Data Dictionary. Reference Table 18. Reference Table 13 List of updates made to Reference Tables 26

Data Dictionary Definitions and Data Availability Pages 2-9 This section provides as list of all data elements with their definitions, and the availability for release of each element. Lookup Tables Pages 10-26 This section provides reference tables related to certain data elements. Accepted values and definitions are listed in each section. Reference Table 1 Admit Source 10 Reference Table 2 Admit Type 12 Reference Table 3 Discharge Status 13 Reference Table 4 Encounter Type 16 Reference Table 5 Ethnicity 17 Reference Table 6 Language 18 Reference Table 7 Payer Grouping 19 Reference Table 8 Place of Service - Inpatient 20 Reference Table 9 Place of Service - Outpatient 21 Reference Table 10 Present on Admission Indicator 23 Reference Table 11 Race 24 Reference Table 12 Sex 25 Reference Table 13 List of updates made to Reference Tables 26 Patient Class Mapping This section provides more information on how patient class is populated. Reference Table 14 Patient Class Mapping Pages 27 27 Hospital ID's Pages 28-41 This section provides a list of Facilities and their associated Hospital ID. Reference Table 15 List of Hospital ID's - By Facility Name 28 Reference Table 16 List of Hospital ID's - By Hospital ID 35 Crosswalk of Field Names Pages 42-43 This section provides a crosswalk for different field names used for each data element related to OHA Insight, OHA DataTrack, and the Patient Origin Study (POS) Files. Reference Table 17 Crosswalk of Field Names 42 Data Validations Pages 44-48 This section provides all data validations that are used in OHA DataTrack. Each batch of data submitted is run against these validations. Reference Table 18 Data Validations 44 OHA Data Dictionary, Updated 9/16/14

Data Definitions and Availability Notes: Data Element The name of the data field used in OHA Data Systems. Definition The definition for the data element. Calculated/ Submitted C = This data element is calculated from data elements that are submitted. Data? S = This data element is a field that is submitted by Hospitals. Data Available For Y = Available for release (when requested) Release? Y* = Yes with exceptions (See note in corresponding definition field for requirement) N = Not Available for Release Data Element Definition 95% Confidence Level Is the observed vs. expected statistically significant at the 95% confidence level Address House number and street name of patient Calculated/ Submitted Data? Data Available For Release? Insight Standard POS File *as requested Custom POS File *as requested C Y N N S N N N Admit Date Admit Source Admit Time Admit Type Date of admission or start of care Point of Origin for Admission or Visit, a code indicating the point of patient origin for this admission or visit - See Reference Table 1 for accepted values. The time the patient was admitted or start of care *Note: Data not available on all encounters. Admission Type, a code indicating the priority of this admission/visit - See Reference Table 2 for accepted values. S N Y Y S Y Y Y S N N Y* S Y Y Y Age Patient age at date of admission C Y Y Y Arrival Date Arrival date - Data Field used by CMS and TJC for Care Measures, and their definitions apply S N N N Arrival Time Arrival time - Data Field used by CMS and TJC for Care Measures, and their definitions apply S N N N Birth Date The patient s month, day, and complete year of birth S N Y Y* Birth Weight The weight of a baby at birth measured in grams S N N N OHA Data Dictionary Definitions and Data Availability, Updated 5/27/14 Page 2 of 48

Data Element County Code Definition A numeric code identifying the county of patient residence, calculated from the patient's zip code Calculated/ Submitted Data? Data Available For Release? Insight Standard POS File *as requested Custom POS File *as requested C Y Y Y CPT Code CPT Date Decision to Admit Date Decision to Admit Time Diagnosis - Admit Diagnosis - Primary Diagnosis - Secondary A five digit code describing non-inpatient procedures and services performed by physicians and hospitals - CPT and HCPCS Codes are combined in this element The date corresponding to the CPT Code when the procedure or service was performed or occurred Decision to admit date - Data Field used by CMS and TJC for Care Measures, and their definitions apply Decision to admit time - Data Field used by CMS and TJC for Care Measures, and their definitions apply S N N Y S N N Y S N N N S N N N The ICD-9 Code describing the initial diagnosis upon arrival S N N Y The ICD-9 Code describing the primary condition of the patient during the encounter. S Y Y Y The ICD-9 Code describing a secondary condition of the patient during the encounter. S Y Y Y Discharge Date The date the patient was discharged S N Y Y Discharge Month Month of the Discharge Date C N N Y Discharge Quarter Quarter of the Discharge Date C Y N Y Discharge Status Discharge Status or the final place or setting to which the patient was discharged on the day of discharge - See Reference Table 3 for accepted values. S Y Y Y Discharge Time The time the patient was discharged from care *Note: Field not required for submission. S N N Y* Discharge Year Year of the Discharge Date C Y Y Y DRG A Diagnosis Related Group that organizes ICD-9 codes into a complex, comprehensive system based upon multiple factors. C Y Y Y OHA Data Dictionary Definitions and Data Availability, Updated 5/27/14 Page 3 of 48

Data Element DRG Weight ED Departure Date ED Departure Time EM Code Encounter Type Ethnicity Expected - Length of Stay Expected Average Charges Definition Each DRG has a payment weight assigned to it, based on the average resources used to treat Medicare patients in that DRG. ED Departure Date - Data Field used by CMS and TJC for Care Measures, and their definitions apply ED Departure Time - Data Field used by CMS and TJC for Care Measures, and their definitions apply E/M Code - Data Field used by CMS and TJC for Care Measures, and their definitions apply The type of visit for this record, specifies Inpatient or Outpatient - See Reference Table 4 for accepted values. Ethnicity code assigned to patient record - See Reference Table 5 for accepted values. *Note: Field not required for submission. Required for GCHC Hospitals. Is the benchmark value created from the average length of stay for all patients by each RDRG, DRG, Year and Patient Class. This Expected LOS excludes outliers, which are three standard deviations away from the mean. The mean also excludes any LOS less than 1 day and greater than 365 days. Is the benchmark value created from the average of charge for all patients by each RDRG, DRG, Year and Patient Class. This Expected Charge excludes outliers, which are three standard deviations away from the mean. The mean also excludes any charge less than $700 and greater than $2,000,000. Calculated/ Submitted Data? Data Available For Release? Insight Standard POS File *as requested Custom POS File *as requested C N N Y S N N N S N N N S N N N S N N Y S N N Y* C Y N N C Y N N Expected Mortality Is the benchmark value created from the average mortality for all patients by each C Y N N RDRG, DRG, Year and Patient Class. First Name First name of patient S N N N OHA Data Dictionary Definitions and Data Availability, Updated 5/27/14 Page 4 of 48

Data Element Fiscal Year Hospital ICU Admission Date ICU Discharge Date Language Definition State Fiscal Calendar Year Dates of 7/1/YYYY to 6/30/YYYY The hospital that submitted this patient record. This is a unique identifier assigned to each hospital by OHA. - See Reference Table 15 for values ICU admission date - Data Field used by CMS and TJC for Care Measures, and their definitions apply ICU discharge date - Data Field used by CMS and TJC for Care Measures, and their definitions apply Language code assigned to patient record - See Reference Table 6 for accepted values. Note: Field not required for submission. Required for GCHC Hospitals. Calculated/ Submitted Data? Data Available For Release? Insight Standard POS File *as requested Custom POS File *as requested C Y N N S Y Y Y S N N N S N N N S N N Y* Last Name Last name of patient S N N N Length of Stay The length of the patient encounter in days. C Y Y Y MDC MDC - MSDRG Medical Record Number Medical/Surgical The Medical Diagnostic Coding that groups DRGs into similar categories C Y Y Y The Medical Diagnostic Coding that groups DRGs into similar categories C Y Y Y The number assigned to the patient s medical/health record by the hospital that distinguishes that patient and their medical record from all other patients. S N N N Medicare categorization of DRG s as medical or surgical. C Y N Y Middle Name Middle name of patient S N N N MSDRG A Diagnosis Related Group that organizes ICD-9 codes into a complex, comprehensive system based upon multiple factors C Y Y Y Outlier The patients determined to be three standard deviations away from the means for each RDRG, DRG, Year and Patient Class for either LOS or Charges. C N N N OHA Data Dictionary Definitions and Data Availability, Updated 5/27/14 Page 5 of 48

Data Element Definition Patient Account Number The patient s unique alphanumeric number assigned by the hospital to facilitate retrieval of individual s account of services containing financial billing records and posting of the payment Patient Class Code submitted by the hospital defining the patients class. This code is determined from the Encounter type ID and the Place of Service code given by the hospital. - See Reference Table 14 for more information Calculated/ Submitted Data? Data Available For Release? Insight Standard POS File *as requested Custom POS File *as requested S N N N C* Y Y Y Payer Group (Primary Payer) Payer ID Payer Name Payer group code, a code indicating the responsible party for primary payment - See Reference Table 7 for accepted values. Patient's health insurance policy number associated with the primary payer on the record Full name of the primary payer on the record S Y Y Y S N N N S N N N Place of Service The place of service that the patient was last seen in before discharge. - See Reference Tables 8 and 9 for accepted values. Practitioner - Attending A code identifying the attending practitioner or attending refers to the patient's primary doctor. *Note: Physician identifying information is not shared amongst hospitals therefore hospitals can request to see their own physician data but cannot see that physicians data from another hospital. Practitioner - Attributing A code identifying the primary surgeon of record. *Note: Physician identifying information is not shared amongst hospitals therefore hospitals can request to see their own physician data but cannot see that physicians data from another hospital. S N N Y S Y* N Y* S Y* N Y* OHA Data Dictionary Definitions and Data Availability, Updated 5/27/14 Page 6 of 48

