Data Reporting Information for New Facilities

All licensed health care facilities are responsible for providing claims data to the Pennsylvania Health Care Cost Containment Council (PHC4) on a quarterly basis. PHC4 is notified by the Pennsylvania Department of Health, Division of Licensing when a health care facility is granted a license to do business in Pennsylvania.

PHC4 was established as an independent state council in 1986 by the Pennsylvania General Assembly. PHC4's mission is to address the cost and quality of health care in Pennsylvania by promoting health care competition through the collection, analysis, and public dissemination of health care information. To fulfill this mission, Act 89 (as reauthorized by Act 15 of 2020 ), the Health Care Cost Containment Act, mandates the collection of data from all health care facilities licensed in Pennsylvania, including hospitals and ambulatory service facilities. The information is then used to produce a number of widely distributed public reports for use by payers, providers, purchasers of health care and the general public.

PHC4 validates submitted data and provides facilities with the opportunity to correct errors. However, it is the responsibility of the facilities to ensure data accuracy.

The next section is an introduction to the types of data PHC4 collects, followed by documents to help facilities with submitting data to PHC4.

Inpatient Discharges and Select Ambulatory/Outpatient Surgical Procedures

Generally, claims and clinical data are collected on a quarterly basis and received 90 days from the close of each quarter. The following table shows the frequency of data submission to PHC4:

More specifically, the start of each collection period is the first business day of each quarter. Data is due at on the last day of that quarter. If the last day of the quarter does not fall on a business day, the data is due on the next business day.

Data can be corrected until the last day of the month following the quarter. If the last day of the month does not fall on a business day, the data correction due date is the next business day.

Newly-licensed facilities will be notified several months in advance before their first data submission is due. However, it is highly recommended that facilities send data early to gain familiarity with the data submission process and test their data in advance. Facilities submit data via PHC4's Web-based portal, which is free, safe, and provides proof that data was sent. Data can be entered directly online or submitted by data upload. Data upload instructions are included in the list of Instructions and Manuals below.

• Inpatient – PHC4 collects data on all inpatient discharges including psychiatric and/or behavioral health, rehabilitation, and drug and alcohol records. Skilled nursing facility (SNF), swing bed, transitional care, 23-hour observation and hospice records should not be sent.
• Ambulatory/Outpatient – PHC4 collects a designated range of ambulatory/outpatient procedures which, in general, includes surgeries, endoscopies, chemotherapy administration, cardiac catheterizations, and cardiovascular therapeutic procedures when they are performed within a hospital facility's or freestanding ambulatory surgery center's general operating room, ambulatory surgery room, short-term procedure unit, endoscopy or GI lab/unit, cardiac catheterization laboratory, radiology department, outpatient oncology unit, etc. The names of the locations/units listed above are intended to be used as general terms. Location names may differ from facility to facility. Emergency room claim records should not be submitted.

Annual Financial and Utilization Data

All licensed facilities provide annual financial, utilization and payer data. In addition, hospitals send annual malpractice expense data. Facilities enter this data on PHC4's Web portal and concurrently send annual financial statements. The reporting or fiscal year used for financial data collection is the same accounting year used by the facility. Facilities that provide a Medicare Cost Report (MCR) to CMS are asked to send a copy of the MCR to PHC4 at the normal MCR filing date.

Depending on the facility's fiscal year end, PHC4 will send the facility a notice of the forthcoming filing date with the facility’s username and password for PHC4's Web portal. New facilities send data for their first accounting period that is six months or longer.