing the new source of payment typology I, II and III. Please refer to the October 1, 2008 letter.

DE-005b Source of Payment Typology Note: Go to Source of Payment Typology Category to find more Questions and Answers regarding Source of Payment Typology.

DE-005c Source of Payment Typology Q: We have patients that are enrolled in out-of-state Medicaid Managed Care plans. Should we be using 219 (Medicaid Managed Care Other), or 25 (Medicaid Out-of-State) when reporting Source of Payment Typology(SoP)?

A: These should be coded as 25 Medicaid-Out-of-State. Please refer to Appendix P at for guidelines when reporting SoP.

DE-006a AMI Q: I have an AMI patient who was DOA and revived in the ER, there is no BP or Heart rate what should I report?

A: Report the values as '000'. The patient was dead on arrival, and thus there was no recordable BP or Heart Rate. The treatment you provided helped revive the patient

DE-007a POA Q: Does my outpatient facility have to report Present on Admission?

A: No. It is only required for inpatient. It is not required for outpatient.

DE-007b POA Q: Can I use an E in my POA indicator?

A: No. SPARCS does not accept the value of E in POA. The valid values are Y, N, U, W, 1 or " " (blank).

DE-008a Payer ID Q: Where can I find the Payer ID numbers?

A: Located in Appendix K and Appendix L.

DE-008b Payer ID Q: Since August of 2011, I have been getting Payer ID failures for the values of MA (Medicare Part A), MB (Medicare Part B) and MC (Medicaid). Why is this occurring?

A: Effective August of 2011, a new edit was implemented requiring a numeric value for the Payer ID. These numeric values can be found in the SPARCS Appendices on our website. The main source of the Payer ID is maintained by the Department of Insurance, but miscellaneous Payer ID values can also be found in the SPARCS Appendix K (Payer IDs for Commercial Insurance and Other Payers) and Appendix L (Blue Cross and Blue Shield Plan Numbers).
DE-008c Payer Identification Number Q: I received a number of errors (Error #2000NM1900 (Payer ID- Primary Payer) and Error #2300NM19000 (Payer ID-Other Payer)) in my submitted claims for both my MA (Medicare) and MC (Medicaid) records. All other records passed. The submission results show no value in the NM109 segment. Is there anyway you can tell me what I am doing wrong?

A: Indirectly, this is a "multiple" error, i.e., a multiple error requires you to examine two or more data elements and their values. The two data elements for these errors are the "Claim Filing Indicator" and the "Payer ID". The error code(s) received indicate that you submitted a value for the data element "Claim Filing Indicator" (located in either or both Loops 2000B and Loop 2320 in the SBR09 segment) and are missing the corresponding value needed for the "Payer ID" (located in either or both Loops 2010BB and 2330B in the NM109 segment). For any submission after August 2, 2011, you will need a corresponding Payer ID when submitting a "Claim Filing Indicator" when you have a value of MA (Medicare Part A), MB (Medicare Part B) and MC (Medicaid). Specifically, if your Claim Filing Indicator value is 12, 16, BL, CI, HM, MA, MB, or MC, then you will need to report the appropriate (Primary and/or Secondary) Payer ID.

The values for "Payer ID" can be found in Appendix K on our website: Additional Payer IDs for Medicaid Managed Care can be found in Appendix O: You need to place a value for the Payer ID in the appropriate loop ('payer name' loop 2010BB and/or 'other payer' loop 2330).
DE-009a Diagnosis Codes Q: I am not sure of the diagnosis code for a patient can SPARCS help me?

A: While SPARCS edits for valid Diagnosis and Procedure codes, we do not make determinations as to which codes accurately reflect a patient's particular diagnosis or procedure. We suggest you contact NYHIMA with any questions regarding coding.

DE-010a Patient Discharge Status Q: Do you have general guidelines for reporting Patient Discharge Status?

A: Yes. We are recommending using the references distributed by the National Uniform Billing Committee (NUBC) - Official UB-04 Data Specifications Manual. Please use the following link to read the complete Patient Discharge Status FAQs from NUBC. In addition, please refer to Appendix C for the codes and values associated with this data element.

DE-010b Patient Discharge Status Q: An established nursing home patient (i.e. the nursing home is their permanent residence) is transferred to an acute setting. Upon discharge, they are sent back to the same nursing home. What patient status code would be appropriate?

A: Use Code 04, Discharged/transferred to a Facility that Provides Custodial or Supportive Care.

DE-011a Date of Service Q: I am an ambulatory surgery facility, and I am getting an error for Date of Service. Isn't this a new data element that is only applicable for EODC submissions?

A: Yes, this is a new SPARCS data element for Outpatient Services (OP) visits for 2011. However, the collection of this data element is based upon on the exclusion of the revenue codes for Ambulatory Surgery (0360, 0362, 0369, 0481, 0490, 0499, 0750, 0790) and ED (045x). Any records that do not have any of the above revenue codes or contain a procedure time greater than zero will default to an OP record. To prevent a record from defaulting to an OP data type you must enter one of the above Ambulatory Surgery Revenue Codes, along with the procedure time.

DE-012a GS/GS08 (Header) Q: For GS08 (Header) element, there are three values given. 005010X225A1 or 005010X225E1 or 005010X225A2. Which one needs to be reported?

A: SPARCS currently allows all three values (005010X225A1 - 005010X225E1 - 005010X225A2) to be reported at SPARCS X12-837 Input Data Specifications CUE List. The difference in the values is a result of the periodic changes made by the X12N Health Care Service: Data Reporting (Errata Changes). The A1 value reflects changes made to the GS08 segment in May of 2006; the E1 value is a Type 2 Errata, and fixes an error in Appendix B of the Health Care Service: Data Reporting Implementation Guide; the A2 value reflects changes that were made to the guide in June of 2010. SPARCS has incorporated all of the above changes, and will accept all three of the X12N values above.