Data Element Practitioner - Referring Practitioner - Admitting Present on Admission (POA) Procedure - Primary Procedure - Secondary Procedure Date - Primary Procedure Date - Secondary Product Group - Diagnosis Product Group - Procedure Product Line - Diagnosis Product Line - DRG Product Line - MSDRG Definition A code identifying the referring physician during encounter of care. *Note: Physician identifying information is not shared amongst hospitals therefore hospitals can request to see their own physician data but cannot see that physicians data from another hospital. A code identifying the physician who admits the patient. *Note: Physician identifying information is not shared amongst hospitals therefore hospitals can request to see their own physician data but cannot see that physicians data from another hospital. Present on admission indicator related to each ICD-9 diagnosis The ICD-9 code describing the primary procedure performed during the episode of care The ICD-9 code describing the secondary procedures performed during the episode of care. - See ICD-9 Procedure tab for lookup codes and definitions. The date the principal procedure was performed. The date secondary procedure 2-9 was performed. A code made of the 1st 3 characters of the primary diagnosis. - See ICD-9 Diagnosis tab for lookup codes and definitions. A rollup of encounters based on primary procedure. The product group is the first 2 characters of primary procedure. Rollup of primary diagnosis based on general categorization. - See ICD-9 Diagnosis tab for lookup codes and definitions. Rollup of DRGs based on general categorization. Rollup of MSDRGs based on general categorization. Product Line - Procedure Rollup of primary procedures based on general categorization. Calculated/ Submitted Data? Data Available For Release? Insight Standard POS File *as requested Custom POS File *as requested S Y* N Y* S Y* N Y* S N N Y S Y Y Y S Y Y Y S N N Y S N N Y C Y N Y C N N Y C Y N Y C Y Y Y C Y Y Y C Y N Y OHA Data Dictionary Definitions and Data Availability, Updated 5/27/14 Page 7 of 48

Data Element Provider Contact Date Provider Contact Time PTHIC Number Race RDRG Definition Provider contact date - Data Field used by CMS and TJC for Care Measures, and their definitions apply Provider contact time - Data Field used by CMS and TJC for Care Measures, and their definitions apply The patient's Medicare health insurance claim number - Data Field used by CMS and TJC for Care Measures, and their definitions apply A self identified classification indicating the race with which the patient most closely identifies. - See Reference Table 11 for accepted values. The Refined Diagnosis-Related Group are classes of secondary diagnosis that are disease and procedure specific. Each class represents a different level of utilization for a given principal diagnosis or surgical procedure. Calculated/ Submitted Data? Data Available For Release? Insight Standard POS File *as requested Custom POS File *as requested S N N N S N N N S N N N S N N Y* S Y Y Y Recurring Code that specifies that this episode of the outpatient care is recurring. S N N Y* *Note: Field not required for submissio n. Revenue Charge The sum of charges corresponding to the Revenue Code S N N N Revenue Code UB-04 Revenue code S N N N Severity The severity is the classification assigned using the Refined DRG where each patient is assigned a rating between 1 and 4 in which 1 is the least complicated and 4 is the most complicated. C Y N N Severity Adjusted Case Mix Sex This estimates the average resources used to treat each patient by taking the DRG Weight of that patient and multiplying by the Severity Rating. The sex of the patient's recorded at admission or start of care. - See Reference Table 12 for accepted values. C Y N N S Y Y Y State Total Charges The state of residence of the patient, based on the zip code. The total hospital charges for the episode of care, including both covered and non-covered charges. C Y N Y S Y Y Y OHA Data Dictionary Definitions and Data Availability, Updated 5/27/14 Page 8 of 48

Data Element Units of Service Zip Code Definition Total units of service for the CPT or HCPCS code provided. The postal code of the patient's primary residence. Calculated/ Submitted Data? Data Available For Release? Insight Standard POS File *as requested Custom POS File *as requested S N N N S Y Y Y OHA Data Dictionary Definitions and Data Availability, Updated 5/27/14 Page 9 of 48

Admit Source Definition: The source of the referral for this admission or visit. Code Description Definition 1 2 Inpatient: The patient was admitted to this facility. Outpatient: The patient presented for outpatient services. Examples: Includes patients coming from home or workplace and patients receiving care at home (such as home health services.) Inpatient: The patient was admitted to this facility. Outpatient: The patient presented to this facility for outpatient services. Office 3 Reserved for national assignment. Discontinued effective 10/1/2007. Inpatient: The patient was admitted to this facility as a hospital transfer from an acute 4 5 6 7 Discontinued. Effective 7/1/2010. 8 9 care facility where he or she was an inpatient or outpatient. Outpatient: The patient was transferred to this facility as an outpatient from an acute care facility. Usage Note: Excludes transfers from hospital inpatient in the same facility (see Code D) Inpatient: The patient was admitted to this facility as a transfer from a SNF, ICF or ALF where he or she was a resident. Outpatient: The patient presented to this facility for outpatient or referenced diagnostic services from a SNF, ICF or ALF where he or she was a resident. Inpatient: The patient was admitted to this facility as a transfer from another type of health care facility not defined elsewhere in this code list. Outpatient: The patient presented to this facility for services from another health care facility not defined elsewhere in this code list. Inpatient: The patient was admitted to this facility upon the direction of a court of law or upon the request of a law enforcement agency representative. Outpatient: The patient presented to this facility upon the direction of a court of law or upon the request of a law enforcement agency representative for outpatient or referenced diagnostic services. Usage Note: Includes transfers from incarceration facilities. Inpatient: The patient s Point of Origin is not known. Outpatient: The patient s Point of Origin is not known. Available A Reserved for national assignment. Discontinued effective 10/1/2007. B Discontinued. Effective 7/1/2010. C Discontinued. Effective 7/1/2010. D Non-health Care Facility Point of Origin Clinic or Physician s Transfer From a Hospital (Different Facility) Transfer From a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF) or Assisted Living Facility Transfer From Another Health Care Facility Court/Law Enforcement Information not Transfer From One Distinct Unit of the Hospital to another Distinct Unit of the Same Hospital Resulting in a Separate Claim to the Payer Reference Table 1 Inpatient: The patient was admitted to this facility as a transfer from hospital inpatient within this hospital resulting in a separate claim to the payer. Outpatient: The patient received outpatient services in this facility as a transfer from within this hospital resulting in a separate claim to the payer. Usage Note: For purposes of this code, Distinct Unit is defined as a unique level of care at the hospital requiring the issuance of a separate claim to the payer. Examples could include observation services, rehab units, a unit in a critical access hospital, or a swing bed located in an acute hospital. OHA Data Dictionary Lookup Tables, Updated 5/27/14 Page 10 of 48

E F G-Z Transfer From Ambulatory Surgery Center Transfer From Hospice Inpatient: The patient was admitted to this facility as a transfer from an ambulatory surgery center. Outpatient: The patient presented to this facility for outpatient or referenced diagnostic services from an ambulatory surgery center. Inpatient: The patient was admitted to this facility as a transfer from hospice facility. Outpatient: The patient presented to this facility or outpatient or referenced diagnostic services from a hospice facility. Reserved for national assignment. Admit Source (Code Structure for Newborns) Note: Newborn coding structure must be used when the Type of Admission Code 4 is used. Code Description Definition 1 Reserved for national assignment. Discontinued effective 10/1/2007. 2 Reserved for national assignment. Discontinued effective 10/1/2007. 3 Reserved for national assignment. Discontinued effective 10/1/2007. 4 Reserved for national assignment. Discontinued effective 10/1/2007. 5 Born Inside this Hospital A baby is born inside this hospital. 6 Born Outside this Hospital A baby is born outside of this hospital. 9 Reserved for assignment by the NUBC. OHA Data Dictionary Lookup Tables, Updated 5/27/14 Page 11 of 48

Admit Type Reference Table 2 Definition: The priority of the admission or visit. Code Description Definition 1 Emergency The patient requires immediate medical intervention as a result of severe, lifethreatening or potentially disabling conditions. Generally, the patient is admitted through the emergency room. 2 Urgent The patient requires immediate attention for the care and treatment of a physical or mental disorder. Generally, the patient is admitted to the first available and suitable accommodation. 3 Elective The patient s condition permits adequate time to schedule the availability of a suitable accommodation. 4 Newborn A baby born within this facility. Use of this code necessitates the use of special Point of Origin/Source of Admission table. 5 Trauma Center Visit to a trauma center hospital as licensed or designated by the state or local government authority authorized to do so, or as verified by the American College of Surgeons and involving trauma activation. (Use Revenue Code 068x to capture trauma activation charges involving pre-hospital notification.) 6-8 Reserved for national assignment. 9 Information Not Available The hospital does not have this information in its records. OHA Data Dictionary Lookup Tables, Updated 5/27/14 Page 12 of 48

