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          44:66:02:03.  Required patient data to be reported. Each hospital required to report pursuant to ยง 44:66:02:01 shall provide the following information from the UB-04 form:


          (1)  Record type;

          (2)  Hospital number;

          (3)  Patient control number;

          (4)  Date of birth;

          (5)  Sex;

          (6)  Admission date;

          (7)  Principal diagnosis;

          (8)  Admitting diagnosis;

          (9)  Principal procedure;

          (10)  Discharge date;

          (11)  Patient status; and

          (12)  Total charges.


          All other fields on the UB-04 form shall be submitted as entered on the form or submitted with filler data as specified by the SDAHO.


          Source: 32 SDR 69, effective November 7, 2005; 34 SDR 88, effective September 10, 2007; 35 SDR 183, effective February 2, 2009.

          General Authority: SDCL 34-12E-11.

          Law Implemented: SDCL 34-12E-11(1).


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