DE-013a Revenue Codes Q: We have been using Revenue code 361 for Minor Surgery on ambulatory surgery cases when reporting to SPARCS in the past, and they have always been accepted. Now, the records we are submitting with Revenue Code 361 are being rejected. Why?

A: The definition of reporting Ambulatory Surgery to SPARCS was changed in February 2011 to use revenue codes and was modified in June 2011 to a shorter list of revenue codes. Currently, 0361 is not classified as a reportable Ambulatory Surgery Code. If you are reporting Ambulatory Surgery claims, you must use the following codes, along with the Procedure Time, 72 hour edit, Method of Anesthesia and the Operating Room Physician.
DE-013b Revenue Codes Q: Are Revenue Codes required on every service line? What about CPT codes?

A: Yes, a revenue code is required on every service line. Some service lines which contain "total" revenue codes (codes that are used to total many of the same charges, i.e., like many days in the same room) do not require CPT codes. However, in general most service lines do require a CPT code.
DE-014a Accommodation Rate Q: How do you code Accommodation Rate in the 5010R format?

A: Accommodation Rates are no longer reported in the 5010R version. Previously you sent us accommodation days, rates and totals. In the 5010 version you only need to send in the days/units and totals, which can be use to calculate the accommodation rate.
SV2*0210**10422.00*DA*3*3474.00~ (DA=Days) or
SV2*0250**3073.90*UN*0~ (UN=Units)
Categories Menu EODC FAQS
Q - # Topic Questions & Answers Posted
EODC-001 Law/Regulation Q:What is the law obligating a facility to report the expanded outpatient data?

A: The Public Health Law (PHL) authorizing the collection of data is Article 2816. This law authorizes the Statewide Planning and Research Cooperative System (SPARCS). Specifically, the section 2816 (2) (a)(iv) was added in 2006.

EODC-002 Submission Process Q:How will the data be reported?

A: You will report the EODC data (referred to as "OP" data) on the same "Outpatient" file, along with your Emergency Department (ED) and Ambulatory Surgery (AS) Data.

EODC-003 Submission Process Q:Does the EODC data have to be reported with ED and AS?

A: No. You may send a separate file.

EODC-004 Submission Schedule Q:When does the data have to be submitted? What will the first year of discharge be?

A: The first time you will be able to submit EODC data is when the Department of Health's data reporting system is in place. We expect the system to be operational August 2, 2011. The first year of "OP" data will be the 2011 discharge year.

2/16/2011 (Modified 7/28/11 per SPARCS-L 7/19/11 email)
EODC-005 Law/Regulation Q:How are you defining "outpatient"?

A: The new regulations define outpatient data as:
"Outpatient clinic data shall mean all data submitted by a licensed
Article 28 general hospitals and diagnostic and treatment
centers, excluding inpatient hospitalization data,
emergency department data, and ambulatory surgery data".
After several meetings and discussions, the intent behind this definition was to make it easier for hospitals to submit their remaining outpatient data. Instead of creating a long list of services or "excepting-out" certain services, facilities felt it would be easier to submit the remaining outpatient data from their facility. The Department of Health will be collecting "lab-only" and "x-ray only" patient records for all patient records with servce dates on or after January 1, 2016.

Originally posted 2/16/2011. Modified 08/21/2015 per the SPARCS-L email dated 09/03/2105.
EODC-006 Type of Data/Clarification Q:What records need to be sent?

A: An outpatient service visit consists of all services provided by one or more licensed professionals provided to patients at the site of service. The service provided must be charted. Each facility classifies outpatient services/departments differently. Some examples of services to be sent are: Cardiology/stroke (heart programs), diabetes centers, rehabilitation services, wound care services, and women's health services. As mentioned in "EODC-005" (above), "lab-only" and "x-ray only" visits should be sent at this time. When reported, these records must conform to the "OP" required data elements and edits. If you need further clarification, SPARCS Operations can assist you.

Originally posted 2/16/2011. Modified 08/21/2015 per the SPARCS-L email dated 09/03/2105.
EODC-007 Data Elements Q:What data elements are being collected?

A: The data elements are a subset of the outpatient data elements that are submitted with only minor exceptions. A list of the data elements was mailed to all SPARCS Coordinators and is included in the December 27, 2010 Announcement Letter. It is also posted on the Department's secure website, Health Commerce System (HCS) (

EODC-008 Data Elements Q:What are the additional data elements being collected for EODC?

A: They are:
  • Date(s) of Service
  • Unit of Service
  • Value Code for Medicaid Rate Code

EODC-009 Data Elements Q:What are the "Outpatient file" data elements that will not be required for EODC?

A: There are several data elements on the submission specifications for the Outpatient file structure that will not be needed for the EODC. You should refer to the list of data elements for the EODC project. Some of the data elements that will not pertain to this data collection are:
  • Discharge Hour
  • Admission Hour
  • Patient Status or Disposition
  • Expected Principal Reimbursement
  • Patient Reason for Visit
  • Accident Hour
  • Method of Anesthesia
  • Heart Rate on Arrival (AMI only)
  • Systolic Blood Pressure (AMI only)
  • Diastolic Blood Pressure (AMI only)
  • Procedure Time

EODC-010 Type of Data/Clarification Q:How are you distinguishing among Emergency Department (ED), Ambulatory Surgery (AS) and Expanded Outpatient (OP) on the one outpatient file submitted?

A: Revenue Codes will be used to distinguish between the different types of outpatient data.

ED - will continue to use the revenue code series "045x".
AS - starting in July, 2011, the data edits for AS will use the following revenue codes to perform AS edits:

  • 0360 General Services, Operating Room Services
  • 0362 Organ Transplant - Other Kidney, Operating Room Services
  • 0369 Other Operating Room Services, Operating Room Services
  • 0481 Cardiac Cat Lab, Cardiology
  • 0490 General Clasification, Ambulatory Surgery
  • 0499 Other Ambulatory Surgical Care, Ambulatory Surgery
  • 0750 General Classification, Gastro-Intestinal Services
  • 0790 General Classification, Lithotripsy
OP - the residual records submitted on the outpatient file will be considered expanded outpatient visit data. That is, the OP records will not have any of the above revenue codes or contain a procedure time greater than zero.