Discharge Status Definition: The patient s status as of the ending service date of the period covered on the record. Code Description/Definition Discharged to Home or Self Care (routine discharge) Usage Note: Includes discharge to home, home on oxygen if DME only, any other DME only, group home, 01 foster care, independent living and other residential care arrangements, outpatient programs, such as partial hospitalization or outpatient chemical dependency programs. Effective 10/1/2009 02 03 04 05 06 07 08 09 10-19 20 21 22-29 30 31-39 40 41 42 Reference Table 3 Discharged/transferred to a Short Term General Hospital for Inpatient Care Discharged/transferred to Skilled Nursing Facility (SNF) with Medicare Certification in anticipation of Skilled Care Usage Note: Medicare Indicates that the patient is discharged/ transferred to a Medicare certified nursing facility. For hospitals with an approved swing bed arrangement, use Code 61 - Swing Bed. For reporting other discharge/transfers to nursing facilities see 04 and 64. Discharged/transferred to a facility that provides Custodial or Supportive Care Usage Note: Includes intermediate care facilities (ICFs) if specifically designated at the state level. Also used to designate patients that are discharged/ transferred to a nursing facility with neither Medicare nor Medicaid certification and for discharges/transfers to Assisted Living Facilities. Effective 10/1/2009 Discharged/transferred to a Designated Cancer Center or Children s Hospital Usage Note: Transfers to non-designated cancer hospitals should use Code 02. A list of (National Cancer Institute) designated cancer centers can be found at http://www3.cancer.gov/cancercenters/centerslist.html. Discharged/transferred to Home Under Care of Organized Home Health Service Organization in Anticipation of Covered Skilled Care Usage Note: Report this code when the patient is discharged/transferred to home with a written plan of care (tailored to the patient's medical needs) for home care services. Not used for home health services provided by a DME supplier or from a Home IV provider for home IV services. Left Against Medical Advice or Discontinued Care Reserved for National Assignment Admitted as an Inpatient to this Hospital. Usage Note: For use only on Medicare outpatient claims. Applies only to those Medicare outpatient services Reserved for National Assignment Expired Discharged/transferred to Court/Law Enforcement Usage Note: Includes transfers to incarceration facilities such as jail, prison or other detention facilities. Effective 10/1/2009 Reserved for National Assignment Still Patient Usage Note: Used when the patient is still within the same facility, typically used when billing for leave of absence days or interim bills. Reserved for National Assignment Expired at Home Usage Note: For use only on Medicare and TRICARE claims for hospice care. Expired in a Medical Facility (e.g. hospital, SNF, ICF, or free standing hospice) Usage Note: For use only on Medicare and TRICARE claims for hospice care. Expired Place unknown Usage Note: For use only on Medicare and TRICARE claims for hospice claims. OHA Data Dictionary Lookup Tables, Updated 5/27/14 Page 13 of 48

43 44-49 50 51 52-60 61 62 63 64 65 66 67-68 69 70 71-72 73-80 81 82 83 84 85 86 87 88 89 90 91 Discharged/transferred to a Federal Health Care Facility. Usage Note: Discharges and transfers to a government operated health facility such as a Department of Defense Hospital, a Veteran's Administration hospital or a Veteran's Administration nursing facility. To be used whenever the destination at discharge is a federal health care facility, whether the patient lives there or not. Reserved for National Assignment Hospice Home Hospice Medical Facility (Certified) Providing Hospice-Level Care Reserved for National Assignment Discharged/transferred to a Hospital-Based Medicare Approved Swing Bed Usage Note: Medicare Used for reporting patients discharged/transferred to a SNF level of care within the hospital's approved swing bed arrangement. Discharged/ transferred to an Inpatient Rehabilitation Facility (IRF) including Rehabilitation Distinct Part Units of a Hospital Discharged/transferred to a Medicare-certified Long Term Care Hospital (LTCH) Usage Note: For hospitals that meet Medicare criteria for LTCH certification. Discharged/transferred to a Nursing Facility Certified under Medicaid but not Certified under Medicare Discharged/transferred to a Psychiatric Hospital or Psychiatric Distinct Part Unit of a Hospital Discharged/transferred to a Critical Access Hospital (CAH) Reserved for National Assignment Discharged/transferred to a Designated Disaster Alternative Care Site (Effective 10/1/13) Discharged/transferred to Another Type of Health Care Institution not Defined Elsewhere in this Code List (See Code 95 for a discharge with a Planned Acute Care Hospital Inpatient Readmission) Discontinued 4/1/03 Reserved for Assignment by the NUBC Discharged to Home or Self Care with a Planned Acute Care Hospital Inpatient Readmission (Effective 10/1/13) Discharged/Transferred to a Short Term General Hospital for Inpatient Care with a Planned Acute Care Hospital Inpatient Readmission (Effective 10/1/13) Discharged/Transferred to a Skilled Nursing Facility (SNF) with Medicare Certification with a Planned Acute Care Hospital Inpatient Readmission (Effective 10/1/13) Discharged/Transferred to a Facility that Provides Custodial or Supportive Care with a Planned Acute Care Hospital Inpatient Readmission (Effective 10/1/13) Discharged/Transferred to a Designated Cancer Center or Children s Hospital with a Planned Acute Care Hospital Inpatient Readmission (Effective 10/1/13) Discharged/Transferred to Home Under Care of Organized Home Health Service Organization with a Planned Acute Care Hospital Inpatient Readmission (Effective 10/1/13) Discharged/Transferred to Court/Law Enforcement with a Planned Acute Care Hospital Inpatient Readmission (Effective 10/1/13) Discharged/Transferred to a Federal Health Care Facility with a Planned Acute Care Hospital Inpatient Readmission (Effective 10/1/13) Discharged/Transferred to a Hospital-based Medicare Approved Swing Bed with a Planned Acute Care Hospital Inpatient Readmission (Effective 10/1/13) Discharged/Transferred to an Inpatient Rehabilitation Facility (IRF) including Rehabilitation Distinct Part Units of a Hospital with a Planned Acute Care Hospital Inpatient Readmission (Effective 10/1/13) Discharged/Transferred to a Medicare Certified Long Term Care Hospital (LTCH) with a Planned Acute Care Hospital Inpatient Readmission (Effective 10/1/13) OHA Data Dictionary Lookup Tables, Updated 5/27/14 Page 14 of 48

92 93 94 95 96-99 Discharged/Transferred to a Nursing Facility Certified Under Medicaid but not Certified Under Medicare with a Planned Acute Care Hospital Inpatient Readmission (Effective 10/1/13) Discharged/Transferred to a Psychiatric Hospital or Psychiatric Distinct Part Unit of a Hospital with a Planned Acute Care Hospital Inpatient Readmission (Effective 10/1/13) Discharged/Transferred to a Critical Access Hospital (CAH) with a Planned Acute Care Hospital Inpatient Readmission (Effective 10/1/13) Discharged/Transferred to Another Type of Health Care Institution not Defined Elsewhere in this Code List with a Planned Acute Care Hospital Inpatient Readmission (Effective 10/1/13) Reserved for Assignment by the NUBC OHA Data Dictionary Lookup Tables, Updated 5/27/14 Page 15 of 48

Encounter Type Reference Table 4 Definition: The type of patient. Code Description Definition I Inpatient All discharges from Acute Care, Newborns, Medical Rehabilitation, Skilled Nursing Care (including swing beds, long term acute care, inpatient hospice and designated units), and Behavioral Health (including Psychiatric Care and Chemical Dependency Care). Submit all inpatient visits on discharge. O Outpatient All patient visits treated on an outpatient basis. A person who is not admitted to the hospital as inpatient, but is registered on the hospital records as an outpatient and receives services (rather than supplies alone) from the hospital. Where a tissue sample, blood sample, or specimen is taken by personnel that are neither employed nor arranged for by the hospital and is sent to the hospital for performance of tests, the tests are not outpatient hospital services since the patient does not directly receive services from the hospital. OHA Data Dictionary Lookup Tables, Updated 5/27/14 Page 16 of 48

Ethnicity Definition: The ethnicity code assigned to the patient s record. Reference Table 5 Note: If Hispanic or Latino is being reported under Ethnicity (preferred), do not report Hispanic or Latino under Race (Code 6 ). Code Description Definition 1 Hispanic or Latino A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. 2 Non Hispanic or Latino Patient is not of Hispanic or Latino ethnicity. 3 Unavailable or Unknown Select this category if the patient is unable to physically respond, there is no available family member or caregiver to respond for the patient, or if for any reason, the demographic portion of the medical record cannot be completed. 4 Declined A person who is unwilling to provide an answer to the question of Hispanic or Latino ethnicity. OHA Data Dictionary Lookup Tables, Updated 5/27/14 Page 17 of 48

Language Reference Table 6 Definition: The language code assigned to the patient s record. Code Description Definition 1 English A person who's primary language is English. 2 Spanish A person who's primary language is Spanish. 3 Other Some other language not classified on this list. 4 Declined A person not wanting to respond to the question regarding language. 5 Unavailable or Unknown Attempts to capture race were unattainable due to other circumstances. OHA Data Dictionary Lookup Tables, Updated 5/27/14 Page 18 of 48

Reference Table 7 Payer Grouping Definition: The financial class (high-level) of the primary payer on the claim. Code Description Definition A B C Self Pay Bureau of Workers Compensation (BWC) Medicare (traditional/ fee-for-service) The patient has no insurance and is ineligible for governmental assistance. Patient paid for service out of pocket. HCAP should be classified under this category. Primary payer is the Bureau of Workers Compensation. Primary payer is traditional fee for service Medicare provider. D Medicaid (traditional) Primary payer is traditional Ohio Medicaid provider. E Other Government Primary payer is a government provider and is NOT Ohio Medicaid or Medicare. (Examples: Champus, Veterans, DOD/Tricare, Indiana Medicaid, etc.) F Commercial Insurance Private or group plans including auto insurances. All commercial insurance payers including commercial managed care payers should be classified here. (Examples: Blue Cross Primary, HMO, PPO, Med Mutual, UHC, Blue Cross, Aetna.) I Other Some other payer not classified in this list. M Medicaid Managed Care Non fee for service, Medicaid Managed Care Plan. O Medicare Managed Non fee for service, Medicare Managed Care Plan. Blue Cross Crossover should be Care classified here. Q Charity Uncompensated No charge was submitted and the episode was classified as Charity Care. OHA Data Dictionary Lookup Tables, Updated 5/27/14 Page 19 of 48

Reference Table 8 Place of Service - Inpatient Definition: The place of service that the patient was last seen in before discharge. Code Description Definition 1 Acute Medical/Surgical Unit Assigned to inpatients, including newborns receiving care in the medical/surgical areas of a short-term hospital and not included in any other described level of care. 2 3 Medical Rehabilitation Unit Alternate Level of Care (SNF/Swing Bed Skilled) Relatively intense program including cardiology rehab, physical therapy and/or occupational therapy that requires a multidisciplinary coordinated team approach to upgrade the patient s ability to function. Care is provided in an inpatient setting. Maintains an organized professional staff and permanent facilities including inpatient beds that provide continuous nursing and other health-related psychosocial and personal services to patients who are not in an acute phase of illness but who primarily require continued care on an inpatient basis. Long Term Acute Care Hospital (LTACH) patients would also be included in this category. 5 Hospice Inpatient care or services means short-term, general inpatient care provided either through a contract arrangement with an appropriately licensed and Medicare-certified hospital or long term care facility or directly by a hospice program in its hospice inpatient facility to provide pain control and symptom management that cannot be accomplished in another setting. 6 Psychiatric/ Behavioral Health Chemical Dependency Care: Provides diagnostic and therapeutic services to patients with alcoholism or other drug dependencies. Includes care for inpatient/resident treatment for patients whose course of treatment involves more intensive care than provided in an outpatient setting or where patient requires supervised withdrawal. Psychiatric Care: Provides acute or long-term inpatient care to emotionally disturbed patients, including patients admitted for diagnosis and those admitted for treatment of psychiatric problems, on the basis of physician s orders and approved nursing care plans. Long term care may include intensive supervision to the chronically mentally ill, mentally disordered, or other mentally incompetent persons. OHA Data Dictionary Lookup Tables, Updated 5/27/14 Page 20 of 48

this hierarchy. Code Description Definition Reference Table 9 Place of Service - Outpatient Definition: The outpatient place of service identifies where the patient received treatment. Use one of the following codes in 3 Observation Patients put into an observation bed and not admitted as an inpatient, regardless of point of referral. Observation Services are those services furnished by a hospital on its premises, including the use of a bed, periodic monitoring by nursing and other staff, and any other services that are reasonable and necessary to evaluate a patient s condition or to determine the need for a possible (inpatient) admission to the hospital. Any record with a revenue code in category 0760, 0762, and 0769 including those with a surgical or emergency service revenue code. 2 Outpatient Surgery 1 Emergency Room 4 Therapy Patients seen on an outpatient basis for some billable procedure regardless of whether it was performed in a surgery suite. Any record not classified as Observation AND with a revenue code in categories 036X, 0481, 049X or 0750, or any record from a free standing ambulatory surgery center. Patients seen at a hospital based emergency room and treated then released. Any record not classified as Observation or Outpatient Surgery AND with revenue codes 0450, 0451, 0452, 0459. Patients seen on an outpatient basis for rehabilitation. Any record not classified as Emergency Room, Outpatient Surgery or Observation AND with revenue codes in categories 041X-044X, or 093X-095X. This includes Respiratory, Physical, Occupational and Speech Therapies, Medical Rehabilitation, Therapeutic Rehabilitation or Athletic Training respectively. 5 Lab/ Radiology Any record not classified as Emergency Room, Outpatient Surgery or Observation AND with revenue codes in categories 030X, 031X, 032X-035X, 040X, 048X except 481, 061X, 073X-074X or 092X. This includes Diagnostic and Routine Laboratory Testing, Diagnostic and Therapeutic Radiology, Nuclear Medicine, CAT Scans, Imaging, MRIs, EKGs and ECGs, EEGs. 7 Hospice Medicare Certified Hospice care provided by the hospital in the patient s home residence whether it's a private residence, nursing home, off-site hospital or an assisted living facility. Includes records with but not limited to records with revenue codes in category 065X. 8 Psychiatric/Behavioral Health Patients seen on an outpatient basis for psychiatric or behavioral health treatment. Records may include but not limited to records with revenue codes 090X-091X. 9 Urgent Care Off Site Patients seen in an offsite urgent care facility on an outpatient basis. Records may include but not limited to records with revenue codes 0456. OHA Data Dictionary Lookup Tables, Updated 5/27/14 Page 21 of 48

10 Urgent Care On Site (Fast Track) Patients seen at a hospital based emergency room then referred to an urgent care site in the hospital. Includes records not previously designated and may include but not limited to records with revenue codes 0456. 11 Clinic Off Site Patients seen on an outpatient or physician visit at an off-site hospital based outpatient clinic. Some of the requirements for a hospital based clinic: Off-site clinic must be off the hospital s main campus but within 35 miles of the main campus. Operates under the main provider s license unless state law mandates separate licensure. Has ready access to the hospital and other provider-based clinics medical records. Physicians and staff operating within the clinic are under the same reporting structure as all other hospital departments. Incorporated into the hospital s organizational chart. Includes records with but not limited to records with revenue codes 051X-052X. 12 Clinic On Site Patients seen on an outpatient or physician visit at an on-site hospital based outpatient clinic. Some of the requirements for a hospital based clinic: On-site clinic must be on the hospital s main campus. Operates under the main provider s license unless state law mandates separate licensure. Has ready access to the hospital and other provider-based clinics medical records. Physicians and staff operating within the clinic are under the same reporting structure as all other hospital departments. Incorporated into the hospital s organizational chart. Includes records with but not limited to records with revenue codes 051X-052X. 6 Other Outpatient Includes records not previously designated and may include but not limited to records with revenue codes in categories 038X-039X, 046X-047X, 058X-060X, 064X, 066X, 082X- 085X, or 088X. This includes Blood Products and Storage, Audiology and Pulmonary, Home Health visits & units, Home Health Oxygen & IV, Preventative Care, 0761 treatment room and 0769 other specialty servicers, Hemodialysis, peritoneum and miscellaneous dialysis. OHA Data Dictionary Lookup Tables, Updated 5/27/14 Page 22 of 48

Present on Admission Indicator Reference Table 10 Definition: Indicator related to each ICD-9 diagnosis Code Description/ Definition Y Diagnosis was present at the time of inpatient admission N Diagnosis was not present at the time of inpatient admission U W 1 Documentation is insufficient to determine if the condition was present at the time of inpatient admission Clinically undetermined, provider unable to clinically determine whether the condition was present at the time of inpatient admission Unreported/ Not Used, exempt from POA reporting. OHA Data Dictionary Lookup Tables, Updated 5/27/14 Page 23 of 48

Race Definition: The Race code assigned to the patient s record. Reference Table 11 *Notes: - The preferred standard is to report Hispanic or Latino under Ethnicity. If you are unable to report Ethnicity, then please include Hispanic or Latino under Race (Code 6 ). - If documentation indicates the patient has more than one race, and you are only able to submit one race, select the first listed race (ex. Black-White, Indian-White). Code Description Definition 1 White or Caucasian A person having origins in any of the peoples of Europe, North Africa or the Middle East. 2 African American /Black A person having origins in any of the black racial groups of Africa. 3 American Indian /Alaska Native A person having origins in any of the people of North and South America (including Central America) and who maintains tribal affiliation or community attachment. 4 Asian A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian subcontinent including Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam. 5 Native Hawaiian A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other /Other Pacific Islander Pacific Islands. 6 7 Hispanic/Latino of Any Race *Please see note Unavailable or Unknown A person of Cuban, Mexican, Puerto Rico, South or Central American or other Spanish culture or origin. Attempts to capture race were unattainable due to other circumstances. 9 Declined A person NOT wanting to respond to the question regarding race. OHA Data Dictionary Lookup Tables, Updated 5/27/14 Page 24 of 48

Sex Reference Table 12 Definition: The sex of the patient as recorded at admission, outpatient service, or start of care. Code Description/ Definition F Female M Male U Unknown OHA Data Dictionary Lookup Tables, Updated 5/27/14 Page 25 of 48

List of Updates Reference Table 13 Date Category Reason for Update 10/1/2013 Discharge Status Added codes 81-95; Updated to reflect NUBC standards effective 10/1/2013 1/3/2013 Outpatient Place of Service Updated code usage; Added hierarchy to definition to prioritize observation patients 5/27/2014 Language Corrected definitions for values 4 and 5 (Descriptions were correct; Definitions were switched.) OHA Data Dictionary Lookup Tables, Updated 5/27/14 Page 26 of 48

Patient Class Mapping Reference Table 14 The data submission process changed starting with 2012 Discharge Data. The new format included a change in the way that the "Patient Class" was collected for each patient encounter. Prior to 2012 data, hospitals grouped each encounter into one patient class. For 2012 and later data, hospitals grouped each patient encounter into an "Encounter Type" (Inpatient or Outpatient), and a "Place of Service" to further define the type of patient. OHA has created a mapping for the process of submitting patient class back to the older patient class categories. This was done to not interfere with the existing data systems, including Insight and the POS Files that many hospitals receive. The tables below show the mapping from the Encounter Type and Place of Service codes used in the new file format to the Patient Classes shown in Insight and the POS Files. Please Note: - The definitions for the Encounter Type and Place of Service can be found in Reference Tables 4, 8 and 9. - Prior to 2012 data, the Patient Class included a category for "Recurring". This no longer exists as a category under Place of Service. Inpatient Encounter Type Place of Service Patient Class I - Inpatient 1 - Acute Medical/Surgical Unit I Inpatient I - Inpatient 2 - Medical Rehabilitation Unit I Inpatient I - Inpatient 3 - Alternate Level of Care (SNF/Swing Bed Skilled) S Inpatient SNF I - Inpatient 5 - Inpatient Hospice I Inpatient I - Inpatient 6 - Inpatient Psychiatric/ Behavior Health I Inpatient Outpatient Encounter Type Place of Service Patient Class O - Outpatient 1 - Emergency room E Emergency O - Outpatient 2 - Outpatient surgery U Ambulatory Surgery O - Outpatient 3 - Observation B Observation O - Outpatient 4 - Therapy H Outpatient Rehabilitation O - Outpatient 5 - Lab/ Radiology L Lab O - Outpatient 6 - Other Outpatient O Outpatient O - Outpatient 7 - Hospice O Outpatient O - Outpatient 8 - Psychiatric/ Behavior Health P Outpatient Pysch O - Outpatient 9 - Urgent Care - Off Site G Urgent Care O - Outpatient 10 - Urgent Care - On Site F Fast Track ER O - Outpatient 11 - Clinic - Off Site C Clinic O - Outpatient 12 - Clinic - On Site C Clinic OHA Data Dictionary Patient Class Mapping, Updated 5/27/14 Page 27 of 48