Modified per SPARCS-L 6/29/11 email Revenue codes removed

EODC-011 Type of Data/Clarification Q:What records do not need to be sent?

A: All outpatient records should be sent at this time.

Originally posted 2/16/2011. Modified 08/21/2015 per the SPARCS-L email dated 09/03/2105.
EODC-012 Type of Data/Clarification Q:How do you suggest removing lab-only or x-ray only visits?

A: We are no longer suggesting removing lab-only or x-ray only visits from SPARCS outpatient data reporting.

Originally posted 2/16/2011. Modified 08/21/2015 per the SPARCS-L email dated 09/03/2105.
EODC-013 Type of Data/Clarification Q:Should the outpatient visit data reported include recurring patients, such as physical therapy, wound care and pain management?

A: Yes. If your facility would submit a claim for these outpatient services performed at your facilty, this information should be submitted to SPARCS.

EODC-014 Submission Schedule Q:How is the collection being implemented?

A: The collection of data is being implemented in Phases.
Phase 1 -Hospital Outpatient Departments for hospitals that
are currently submitting IP, ED, or AS data to SPARCS.
These hospitals will report by Permanent Facility Identifier (PFI)
location/SPARCS Facility ID. (222 Hospitals). Implementation date July, 2011.
Phase 2 -Hospital-owned extension clinics that are under the same
operating certiicate as the current hospitals submitting data to SPARCS.
Hospital-owned extension clinics (that do not have ambulatory surgery services)
will be submitting data to SPARCS by Permanent Facility Identifier (PFI)
location/SPARCS Facility ID for the first time (approximately 1000 clinics).
This includes hospital-owned extension clinics currently submitting
ambulatory surgery data tha are certified for other outpatient services.
Implementation date est. January 2013.
Phase 3 -Free-standing Diagnostic and Treatment Centers
(currently non-submitters) (D&TC) (approximately 1000 clinics)
EODC-015 Audit/Enforcement Q:Is there going to be a reconciliation process for the EODC?

A: "OP" data will not be included in the 2011 Annual Reconciliation Process that would result in a Statement of Deficiency. We will, however, be contacting facilities that submit no, or very little data. Please note that Phase 1 facilities are still obligated to send all 2011 data to the department by June 30, 2012.


(Modified 3/7/2011)
EODC-016 Type of Data/Clarification Q:Do we need to send data for patients at our hospital clinic sites?

A: Not at this time. Only send the data relating to patient services provided at your physical facility location. This is because we are in Phase 1 of EODC. Phase 2 will require the collection of all the visits at hospital owned clinics. See response to Question EODC-014.

EODC-017 Type of Data/Clarification Q:A patient visits their Primary Care Physician at one of our non-hospital (offsite) clinic locations... the doctor orders labs and/or x-rays that are performed at a hospital outpatient location. The same account number is used for all services. How does this get reported?

A: This example indicates that a lab or x-ray only outpatient service was performed at the Hospital Outpatient Department. At this time, the visit to the Hospital Outpatient Department that is only for a lab/x-ray service is not needed for SPARCS reporting.

EODC-018 Submission Process Q:Will you be accepting the X12-837 "P" (Physician) claim format?

A: Not at this time. SPARCS is only accepting the X12-837 "I" (Institutional) claim format. This is the only claim format you may use to send your data.

EODC-019 Submission Process Q:Will you be accepting the X12-837 5010R (Reporting) format?

A: Yes. The 5010R version can be used starting August, 2011.

2/16/2011 (Modified 7/28/2011)
EODC-020 SPARCS 837 PC Application Q:Can we still use the SPARCS-837 software for translating/importing and exporting?

A: At this time, the SPARCS-837 will not be available for the EODC. We hope to have this program modified as soon as possible after the August 2011 implementation.


(Modified 7/28/2011)
EODC-021 Training Q:Will there be training/meetings to discuss the EODC requirements?

A: Yes. These meetings/trainings will be conducted in the spring of 2011.

Categories Menu Health Commerce System (HCS) Accounts
Q - # Topic Questions & Answers Posted
HCS-001 Account Q: How many months until an HCS account is locked due to inactivity?

A: Five months, at which time you will need to call the Commerce Accounts Management Unit (CAMU) at (866) 529-1890 to activate your account.

HCS-002 Account Q: Who do I need to contact to get an HCS Account?

A: Your Facility's HCS Coordinator. If you do not know who your HCS Coordinator is, you can call (518) 473-8144 or e-mail the SPARCS at

HCS-003 Commerce Account Q: A new staff person has just been added to our organization. Should they be given access to the Health Commerce System?

A: There are many applications and uses on the HCS within the Department of Health. SPARCS is only one of the many program areas using the HCS. Each program area grants individual permission to their application on the HCS. Once an individual has an HCS account, they will need to contact SPARCS Operations to obtain the appropriate SPARCS applications.

HCS-004 Commerce Account Q: A member of our staff who had an HCS access has left. Does this affect the Health Commerce System in any way?

A: Yes. It is important that this person's user ID is disabled in the system, since it is no longer appropriate that they access the Health Commerce System. Even if the person left on amicable terms, or transferred to another organization, it is important to protect the security of the Commerce Network and inform the Commerce Accounts Management Unit (CAMU) to have the person's user ID deactivated.

HCS-005 SPARCS Report Requests Q: I submitted records for our facility, but due to mitigating circumstances I was unable to download the edit reports within a particular time frame for either the Inpatient or Outpatient submissions. Since reports show that all claims were rejected, it would be helpful to have those reports to resolve the problems. Is there a way to receive those reports now?