List of Hospital ID's - By Facility Name Reference Table 15 Facility Name Hospital ID Acuity Specialty Hospital-Ohio Valley 266 Adams County Regional Medical Center 185 Adena Greenfield Medical Center 090 Adena Medical Center 026 Adena Pike Medical Center 183 Advanced Specialty Hospital of Greenbriar Rehabilitation 446 Affinity Medical Center 119 Affinity Medical Center - Doctors Campus 120 Akron Children's Hospital 003 Akron General Edwin Shaw Rehab 196 Akron General Medical Center 002 Alliance Community Hospital 005 Alliance Primary Care, Inc. 430 Appalachian Behavioral Healthcare - Cambridge Campus 271 Ashtabula County Medical Center 008 Atrium Medical Center 126 Aultman Hospital 023 Aultman Orrville Hospital 138 Aultman West 242 Bariatric Care Center of Ohio 224 Barnesville Hospital 011 Bedford Medical Center Campus 013 Beeghly Oaks 226 Belmont Community Hospital 014 Belmont Pines Hospital 210 Berger Health System 039 Bethesda Arrow Springs 262 Bethesda Butler Hospital 354 Bethesda North Hospital 197 Bethesda Oak Hospital 027 Blanchard Valley Health System 425 Blanchard Valley Hospital 082 Bluffton Hospital 017 Bucyrus Community Hospital 020 Cabell Huntington Hospital 360 Cambridge Health & Rehab. Center 350 Chalmers P. Wylie VA Ambulatory Care Center 218 Champaign Mercy Health Services, McAuley Center 297 Cincinnati Children's Hospital Medical Center 028 Cincinnati Children's Liberty Campus 363 Cleveland Clinic 041 Cleveland Clinic Children's Hospital For Rehabilitation 223 CMH Regional Health System - Clinton Memorial Hospital 188 Columbus Community Hospital 061 OHA Data Dictionary Hospital ID's, Updated 5/27/14 Page 28 of 48

Community Health Partners, East Campus 107 Community Hospitals & Wellness Centers - Archbold Hospital 429 Community Hospitals & Wellness Centers-Bryan Hospital 019 Community Hospitals & Wellness Centers - Montpelier 408 Community Memorial Hospital 094 Coshocton County Memorial Hospital 067 Cottingham Retirement 214 Dayton Children's Hospital 070 Dayton Heart Hospital 215 Dayton Rehab Institute 203 Dayton VA Medical Center 217 Deaconess Health Care 401 Deaconess Hospital 030 Deaconess Hospital - Cleveland 043 Deaconess Long Term Care of Ohio 332 Dearborne County Hospital 261 Dettmer Hospital 170 Diley Ridge Medical Center 139 Doctors Hospital North 058 Doctors Hospital of Nelsonville 132 Doctors Hospital Ohio Health 264 Drake Center, Inc. 219 Drake Pavilion at the Christ Hospital 428 Dublin Methodist Hospital 216 Dupont Hospital 179 East Liverpool City Hospital 079 East Ohio Regional Hospital 117 Elmwood Healthcare Center At the Springs 244 EMH Amherst Hospital 006 Euclid Hospital 081 Fairfield Medical Center 100 Fairview Hospital 044 Fayette County Memorial Hospital 181 Fayette Memorial Hospital 254 Firelands Regional Medical Center 152 Firelands Regional Medical Center - South Campus 153 Fisher-Titus Medical Center 134 Fort Hamilton Hospital 092 Forum Health 343 Forum Health Western Reserve Care System-Southside 192 Fox Run Hospital 221 Franciscan at St. John 293 Franciscan Health System of Dayton 278 Fulton County Health Center 182 Galion Community Hospital 085 Gateway Rehab 236 Genesis Healthcare System/Bethesda 194 Genesis Healthcare System/Good Samaritan 195 Glenbeigh Health Sources 227 OHA Data Dictionary Hospital ID's, Updated 5/27/14 Page 29 of 48

Good Samaritan Hospital 071 Good Samaritan Hospital 031 Good Samaritan Western Ridge 184 Grace Hospital 045 Grady Memorial Hospital 076 Grand Lake Health System 159 Grandview Medical Center 072 Grant Medical Center 059 Greene Memorial Hospital 190 Hardin Memorial Hospital 097 Harrison Community Hospital 021 Harrison MediCenter 263 Health Recovery Services 241 HealthSouth Rehabilitation Hospital At Drake 494 Heartland Behavioral Healthcare 230 Heather Hill Care Communities 318 Henry County Hospital 131 Highland District Hospital 095 Hillcrest Hospital 122 Hillside Rehabilitation Hospital 205 Hocking Valley Community Hospital 104 Holzer Gallipolis 086 Holzer Medical Center-Jackson 229 Huron Hospital 046 Institute For Orthopedic Surgery 432 Kettering Behavioral Medicine Center 238 Kettering Medical Center 098 Kindred Gateway Hospital of Cleveland 409 Kindred Hospital Dayton 402 Kindred Hospital Lima 232 King's Daughters Medical Center Kentucky 250 King's Daughters Medical Center Ohio 495 Knox Community Hospital 130 Lake Health Tripoint Medical Center 141 Lakewood Hospital 099 Licking Memorial Hospital 133 LifeCare Hospital of Dayton 311 Lima Memorial Health System 101 Lindner Center of HOPE 303 Lodi Community Hospital 103 Louis Stokes Cleveland VA Medical Center 259 Lutheran Hospital 047 Lutheran Hospital of Indiana 147 Madison County Hospital 105 Magruder Hospital 146 Mahoning Valley Hospital - Trumbull Campus 426 Margaret Mary Hospital 265 Marietta Memorial Hospital 113 Marion General Hospital 116 OHA Data Dictionary Hospital ID's, Updated 5/27/14 Page 30 of 48

Marymount Hospital 087 Mary Rutan Hospital 015 McCullough-Hyde Memorial Hospital 140 MedCenter Hospital 115 MedCentral Health System 068 MedCentral - Mansfield Hospital 110 MedCentral - Shelby Hospital 155 Medical Center of Newark 361 Medina Hospital 123 Memorial Hospital of Union County 118 Mental Health Services for Clark County 208 Mercer Health 056 Mercy Allen Hospital 136 Mercy Health Anderson Hospital 034 Mercy Healthcare Center 165 Mercy Health Clermont Hospital 012 Mercy Health Fairfield Hospital 206 Mercy Health Mt. Airy Hospital - CLOSED 035 Mercy Health Western Hills Hospital 036 Mercy Hospital of Defiance 272 Mercy Hospital of Hamilton 093 Mercy Medical Center 024 Mercy Memorial Hospital 173 Mercy Regional Medical Center 106 Mercy St. Anne Hospital 237 Mercy St. Charles Hospital 137 Mercy St. Vincent Medical Center 168 Mercy Tiffin Hospital 163 Mercy Willard Hospital 187 MetroHealth System 042 Miami Valley Hospital 073 Miami Valley Hospital South 144 Morrow County Hospital 129 Mount Carmel East 198 Mount Carmel New Albany Surgical Hospital 353 Mount Carmel St. Ann's 066 Mount Carmel West 060 Mt. Orab Medical Center 128 Nationwide Children's Hospital 057 Neil Kennedy Recovery Unit 435 Northside Medical Center 200 Oak Hill Community Medical Center 135 OhioHealth O'Bleness Hospital 009 Ohio Hospital for Psychiatry 357 Ohio Valley Medical Center 274 Paulding County Hospital 143 Peoples Hospital 111 PHS Mt. Sinai University Circle 048 Pleasant Valley Hospital 492 OHA Data Dictionary Hospital ID's, Updated 5/27/14 Page 31 of 48

Pomegranate Health Systems 212 Pomerene Hospital 127 ProMedica Bay Park Hospital 344 ProMedica Bixby Hospital 273 ProMedica Defiance Regional Hospital 075 ProMedica Flower Hospital 162 ProMedica Fostoria Community Hospital 083 ProMedica Herrick Hospital 275 Promedica Memorial Hospital 084 ProMedica St. Luke's Hospital 121 ProMedica Toledo Children's Hospital 209 ProMedica Toledo Hospital 169 Quorum Health Resources 315 Regency Hospital Of Toledo 358 Regency North Central Ohio - Akron 436 Reid Hospital 302 Richland Hospital 112 Richmond Medical Center Campus 049 Riverside Mercy Hospital 167 Riverside Methodist Hospital 063 River Valley Health System 096 River Valley Health System Behavioral Health Services 235 Riverview Health Institute 445 Robinson Memorial Hospital 150 Rookwood Medical Center 496 Ross County Health District 260 Saint Luke's Medical Center 052 Salem Regional Medical Center 151 Samaritan Hospital 007 Selby General Hospital 114 Select Specialty Hospital - Cincinnati 437 Select Specialty Hospital - Cleveland 440 Select Specialty Hospital - Columbus 314 Select Specialty Hospital (Mount Carmel West) 225 Select Specialty Hospital - NE Ohio/Akron 220 Select Specialty Hospital - Riverside 438 Select Specialty Hospital - Youngstown 439 Select Specialty Hospital - Zanesville 391 Sharon Regional Health System 364 Shepherd Hill Hospital 493 Shriners Hospitals for Children 239 Soin Medical Center 231 Southeastern Ohio Regional Medical Center 022 Southeast Psychiatric Hospital 211 Southern Ohio Medical Center 148 South Pointe Hospital 180 Southview Medical Center 199 Southwest Community Health Foundation 296 Southwest General Health Center 125 OHA Data Dictionary Hospital ID's, Updated 5/27/14 Page 32 of 48