A: You can access previous edit reports for your facility by requesting these reports from the Health Commerce System SPARCS "Data Submission and Data/Report System". Simply log into the HCS portal, migrate to the SPARCS Data Submission and Data/Report page, select the "Data/Report Request". On this page you will see two drop boxes; one for the type of file (select "Inpatient" or "Outpatient"), the other drop box contains the following selections:

  • Edit Report by Log Number
  • Error Records by Log Number
  • Audit Reports by Year
  • ICR Comparison by year (Inpatient Only)
  • Health Facilities Own Data by Year, Months(s)
  • Listing of Records on Master File, for Year, Month(s)
  • Detailed History Report by year, Months(s)
  • Update Summary Report by Year
For this specific need, select the "Edit Report by Log Number" to request the information. If you don't know your log number, you can first request the "Detailed History reports" for specific periods; this will provide the log numbers submitted during the requested timeframe. All reports requested should be generated and available on the Health Commerce system within two-three hours.
Categories Menu Obtain SPARCS Data
Q - # Topic Questions & Answers Posted
Data Requests Q: Can requests for SPARCS Data be made?

A: Yes. Requests for SPARCS Data should be directed to:

SPARCS Operations
New York State Department of Health
Office of Quality and Patient Safety
Bureau of Health Informatics
Empire State Plaza
Corning Tower, Room 1970
Albany, New York 12237
Phone: (518) 473-8144
Fax: (518) 486-3518
Categories Menu Reports
Q - # Topic Questions & Answers Posted
RPT-001 Quality Reports Q: How do I get Access to my facility's Quality Reports?

A: You must contact your SPARCS coordinator or SPARCS backup coordinator who can access the data for you. If you do not know who your SPARCS Coordinator is, you can contact SPARCS Operations.

RPT-002 Performance Metrics Q: How do I get permission to view my facility's Performance Metrics?

A: You need an HCS Account with granted access to your facility.

Categories Menu Security
Q - # Topic Questions & Answers Posted
SEC-001 Security Q: I need help with my SPARCS File format. Can I e-mail the file to SPARCS for help?

A: Absolutely Not. E-mail is not a secure way of sending confidential data. Please contact SPARCS Operations to get information regarding the acceptable method for sending confidential data to us.

SEC-002 Security Q: If I forget or get locked out of my HCS account, is it okay if I use my co-worker's account to sign on until I get my account reactivated?

A: Absolutely not. Never share user IDs or passwords, even if it only temporary. That would be in violation to the User Agreement you and your organization signed. If you experience any problems with your user ID or password immediately call the Commerce Accounts Management Unit (CAMU). A staff member will assign a new password for you. Use of another's account can result in permanent termination of your HCS account privileges.

SEC-003 Password Q: What do I do if I have forgotten my username or password?

A: Contact the Commerce Accounts Management Unit (CAMU).

SEC-004 Password Q: I have just logged on to the HCS and it says my password is expired, what's going on?

A: Every HCS user, is required to change their password every 60 days. The system automatically prompts you to change your password every 60 days. For no reason should anyone ever know your password. Should you ever feel that the anonymity of your password has been compromised, immediately change the password on your own. (Change password now option at logon.)

Categories Menu SPARCS 837 PC Application
Q - # Topic Questions & Answers Posted
PC-001 Download Q: When will the newest version of the PC-837 Application be available to download?

A: SPARCS Operations will no longer be supporting or distributing the PC-837 Software Application. In December 2011, the SPARCS Unit sent a survey to all the facilities who had been identified as current users of this software in the past. The response rate was 50% (49/101). It was found that only a small percentage of users would be affected by the discontinuation of distributing this application. The last upgrade version, 2.20, was distributed directly to these users with the notification that SPARCS will no longer support or distribute the PC-837 Software Application after October 1, 2013. Each facility was given the understanding that they must make the necessary modifications to their internal health information management software, to replace the duplication of information into the PC Application.

If you have received the 2.20 version and need help or have questions regarding it, please contact SPARCS Operations staff at or 1-518-473-8144.

Categories Menu Submission Process
Q - # Topic Questions & Answers Posted
SP-001 Late Submission Q: What do I do if I can't submit my file on time?

A: You may request an extension by contacting SPARCS via phone or e-mail. Include your PFI, file type (IP/AS/ED) and reason. The request must be made from the SPARCS Primary or Backup Coordinator.

SP-002 Late Submission Q: What happens if I cannot submit my file on time and don't request an extension?

A: SPARCS will send you a notification via e-mail if your submission is below "target" and you did not request an extension. If you continue to submit late or under target and do not request extensions, the SPARCS Coordinator and your CEO will be notified by letter of impending enforcement actions which may include a Statement of Deficiencies (SOD), a fine, or a Medicaid rate reduction.

SP-003 Delete Records Q: I accidentally submitted the same records twice to SPARCS this month – can I delete them before they get processed?

A: Yes. The SPARCS Coordinator, backup coordinator, or authorized vendor must call or send an e-mail to with the log number, file type (IP or OP), and your PFI requesting that the submission be deleted. Requests must be received before the last day of the month.

SP-004 Data Submission Q: Where do I go to submit my data?

A: You submit your data by going to the SPARCS submission page for your facility on the HCS, browsing to your file and uploading it through the secure web page.

SP-005 Test Submission Q: Can I test my submission?

A: Yes. We encourage all submitters to upload a test file to identify any errors. After making your corrections, submit your corrected file as a production submission.

SP-006 Submission Process Q: When I submit my file what happens next?

A: You will receive an upload confirmation page acknowledging your submission. It will contain the name of the file, the submission log number and the type - test or production of the submission. You should print and file this page for future reference.

SP-007 Submission Results Page Q: I got my confirmation page, now what?

A: You will check your submission results page and look for the edit report containing a matching submission log number. It is usually the last log number in the dropdown list.

SP-008 Errors Q: I have errors on my edit report, now what?

A: You should return to your facility's computer system, make corrections to the errors and resubmit the file.

SP-009 Production Submission Q: My report does not have any errors, I submitted in test, am I finished?