Southwest Regional Medical Center 089 Specialty Hospital of Lorain 331 Springfield Regional Medical Center 157 Springfield Regional Medical Center - Fountain Blvd. Campus 158 St. Elizabeth Boardman Health Center 306 St. Elizabeth Covington 281 St. Elizabeth Edgewood 283 St. Elizabeth Florence 256 St. Elizabeth Fort Thomas 252 St. Elizabeth Grant 277 St. Elizabeth Health Center 191 St. Elizabeth Hospitals 251 St. John Medical Center 186 St. Joseph Health Center 176 St. Joseph Hospital 166 St. Rita's Medical Center 102 St. Vincent Charity Medical Center 053 Summa Akron City Hospital 001 Summa Barberton Hospital 010 Summa St. Thomas Hospital 497 Summa Wadsworth-Rittman Hospital 175 Summa Western Reserve Hospital 069 Sycamore Medical Center 124 Ten Lakes Center 491 Test Facility 999 The Bellevue Hospital 016 The Christ Hospital 029 The Franciscan at St. Clare 290 The Jewish Hospital 033 The Maria-Joseph Living Care Center 258 The Medical Center At Elizabeth Place 074 The Ohio State University Harding Hospital 222 The Ohio State University Hospital 062 The Ohio State University Hospital East 065 The Ohio State University James Cancer Hospital 207 The Ohio State University Ross Heart Hospital 356 The Orthopedic Hospital 154 The University of Toledo Medical Center 164 Three Gables Surgery Center 355 Tod Children's Hospital 202 Trihealth Evendale Hospital 498 Trinity Hospital Twin City 077 Trinity Medical Center East 160 Trinity Medical Center West 161 Trumbull Memorial Hospital 177 UHHS Saint Michael Hospital 330 Union Hospital 078 University Hospitals Ahuja Medical Center 149 University Hospitals Case Medical Center 054 OHA Data Dictionary Hospital ID's, Updated 5/27/14 Page 33 of 48

University Hospitals Conneaut Medical Center 064 University Hospitals Elyria Medical Center 080 University Hospitals Geauga Medical Center 025 University Hospitals Geneva Medical Center 088 University Hospitals Parma Medical Center 142 University Hospitals Rainbow Babies & Children's Hosp. 204 University of Cincinnati Medical Center 038 Upper Valley Medical Center 171 Van Wert County Hospital 174 Veterans Affairs Medical Center Chillicothe 257 Veterans Memorial Hospital 145 Warren County Hospital 262 Warren General Hospital 178 Wayne HealthCare 091 West Chester Hospital 362 West Medical Center 201 Wilson Memorial Hospital 156 Windsor-Laurelwood Center for Behavioral Medicine 228 Wood County Hospital 018 Wooster Community Hospital 189 Wright Patterson Medical Center 325 Wyandot Memorial Hospital 172 Youngstown Osteopathic Hospital 213 OHA Data Dictionary Hospital ID's, Updated 5/27/14 Page 34 of 48

Reference Table 16 List of Hospital ID's - By Hospital ID Facility Name Hospital ID Summa Akron City Hospital 001 Akron General Medical Center 002 Akron Children's Hospital 003 Alliance Community Hospital 005 EMH Amherst Hospital 006 Samaritan Hospital 007 Ashtabula County Medical Center 008 OhioHealth O'Bleness Hospital 009 Summa Barberton Hospital 010 Barnesville Hospital 011 Mercy Health Clermont Hospital 012 Bedford Medical Center Campus 013 Belmont Community Hospital 014 Mary Rutan Hospital 015 The Bellevue Hospital 016 Bluffton Hospital 017 Wood County Hospital 018 Community Hospitals & Wellness Centers-Bryan Hospital 019 Bucyrus Community Hospital 020 Harrison Community Hospital 021 Southeastern Ohio Regional Medical Center 022 Aultman Hospital 023 Mercy Medical Center 024 University Hospitals Geauga Medical Center 025 Adena Medical Center 026 Bethesda Oak Hospital 027 Cincinnati Children's Hospital Medical Center 028 The Christ Hospital 029 Deaconess Hospital 030 Good Samaritan Hospital 031 The Jewish Hospital 033 Mercy Health Anderson Hospital 034 Mercy Health Mt. Airy Hospital - CLOSED 035 Mercy Health Western Hills Hospital 036 University of Cincinnati Medical Center 038 Berger Health System 039 Cleveland Clinic 041 MetroHealth System 042 Deaconess Hospital - Cleveland 043 Fairview Hospital 044 Grace Hospital 045 Huron Hospital 046 Lutheran Hospital 047 PHS Mt. Sinai University Circle 048 OHA Data Dictionary Hospital ID's, Updated 5/27/14 Page 35 of 48

Richmond Medical Center Campus 049 Saint Luke's Medical Center 052 St. Vincent Charity Medical Center 053 University Hospitals Case Medical Center 054 Mercer Health 056 Nationwide Children's Hospital 057 Doctors Hospital North 058 Grant Medical Center 059 Mount Carmel West 060 Columbus Community Hospital 061 The Ohio State University Hospital 062 Riverside Methodist Hospital 063 University Hospitals Conneaut Medical Center 064 The Ohio State University Hospital East 065 Mount Carmel St. Ann's 066 Coshocton County Memorial Hospital 067 MedCentral Health System 068 Summa Western Reserve Hospital 069 Dayton Children's Hospital 070 Good Samaritan Hospital 071 Grandview Medical Center 072 Miami Valley Hospital 073 The Medical Center At Elizabeth Place 074 ProMedica Defiance Regional Hospital 075 Grady Memorial Hospital 076 Trinity Hospital Twin City 077 Union Hospital 078 East Liverpool City Hospital 079 University Hospitals Elyria Medical Center 080 Euclid Hospital 081 Blanchard Valley Hospital 082 ProMedica Fostoria Community Hospital 083 Promedica Memorial Hospital 084 Galion Community Hospital 085 Holzer Gallipolis 086 Marymount Hospital 087 University Hospitals Geneva Medical Center 088 Southwest Regional Medical Center 089 Adena Greenfield Medical Center 090 Wayne HealthCare 091 Fort Hamilton Hospital 092 Mercy Hospital of Hamilton 093 Community Memorial Hospital 094 Highland District Hospital 095 River Valley Health System 096 Hardin Memorial Hospital 097 Kettering Medical Center 098 Lakewood Hospital 099 Fairfield Medical Center 100 OHA Data Dictionary Hospital ID's, Updated 5/27/14 Page 36 of 48

Lima Memorial Health System 101 St. Rita's Medical Center 102 Lodi Community Hospital 103 Hocking Valley Community Hospital 104 Madison County Hospital 105 Mercy Regional Medical Center 106 Community Health Partners, East Campus 107 MedCentral - Mansfield Hospital 110 Peoples Hospital 111 Richland Hospital 112 Marietta Memorial Hospital 113 Selby General Hospital 114 MedCenter Hospital 115 Marion General Hospital 116 East Ohio Regional Hospital 117 Memorial Hospital of Union County 118 Affinity Medical Center 119 Affinity Medical Center - Doctors Campus 120 ProMedica St. Luke's Hospital 121 Hillcrest Hospital 122 Medina Hospital 123 Sycamore Medical Center 124 Southwest General Health Center 125 Atrium Medical Center 126 Pomerene Hospital 127 Mt. Orab Medical Center 128 Morrow County Hospital 129 Knox Community Hospital 130 Henry County Hospital 131 Doctors Hospital of Nelsonville 132 Licking Memorial Hospital 133 Fisher-Titus Medical Center 134 Oak Hill Community Medical Center 135 Mercy Allen Hospital 136 Mercy St. Charles Hospital 137 Aultman Orrville Hospital 138 Diley Ridge Medical Center 139 McCullough-Hyde Memorial Hospital 140 Lake Health Tripoint Medical Center 141 University Hospitals Parma Medical Center 142 Paulding County Hospital 143 Miami Valley Hospital South 144 Veterans Memorial Hospital 145 Magruder Hospital 146 Lutheran Hospital of Indiana 147 Southern Ohio Medical Center 148 University Hospitals Ahuja Medical Center 149 Robinson Memorial Hospital 150 Salem Regional Medical Center 151 OHA Data Dictionary Hospital ID's, Updated 5/27/14 Page 37 of 48

Firelands Regional Medical Center 152 Firelands Regional Medical Center - South Campus 153 The Orthopedic Hospital 154 MedCentral - Shelby Hospital 155 Wilson Memorial Hospital 156 Springfield Regional Medical Center 157 Springfield Regional Medical Center - Fountain Blvd. Campus 158 Grand Lake Health System 159 Trinity Medical Center East 160 Trinity Medical Center West 161 ProMedica Flower Hospital 162 Mercy Tiffin Hospital 163 The University of Toledo Medical Center 164 Mercy Healthcare Center 165 St. Joseph Hospital 166 Riverside Mercy Hospital 167 Mercy St. Vincent Medical Center 168 ProMedica Toledo Hospital 169 Dettmer Hospital 170 Upper Valley Medical Center 171 Wyandot Memorial Hospital 172 Mercy Memorial Hospital 173 Van Wert County Hospital 174 Summa Wadsworth-Rittman Hospital 175 St. Joseph Health Center 176 Trumbull Memorial Hospital 177 Warren General Hospital 178 Dupont Hospital 179 South Pointe Hospital 180 Fayette County Memorial Hospital 181 Fulton County Health Center 182 Adena Pike Medical Center 183 Good Samaritan Western Ridge 184 Adams County Regional Medical Center 185 St. John Medical Center 186 Mercy Willard Hospital 187 CMH Regional Health System - Clinton Memorial Hospital 188 Wooster Community Hospital 189 Greene Memorial Hospital 190 St. Elizabeth Health Center 191 Forum Health Western Reserve Care System-Southside 192 Genesis Healthcare System/Bethesda 194 Genesis Healthcare System/Good Samaritan 195 Akron General Edwin Shaw Rehab 196 Bethesda North Hospital 197 Mount Carmel East 198 Southview Medical Center 199 Northside Medical Center 200 West Medical Center 201 OHA Data Dictionary Hospital ID's, Updated 5/27/14 Page 38 of 48

Tod Children's Hospital 202 Dayton Rehab Institute 203 University Hospitals Rainbow Babies & Children's Hosp. 204 Hillside Rehabilitation Hospital 205 Mercy Health Fairfield Hospital 206 The Ohio State University James Cancer Hospital 207 Mental Health Services for Clark County 208 ProMedica Toledo Children's Hospital 209 Belmont Pines Hospital 210 Southeast Psychiatric Hospital 211 Pomegranate Health Systems 212 Youngstown Osteopathic Hospital 213 Cottingham Retirement 214 Dayton Heart Hospital 215 Dublin Methodist Hospital 216 Dayton VA Medical Center 217 Chalmers P. Wylie VA Ambulatory Care Center 218 Drake Center, Inc. 219 Select Specialty Hospital - NE Ohio/Akron 220 Fox Run Hospital 221 The Ohio State University Harding Hospital 222 Cleveland Clinic Children's Hospital For Rehabilitation 223 Bariatric Care Center of Ohio 224 Select Specialty Hospital (Mount Carmel West) 225 Beeghly Oaks 226 Glenbeigh Health Sources 227 Windsor-Laurelwood Center for Behavioral Medicine 228 Holzer Medical Center-Jackson 229 Heartland Behavioral Healthcare 230 Soin Medical Center 231 Kindred Hospital Lima 232 River Valley Health System Behavioral Health Services 235 Gateway Rehab 236 Mercy St. Anne Hospital 237 Kettering Behavioral Medicine Center 238 Shriners Hospitals for Children 239 Health Recovery Services 241 Aultman West 242 Elmwood Healthcare Center At the Springs 244 King's Daughters Medical Center Kentucky 250 St. Elizabeth Hospitals 251 St. Elizabeth Fort Thomas 252 Fayette Memorial Hospital 254 St. Elizabeth Florence 256 Veterans Affairs Medical Center Chillicothe 257 The Maria-Joseph Living Care Center 258 Louis Stokes Cleveland VA Medical Center 259 Ross County Health District 260 Dearborne County Hospital 261 OHA Data Dictionary Hospital ID's, Updated 5/27/14 Page 39 of 48

Bethesda Arrow Springs 262 Warren County Hospital 262 Harrison MediCenter 263 Doctors Hospital Ohio Health 264 Margaret Mary Hospital 265 Acuity Specialty Hospital-Ohio Valley 266 Appalachian Behavioral Healthcare - Cambridge Campus 271 Mercy Hospital of Defiance 272 ProMedica Bixby Hospital 273 Ohio Valley Medical Center 274 ProMedica Herrick Hospital 275 St. Elizabeth Grant 277 Franciscan Health System of Dayton 278 St. Elizabeth Covington 281 St. Elizabeth Edgewood 283 The Franciscan at St. Clare 290 Franciscan at St. John 293 Southwest Community Health Foundation 296 Champaign Mercy Health Services, McAuley Center 297 Reid Hospital 302 Lindner Center of HOPE 303 St. Elizabeth Boardman Health Center 306 LifeCare Hospital of Dayton 311 Select Specialty Hospital - Columbus 314 Quorum Health Resources 315 Heather Hill Care Communities 318 Wright Patterson Medical Center 325 UHHS Saint Michael Hospital 330 Specialty Hospital of Lorain 331 Deaconess Long Term Care of Ohio 332 Forum Health 343 ProMedica Bay Park Hospital 344 Cambridge Health & Rehab. Center 350 Mount Carmel New Albany Surgical Hospital 353 Bethesda Butler Hospital 354 Three Gables Surgery Center 355 The Ohio State University Ross Heart Hospital 356 Ohio Hospital for Psychiatry 357 Regency Hospital Of Toledo 358 Cabell Huntington Hospital 360 Medical Center of Newark 361 West Chester Hospital 362 Cincinnati Children's Liberty Campus 363 Sharon Regional Health System 364 Select Specialty Hospital - Zanesville 391 Deaconess Health Care 401 Kindred Hospital Dayton 402 Community Hospitals & Wellness Centers - Montpelier 408 Kindred Gateway Hospital of Cleveland 409 OHA Data Dictionary Hospital ID's, Updated 5/27/14 Page 40 of 48

Blanchard Valley Health System 425 Mahoning Valley Hospital - Trumbull Campus 426 Drake Pavilion at the Christ Hospital 428 Community Hospitals & Wellness Centers - Archbold Hospital 429 Alliance Primary Care, Inc. 430 Institute For Orthopedic Surgery 432 Neil Kennedy Recovery Unit 435 Regency North Central Ohio - Akron 436 Select Specialty Hospital - Cincinnati 437 Select Specialty Hospital - Riverside 438 Select Specialty Hospital - Youngstown 439 Select Specialty Hospital - Cleveland 440 Riverview Health Institute 445 Advanced Specialty Hospital of Greenbriar Rehabilitation 446 Ten Lakes Center 491 Pleasant Valley Hospital 492 Shepherd Hill Hospital 493 HealthSouth Rehabilitation Hospital At Drake 494 King's Daughters Medical Center Ohio 495 Rookwood Medical Center 496 Summa St. Thomas Hospital 497 Trihealth Evendale Hospital 498 Test Facility 999 OHA Data Dictionary Hospital ID's, Updated 5/27/14 Page 41 of 48

Crosswalk of Field Names Reference Table 17 Data Element DataTrack File Formats POS File Insight 95% Sig 95% Sig Address ADDRESS1 Admit Date ADMITDATE Admit_Date Admit Source ADMSNSRC Admit_Source Admit Source Admit Time ADMITTIME Admit Type Admit_Type Admit Type Age Age Age Arrival Date ARRVLDATE Arrival Time ARRVLTIME Birth Date BIRTHDATE DOB Birth Weight BIRTHWEIGHT County Code County_Code County Code CPT Code CPTCODE CPT Date CPTDATE Decision to Admit Date DCNADMITDT Decision to Admit Time DCNADMITTM Diagnosis - Admit Diagnosis - Primary DX# + DIAGNOSISORDER Diagnosis_Primary Primary Diagnosis Diagnosis - Secondary DX# + DIAGNOSISORDER Diagnosis_# Diagnosis (Secondary only) Discharge Date DISCHDT Discharge_Date Discharge Month Discharge Month Discharge Quarter Discharge Quarter Discharge Status DISCHGSTAT Discharge_Status Discharge Status Discharge Time DISCHTM Discharge Year Discharge Year DRG DRG DRG DRG Weight ED Departure Date EDDEPARTDT ED Departure Time EDDEPARTTM EM Code EMCODE Encounter Type ENCOUNTERTYPEID Patient Class Ethnicity ETHNICITY Expected - Length of Stay Expected ALOS Expected Average Charges Expected Ave Chg Expected Mortality Expected Mort % First Name FIRSTNAME Fiscal Year Fiscal Year Hospital HCOID Hospital_ID Hospital ICU Admission Date ICUADMDATE ICU Discharge Date ICUDSDATE Language LANGUAGE Last Name LASTNAME OHA Data Dictionary Crosswalk of Field Names, Updated 5/27/14 Page 42 of 48

Length of Stay LOS LOS MDC MDC MDC MDC - MSDRG MSMDC MSDRG MDC Medical Record Number MEDRECNO Medical/Surgical Medical/Surgical Middle Name MIDDLENAME MSDRG MSDRG MSDRG Outlier Outlier Patient Account Number PAN Patient Class *See ENCOUNTERTYPEID and SERVCODE Patient_Class Patient Class Payer ID PAYERID Payer Name PMTSRCE Place of Service SERVCODE Patient Class Practitioner - Admitting PRACTITIONERADMIT Admitting Physician Practitioner - Attending PRACTITIONERATTEND Attending Physician Practitioner - Attributing PRACTITIONERATTRIB Surgeon Practitioner - Refering PRACTITIONERREFER Present on Admission (POA) Payer Group (Primary Payer) PMTSRCE2 Payer Primary Payer Procedure - Primary PX# and Procedure_Primary Primary Procedure PROCEDUREORDER Procedure - Secondary PX# and PROCEDUREORDER Procedure_# Procedure (Secondary only) Procedure Date - Primary PX#DT Procedure Date - Secondary PX#DT Product Group - Diagnosis Diag Group Product Group - Procedure Proc Group Product Line - Diagnosis Diagnosis Product Line Product Line - DRG DRG Product Line Product Line - MSDRG MSProd_Line MSDRG Product Line Product Line - Procedure Procedure Product Line Provider Contact Date PROVCONTDT Provider Contact Time PROVCONTTM PTHIC Number PTHIC Race RACE RDRG RDRG RDRG Recurring RECUR Recurring Revenue Charge REVCHG Revenue Code REVCODE Severity Severity Level Severity Adjusted Case Mix Sev Adj Casemix Sex SEX Sex Sex State State Total Charges TC Total_Charges Total Charges Units of Service UNITSERV Zip Code POSTALCODE Zip Zip Code OHA Data Dictionary Crosswalk of Field Names, Updated 5/27/14 Page 43 of 48