A: No. Once you have the errors corrected you need to submit the file in production mode for the claims to make it into the SPARCS master file.

SP-010 Vendor Submission Q: My vendor does my submission, do I have to do anything?

A: You need to check for the edit report to verify that your claims are 100 percent accepted. It is the facility's responsibility to make sure the claims are submitted and accurate.

SP-011 Audit Report Q: When will I see the records reflected in the Audit and Submission History Reports?

A: The files are processed at the beginning of every month. Typically, the Audit Report is completed within 7 to 10 days of the following month.

SP-012 No Confirmation Page Q: I submitted my file but did not get the confirmation page, is something wrong?

A: Yes. Contact SPARCS Operations.

SP-013 Missing Edit Report Q: I submitted my file and got the confirmation page but the edit report is not there, what should I do?

A: If you submit in the morning, the report should be there by the afternoon, but if you submit in the afternoon it should be there the next day. Remember to check for a failure notice on the submission results page, if it is not there contact SPARCS Operations.

SP-014 SPARCS ID Q: Where can I find my SPARCS ID?

A: It is a five digit code consisting of the pfi and a check digit. It is at the top of your edit report on the right - Labeled "SPARCS Facility Identifier".

SP-015 Debugging Edit Report Errors Q: I do not understand an error on my report what should I do?

A: First click on the error code to read the description of the error. Then click the description of the error to go to the page for the element in the data dictionary. Look at the value for the error in the value column of the report and read the requirements in the data dictionary. If you still cannot understand then contact SPARCS Operations.

SP-016 Revenue Code Q: I submitted an ED claim and got an error for procedure time.

A: Check to be sure there is a 450 revenue code indicating it is an ED claim on the file.

SP-017 5010R Format Q: When do I have to switch to the 5010R format?

A: Effective January 1, 2013 SPARCS will no longer accept Inpatient or Outpatient data submissions in 4010A1 or 4050R format. All data submissions after December 31, 2012 MUST be transmitted to SPARCS through the NYSDOH Health Commerce System (HCS) in the 5010R format.

SP-018 Log Numbers Q: How are SPARCS submission log numbers assigned?

A:There are separate log files for your Inpatient and Outpatient submission for each "Test/Production Indicator" (Production, Test and Beta). Inpatient log numbers are always preceded by an "I". Outpatient log numbers are always preceded by an "O". The log number is assigned sequentially based on the highest current number from any facility submitting a file. In the heading of the Edit Reports, the type of "Indicator" will be displayed. When looking for your edit or error file number in the "drop box", please be aware of the different sequence numbers for production, test and beta. The following are the various types of logs and the numbers to which will be assigned:

  • IP Prod I000001 - I103694
  • IP Test I000001 - I019207
  • IP Beta I000001 - I000271
  • OP Prod O000001 - O109953
  • OP Test O000001 - O025919
  • OP Beta O000001 - O000570
Categories Menu Submission Schedule
Q - # Topic Questions & Answers Posted
SS-001 Data Submission Q: When is my Data due to SPARCS?

A: Data is due into SPARCS 60 days following the month of patient discharge.

SS-002 5010R Format Q: When do I have to switch to the 5010R format?

A: Effective January 1, 2013 SPARCS will no longer accept Inpatient or Outpatient data submissions in 4010A1 or 4050R format. All data submissions after December 31, 2012 MUST be transmitted to SPARCS through the NYSDOH Health Commerce System (HCS) in the 5010R format.

SS-003 Production Cycle Q: When are new files created and when is the cut off date for submitters?

A: Data can be uploaded to SPARCS via the Health Commerce System (HCS) 24 hours a day, 7 days a week. Data is then routed to the mainframe computer for processing Monday through Friday, 7:30AM -5:30 PM. Once your submission file has been successfully processed you should receive two submission results: an Edit report and a corresponding Error file (if applicable). These submission result files are usually available on the HCS, within 2 hours of the time of data submission Monday through Friday, 7:30AM -5:30 PM. Beginning August 10, 2010, SPARCS now merges all successful submissions onto the SPARCS Master file weekly. The weekly upload to the Master file takes place at 7AM every Tuesday.

For data users, the SPARCS output files are still on a monthly cycle. The first Tuesday following a complete month will initiate the SPARCS monthly output files that are created from the SPARCS Master file. This process culminates in the creation of the output files (Inpatient and Outpatient) for any discharge year having over 1000 transactions submitted during the month. In order to meet the cut-off date to have your data on the monthly output files processed, you must submit your file(s) prior to 5:30PM on the Monday before the monthly updates begin for the output files.
Categories Menu Vendor Submission
Q - # Topic Questions & Answers Posted
V-001 Vendor Submission Q: What is required of a vendor who wants to submit SPARCS data for a facility?

A: Representatives from both the facility and vendor must complete and sign the SPARCS Data Agreement Notification Form (DOH-4388) and mail the original back to SPARCS Operations (mailing address is on the form).

V-002 Vendor Submission Q: Do facilities need to have an HCS account even if they are using a vendor to submit SPARCS data for them?

A: Yes. All facilities should have an HCS account, as well as a designated SPARCS Coordinator and a backup SPARCS Coordinator.

V-003 Vendor Submission Q: Do you have a list of vendors?

A: Yes. Please see the Results of our 2008 SPARCS Vendor Survey.

Categories Menu Edit Program Errors
Q - # Topic Questions & Answers Posted
E-001 Patient/Subscriber Failed Q: What does the error message "Patient/Subscriber Failed" mean?

A: In the X12-837 input format the data is formatted in a hierarchy of Subscriber->Patient->Claim "loops". When an error is encountered in the subscriber or patient loop, then any claims associated with the patient/subscriber will also fail. The edit report will show one or several errors for the patient or subscriber, followed by the message "Patient Failed" or "Subscriber Failed" for each claim that was associated with the failed subscriber/patient. This same line will display the patient control number of the claim so the subscriber or patient can be corrected.

In this example, the Claim failed (error code 2300CLM0000) because the associated patient had an invalid County Code (error code 2010N46000):

Error Code Patient Control Number Loop HL Index Element Value
2010N46000 N/A 2010 514 N406

E-002 Error Corrections Q: I am trying to correct data that failed during the submission; I can't wait for these corrections to be done by our vendor. There are only a couple elements that are not passing the edits. I would gladly make those corrections manually if I could get to the data already submitted. Can you tell me if there is a way I can update what has already been submitted but failed?

A: Yes, you can simple make manual corrections to the data records that failed, but SPARCS does not advise the use of this process since you will not be making the same changes in your data warehouse/systems, which may conflict with what is submitted to SPARCS if an audit were performed.

Make sure you document the steps taken to change data manually. To do this, simply log into the HCS portal and download the corresponding error file (that corresponds to the edit log number that had the failures). Open notepad on your computer, then copy and paste the error file into notepad or download the file and make the appropriate edits in notepad. Save the corrected file as a text document and upload it to our system as a test file to see if the corrections were accepted. After your test submission is successful, resubmit the file as a Production file. After the Production process has successfully been completed, these records will be added to the SPARCS Master file. Please check your audit reports.

Categories Menu Source of Payment Typology
Q - # Topic Questions & Answers Posted
SOP-001 Source of Payment Typology Q: Who developed the Source of Payment Typology?

A: The Source of Payment Typology was developed by the Payer Subcommittee of the Standards Data Committee of the Public Health Data Standards Consortium (PHDSC). The PHDSC represents all 50 states from a public health / regulatory perspective. It was developed over the course of four years.

SOP-002 Source of Payment Typology Q: Is this a nationally recognized data element?

A: Yes. For those coding data under the HIPAA standards, the Payer Typology is referenced as an external code list in the ANSI X12 standards as a data element in the Subscriber Information Segment in the Subscriber and the Patient Loops. Because this change was made after the October 2003 version of the ANSI X12 was approved and published, this modification will be supported in post 5010 (October 2003) version of the Health Services Data Reporting Guide. It has been adopted by the National Uniform Billing Committee.

SOP-003 Source of Payment Typology Q: Are other States using this?

A: Yes. Georgia started in 2007. Oregon began in June, 2008. New York will start in July, 2009.

SOP-004 Source of Payment Typology Q: Who is maintaining this code set?

A: The Source of Payment Typology is maintained by the PHDSC . Any changes to the typology will be made annually in October.

SOP-005 Source of Payment Typology Q: Has PHDSC developed definition for these values / code set?

A: Yes. The PHDSC has created a 24 page "Users Guide for Source of Payment Typology" for reporting. The link is

The PHDSC website is

SOP-006 Source of Payment Typology Q: When will SPARCS require this data element?

A: The SPARCS system will begin accepting these new data elements on July 1, 2009. All facilities are expected to completely transition to the new data elements by December 31, 2009.

SOP-007 Source of Payment Typology Q: Will SPARCS require a different X12-837 version for this data element?

A: No. At this time, the data element will be placed in the NTE segment and SPARCS will continue to accept the 4050 Reporting and the 4010A (1) Institutional versions. The future version that accepts the Source of Payment Typology data element is the 5010 Reporting version. SPARCS hopes to change to this version in the future.

SOP-008 Source of Payment Typology Q: What will happen to the old payer data elements?

A: The old payer data elements listed will be removed on December 31, 2010:

SOP-009 Source of Payment Typology Q: Will the Source of Payment Code data element (aka Claim Filing Indicator) still be required?

A: Yes. This data element is required until December 31, 2010. Thus, in 2009 you will be reporting in essence, three types of payer data elements (the old NY payer fields called Expected Principal Reimbursement, the X12-837 field Source of Payment Code and the new NY -- adopted nationally depending on version of X12-837 -- payer field). In the 5050 version of the X12-837 the standards committee will allow both to be reported. When SPARCS moves to another version X12-837 we will consider removing the Source of Payment Code data elements so that you will only be reporting one type of payer data element to NYS (the new Source of Payment Typology).

SOP-010 Source of Payment Typology Q: Will there be a cross walk to the other payer types?

A: Yes. The PHDSC has developed a crosswalk with the Source of Payment/Claim Filing Indicator. NYS will provide a crosswalk with the Expected Principal Reimbursement payer type.

SOP-011 Source of Payment Typology Q: Will there be any edits on this data element?

A: Yes. Only the values defined in Appendix P - Source of Payment Typology Codes will be accepted. The Medicaid and Medicare values must have a minimum of two digits when reporting.

In addition, the Payer ID for managed care plans will have a cross-edit to the Source of Payment Typology. With assistance from the NYS Department of Health, Office of Managed Care, this information will be checked. For example, the managed care plan for Capital District Physician Health Plan (CDPHP) is only licensed to have the following products/Source of Payment Typology's:

Example: Capital District Physician Health Plan (CDPHP) -- NAIC #95491
11 = Medicare Managed Care
211 = Medicaid Managed Care
2111 = Family Health Plus
2112 = Healthy New York
23 = Child Health Plus
51 = Managed Care (Private)
Only these values will be accepted for the Payer ID - CDPHP.
SOP-012 Source of Payment Typology Q: Currently we have one Blue Cross plan which encompasses both the HMO and PPO plans. However, the new requirement has two separate plans with codes 611 and 612. The insurance cards do not indicate whether the plan is a HMO or PPO. How should this be handled? This is not just an issue for Blue Cross insurance; this will also be an issue for many of our other insurance plans.

A: Health care facilities should collect the specific typology codes that we are now requiring. We do, however, realize that this is not possible for all situations. In this given situation, you know that it is a Blue Cross Managed Care product, but not the specific type of product (HMO or PPO). For SPARCS collection purposes you can code it as a 61. Hopefully in the future you will be able to collect the specific codes for PPO and HMO.

61 BC Managed Care
611 BC Managed Care - HMO
612 BC Managed Care - PPO
613 BC Managed Care - POS
619 BC Managed Care - Other
62 BC Indemnity
63 BC (Indemnity or Managed Care) - Out of State
64 BC (Indemnity or Managed Care) - Unspecified
69 BC (Indemnity or Managed Care) - Other
SOP-013 Source of Payment Typology Q: What would be the code for a Self-Insured/Self-Administered Insurance Plan that is administered by Blue Cross?

A:Good Question. The idea behind the SOP is to capture the type of insurance product and the type of payer/payment. In this question, the type of insurance product (Self-Pay) is being confused with the a typical payer (Blue Cross). Blue Cross has expanded its scope as a multidimensional insurance services and products company. In this instance, they are acting as the administrator of the product and not the payer. In the future, there could be another contracted administrator. You should use the code 522 = Self-Insured (ERISA) Administrative Services Only plan.

SOP-014 Source of Payment Typology Q: In the past, I have coded my Expected Principle Reimbursement data element as Self Pay for any person that I have not determined the source of payment. Most of these might be Medicaid eligible- and I do not have the determination of their Medicaid status upon submission of the SPARCS file. Should I be coding these people as Self-Pay with the new SOP?

A: No. There is an SOP code 24 for Medicaid Applicant. Do not use Self-Pay for your Medicaid Applicants for the new SOP data elements or the Expected Principle Reimbursement or the Claim Filing Indicator data elements. Most likely, if your staff has determined a person to be Medicaid eligible, then it is beneficial to code them as Medicaid (with your Expected Principle Reimbursement and Claim Filing Indicator). Ideally, if you have had a final determination if the payment will come from Medicaid (or some other payer), then you should submit or resubmit with a discharge with the correct payer/payment.

SOP-015 Source of Payment Typology Q: If I submit a December 2009 discharge to SPARCS on July 5, 2010 will it require Source of Payment Typology?

A: No. Only claims with discharge years of 2010 and future years are required to have the Source of Payment Typology.

SOP-016 Source of Payment Typology Q: If I submit a February 2010 discharge to SPARCS on July 5, 2010 will it require Source of Payment Typology?

A: Yes. Effective July 1, 2010, Source of Payment Typology must be reported on all claims with discharge years of 2010 and forward (2010 and all future years).

Note: If you have been following the SPARCS Submission Schedule, you should have reported 95% of April 2010 discharges by the June 30, 2010 deadline. Thus, your 2010 SPARCS data in our Master file may have January-April discharges without the SoP data fields completed. Ideally, we would like the full 2010 year to be entered for these data elements.

SOP-17 Source of Payment Typology Q: We have patients that are enrolled in out-of-state Medicaid Managed Care plans. Should we be using 219 (Medicaid Managed Care Other), or 25 (Medicaid Out-of-State) when reporting Source of Payment Typology(SoP)?

A: These should be coded as 25 Medicaid-Out-of-State. Please refer to Appendix P for guidelines when reporting SoP.

Categories Menu 5010R Format
Q - # Topic Questions & Answers Posted
5010R-001 Version Q: What segment determines the version of the X12 file to your edit program?

A: The version is determined by the value in ISA 12 segment. Ex. '00501'=for X12 Version 5010 reporting

5010R-002 Race & Ethnicity Q: Will Patient Race and Patient Ethnicity still be accepted in the NTE segment in the 5010?

A: Yes. Patient Race and Patient Ethnicity will be accepted in both the DMG and NTE segments. However, we prefer it to be in the DMG segment, as it might not be allowed in the NTE segment in the future.

5010R-003 2010CA Loop Q: Are segments NM103, NM104, and NM105 required in the 2010CA Loop for 5010R?

A: No. These segments can be blank. However segment NM108 and NM109 are required in the 2010CA Loop for 5010R.

5010R-004 ISA15 Segment Q: Do we need to put a particular code/value in the ISA15 segment to designate that the file is in the 5010R format?

A: No. This data element is not where you tell us about the 5010 version. Continue to use "T" for Test and "P" for Production with the 5010R format. However you should put "00501" in the ISA 12 segment for X12 Version 5010 reporting.

5010R-005 E-Codes Q:What is the difference in the formatting of E-Codes in Version 5010R?

A:In version 4050 E-Codes were sent on one line along with the Patient Reason for Visit. In Version 5010R they are now sent in on separate lines.

Version 4050:

Version 5010:
5010R-006 Covered/Non Covered Days Q: How are covered/non covered days sent in Version 5010R?

A: No longer sent in the Qty segment but sent in as Value Codes in the HI segment.
Example: HI*BE:80:::2*BE:81:::0~
Note: Value Code : (Covered Days= 80 Non-Covered Days= 81)
Categories Menu Formats
Q - # Topic Questions & Answers Posted
Formats-001 Patient & Subscriber Q: What segments and loops are required when the Subscriber is the Patient and when the Subscriber is not the Patient in the 4050 or 5010R version?

A: Basically, you always need the 2010BA NM1, 2010BA N3, 2010BA N4 and the 2010CA NM1. When the suscriber is not the patient, you will then need the 2010CA N3 and the 2010CA N4 segments.


(1)Subscriber is the Patient:

If you have a record containing only the Subscriber because they are the patient you must have the following:
For Subscriber - 2010BA NM1 - with the accompany N3 and N4 segments
For Patient (who is the subscriber) - 2010CA NM1
Note: You will not need the accompanying 2010CA N3 and N4 segments for the patient.

(2)When Patient and Subscriber are different:

If you have a record that contains both a Subscriber and Patient (whether they are the same or not) you must have:
For Subscriber - 2010BA NM1 - with the accompanying 2010BA N3 and N4 segments
For Patient -2010CA and also the accompanying 2010CA N3 and N4 segments for the patient for our system to accept the record.
Categories Menu Expanded Race and Ethnicity Reporting Standards
Q - # Topic Questions & Answers Posted
ERE-001 Data Submission Q: What guidelines should be used for assigning the codes? For example, if a patient is White and Korean, how should the race be reported?

A: The expanded race and ethnicity reporting standards will allow for both the collection of greater granularity of the race or ethnicity, as well as up to ten different race and ethnicity selections. In the above example, both would be reported. Please follow the guidelines included in Appendix RR-Race and Ethnicity Codes and the Input Data Specifications.
ERE-002 Data Submission Q: Will the new values replace the older, high-level ones? For example, will the current data standard X12 value of R2, Asian race, be replaced with a new value, or will the general "Asian" value remain, in addition to the new values?

A: One of the goals of the Affordable Care Act (ACA) is to be able to recognize and eliminate disparities by establishing data collection standards (refer to Section 4302, Understanding Health Disparities: Data Collection and Analysis). To accomplish this, the categories R2, R4, and E1 have been enhanced to include more granular levels of race and ethnicity. Although we will continue to allow the general "Asian", "Native Hawaiian or Pacific Islander" values, we encourage the reporting of more detailed information. SPARCS will be performing quality checks to ensure that more detailed information is reported over time.
ERE-003 Patient Questions Q: If patients have previously answered this question using the current data standard, should they be re-questioned regarding their race/ethnicity using the new expanded data standard?

A: Yes, the patient should be prompted to answer this question using the new expanded standard. However, it is not necessary to collect this information at every visit, unless your database does not retain the data (e.g., this information is purged every three months) or if your system does not allow for flagging.
ERE-004 Expanded Race and Ethnicity Reporting Standards Q: Are these race and ethnicity categories nationally recognized?

A: The Affordable Care Act (ACA), a United States Federal Statue, Section 4302, requires a new minimum data collection standard for race and ethnicity. The codes used to report these standards are the CDC's Race Ethnicity Code Set, version 1.0. This code set has long been a part of the X12/837 list of codes in the DMG segment. The difference is that now, with the implementation of the ACA, instead of collecting the first portion of the code, we will be collecting the full three sections of the code.
ERE-005 Reporting Additional Values Q: The 837 SPARCS specification uses the "*" character as an element separator. Can we use a different character other than the "*"?

A: The "*" was meant to indicate that additional values not displayed on the list, but included in Appendix RR-Race and Ethnicity Codes, should be entered. We understand the confusion this has caused and have replaced the "*" with a "?" in subsequent communications. Regarding the use of the codes, you may find it helpful to use Appendix RR-Race and Ethnicity Codes for these additional values when a patient states that his/her race or ethnicity is not included on the form.
ERE-006 Data Submission Q: Can you provide an example of what the DMG segment should look like if there are multiple races and/or ethnicity values submitted for a patient?

A: Examples of how to report multiple race and/or ethnicity codes can be found in the Input Data Specifications.
ERE-007 Data Submission Q: The current DMG fields are defined as alpha fields of 2 characters. How would you like us to report races and ethnicities greater than two characters (e.g., R4.01.001)?

A: The fields for the required expanded race and ethnicity have been increased to hold nine characters (including the "."). Additional information can be found in the Input Data Specifications.
ERE-008 Patient Questions Q: Does it matter what order race and ethnicity questions are asked?

A: Yes. To improve data quality, separate questions should be used for race and ethnicity; individuals should self-report, and ethnicity should be asked first, and then race.
ERE-009 Data Submission Q: Can we collect even more granular data (i.e., more categories of race and/or ethnicity) than required, or capture a race and/or ethnicity not included on the list?

A: Yes. The data standards required by New York State SPARCS represent minimum standards and are not intended to limit the collection of needed data. Facilities desiring more granularity are permitted and encouraged to collect additional data as needed, provided they are valid codes as listed in the CDC Race and Ethnicity Code Set, version 1.0, and pass the SPARCS edits.
ERE-010 Data Submission Q: If the patient's specific race or ethnicity is not present in the new expanded data standards, how should this be captured?

A: Facilities should make every attempt to include a patient's reported race and/or ethnicity. Appendix RR-Race and Ethnicity Codes lists other codes not included on the form.
ERE-011 Data Collection by Other States Q: Are other states expanding the race and ethnicity categories in their hospital datasets?

A: Yes. A number of states have expanded their race and ethnicity categories to collect more detailed and specific race and/or ethnicity categories. In addition, a number of states (including Massachusetts, New Jersey, California, Idaho, Oregon, and Washington) have been working to improve the accuracy and quality of the race/ethnicity data they collect and report as part of their statewide hospital discharge dataset.
ERE-012 Expanded Race and Ethnicity Reporting Standards Q: Why do the new race and ethnicity standards matter?

A: According to the Institute of Medicine, standardized data collection is critical to understanding and eliminating racial and ethnic disparities in health care. A critical barrier to eliminating disparities and improving the quality of patient care is the frequent lack of even the most basic data on race and ethnicity of patients within health care organizations. The methods for collecting these data are disparate and, for the most part, incompatible across organizations and institutions in the health care sector.
ERE-013 Script Q: Should the script for asking race/ethnicity/language questions be in paper or electronic format?

A: This decision is up to each facility. It is easier for staff if the script is on the patient registration screen, but some facilities have indicated that there is not enough room on their screens to accommodate this option. When the script cannot be placed directly on the screen, it is best to have laminated cards, with the script typed in large bold-faced font, at each registration station.
ERE-014 Recording Method Q: Is it okay to record race and ethnicity by observation when it is obvious to the staff and especially if the person has been coming to the facility for years?

A: No. All information on race and ethnicity needs to be captured through self-report of the patient or his/her caregiver.
ERE-015 Expanded Race and Ethnicity Reporting Standards Q: Do the expanded data standards apply only to electronic medical health records?

A: The expanded data standards apply not only to electronic medical health records, but paper and claim based medical records as well. Providers will need to ensure that their medical health records collect, in structured fields, race and ethnicity according to the expanded data standards.