Reference Table 18 Data Validations Edit Code Related Field Validation Type Error Description Start Date End Date 8330 ADDRESS1 Both Patient address is a required field. 1/1/2014 1080 ADMITDATE Both Admission Date is a required field. 1/1/2000 2020 ADMITDATE Both Admission Date does not correspond to a valid date (mmddyyyy). 1/1/2000 5010 ADMITDATE Inpatient Admission Date must be equal to Birth Date when Principal Diagnosis is V30-V37 with a fifth digit of "0". 1/1/2000 5020 ADMITDATE Inpatient Admission Date can be no more than two days after Birth Date when Principal Diagnosis is V30-V37 with a fifth digit of "1". 1/1/2000 8220 ADMITDATE Both Admission Date is greater than submitted date. 1/1/2000 1060 ADMSNSRC Both Admission Source is a required field. 1/1/2000 3050 ADMSNSRC Both Admission Source does not correspond to accepted values. 1/1/2000 5190 ADMSNSRC Inpatient Admission Source not valid with Admission Type of 4 (Newborn) AND Newborn Flag of Y (Primary Diagnosis of V3x with a 4th digit of 0 ). 1/1/2000 1070 ADMSNTYPE Both Admission Type is a required field. 1/1/2000 3060 ADMSNTYPE Both Admission Type does not correspond to accepted values. 1/1/2000 5200 ADMSNTYPE Inpatient Primary Diagnosis of V3x with a fourth digit of "0" requires Admission Type to be 4 (newborn). 1/1/2000 1010 BIRTHDATE Both Birth Date is a required field. 1/1/2000 2010 BIRTHDATE Both Birth Date does not correspond to a valid date (mmddyyyy). 1/1/2000 4040 BIRTHDATE Both Birth Date exceeds human lifespan of 125 years. 1/1/2000 5070 BIRTHDATE Both Birth Date must be prior to or the same as the Admission Date. 1/1/2000 5330 CPTCODE Outpatient HCPCS/CPT code is gender specific and does not match the Sex specified. 1/1/2014 8020 CPTCODE Both CPT or HCPCS Code does not correspond to accepted values. 1/1/2000 8080 CPTCODE Both CPT Code is a required field. 1/1/2000 8100 CPTDATE Both CPT Date is a required field. 1/1/2000 8120 CPTDATE Both CPT Date does not correspond to a valid date (mmddyyyy). 1/1/2000 3071 DIAGNOSISORDER Both Patient encounter can only have one Primary Diagnosis Code. 1/1/2000 OHA Data Dictionary Data Validations, Updated 10/14/14 Page 44 of 48

3075 DIAGNOSISORDER Both Diagnosis Order does not correspond to accepted values. 1/1/2000 3081 DIAGNOSISORDER Both Patient encounter can only have one Admitting Diagnosis Code. 1/1/2000 2040 DISCHDT Both Discharge Date does not correspond to a valid date (mmddyyyy). 1/1/2000 5050 DISCHDT Both Discharge Date cannot occur before Admit Date. 1/1/2000 8240 DISCHDT Both Discharge Date is greater than submitted date. 1/1/2000 8800 DISCHDT Both Discharge Date is a required field. 1/1/2000 1130 DISCHGSTAT Both Discharge Status is a required field. 1/1/2000 3150 DISCHGSTAT Both Discharge Status does not correspond to accepted values. 1/1/2000 1090 DX#1 Both Primary Diagnosis is a required field. 1/1/2000 3070 DX#1 Both Primary Diagnosis does not correspond to accepted values. 1/1/2000 5240 DX#1 Both Primary Diagnosis is gender specific and does not match the Sex specified. 1/1/2000 5400 DX#1 Inpatient Diagnosis code cannot be used as a Primary Diagnosis code. 1/1/2000 5410 DX#1 Both Primary Diagnosis is adult specific; this patient does not meet the age requirement (15-125). 1/1/2000 5420 DX#1 Both Primary Diagnosis is newborn specific; this patient does not meet the age requirement (0-1). 1/1/2000 5430 DX#1 Both Primary Diagnosis is pediatric specific; this patient does not meet the age requirement (0-17). 1/1/2000 5440 DX#1 Both Primary Diagnosis is maternity specific; this patient does not meet the age requirement (12-55). 1/1/2000 8290 DX#1 Both Patient encounter requires a primary diagnosis. 1/1/2000 3080 DX#2 Both Admitting Diagnosis does not correspond to accepted values. 1/1/2000 4070 DX#2 Both Diagnosis code cannot be used as a Admitting Diagnosis code. 1/1/2000 5250 DX#2 Both Admitting Diagnosis is gender specific and does not match the Sex specified. 1/1/2000 5450 DX#2 Both Admitting Diagnosis is adult specific; this patient does not meet the age requirement (15-125). 1/1/2000 5460 DX#2 Both Admitting Diagnosis is newborn specific; this patient does not meet the age requirement (0-1). 1/1/2000 OHA Data Dictionary Data Validations, Updated 10/14/14 Page 45 of 48

5470 DX#2 Both Admitting Diagnosis is pediatric specific; this patient does not meet the age requirement (0-17). 1/1/2000 5480 DX#2 Both Admitting Diagnosis is maternity specific; this patient does not meet the age requirement (12-55). 1/1/2000 1260 DX#3 Both Secondary Diagnosis is a required field. 1/1/2000 3230 DX#3 Both Secondary Diagnosis does not correspond to accepted values. 1/1/2000 4080 DX#3 Both Diagnosis code cannot be used as a Secondary Diagnosis code. 1/1/2000 5260 DX#3 Both Secondary Diagnosis is gender specific and does not match the Sex specified. 1/1/2000 5310 DX#3 Both Duplicate Secondary Diagnosis codes are not permitted. 1/1/2000 5490 DX#3 Both Secondary Diagnosis is adult specific; this patient does not meet the age requirement (15-125). 1/1/2000 5500 DX#3 Both Secondary Diagnosis is newborn specific; this patient does not meet the age requirement (0-1). 1/1/2000 5510 DX#3 Both Secondary Diagnosis is pediatric specific; this patient does not meet the age requirement (0-17). 1/1/2000 5520 DX#3 Both Secondary Diagnosis is maternity specific; this patient does not meet the age requirement (12-55). 1/1/2000 7010 ENCOUNTERTYPEID Both Encounter Type is a required field. 1/1/2000 7020 ENCOUNTERTYPEID Both Encounter Type does not correspond to accepted values. 1/1/2000 7040 ETHNICITY Both Ethnicity does not correspond to accepted values. 1/1/2000 7080 ETHNICITY Both Ethnicity is a required field. 1/1/2000 8300 FIRSTNAME Both First name is a required field. 1/1/2014 7030 LANGUAGE Both Language does not correspond to accepted values. 1/1/2000 7050 LANGUAGE Both Language is a required field. 1/1/2000 8310 LASTNAME Both Last name is a required field. 1/1/2014 1180 MEDRECNO Both Medical Record Number is a required field. 1/1/2000 8320 MIDDLENAME Both Middle name is a required field. 1/1/2014 6010 PAN Both Duplicate Patient Account Number has been found within this batch and facility. Patient Account Number must be a unique value within each batch and facility. 1/1/2000 8400 PAYERID Both Payer ID is a required field when Payer Group is Medicaid or Medicare. 1/1/2014 1140 PMTSRCE Both Payer Name is a required field. 1/1/2000 OHA Data Dictionary Data Validations, Updated 10/14/14 Page 46 of 48

1141 PMTSRCE2 Both Payer Group is a required field. 1/1/2000 3170 PMTSRCE2 Both Payer Group does not correspond to accepted values. 1/1/2000 3092 POACODE Both Present on Admission code does not correspond to accepted values. 1/1/2000 3236 POACODE Inpatient Present on Admission code is required for acute inpatients with this diagnosis. 1/1/2000 1030 POSTALCODE Both Postal Code is a required field. 1/1/2000 3020 POSTALCODE Both Postal Code does not correspond to accepted values. 1/1/2000 3041 PROCEDUREORDER Both Patient can only have one Primary Procedure Code. 1/1/2000 3073 PROCEDUREORDER Both Procedure Order does not correspond to accepted values. 1/1/2000 1300 PX#1 Both Primary Procedure is required when Secondary Procedures are present. 1/1/2000 1380 PX#1 Both Primary Procedure is a required field. 1/1/2000 3140 PX#1 Both Primary Procedure does not correspond to accepted values. 1/1/2000 5030 PX#1 Both Primary Procedure is gender specific and does not match the Sex specified. 1/1/2000 2030 PX#1DT Both Primary Procedure Date does not correspond to a valid date (mmddyyyy). 1/1/2000 2330 PX#1DT Both Primary Procedure Date is a required field. 1/1/2000 4030 PX#1DT Inpatient Primary Procedure Date occurs outside the allowed boundaries of the admission and discharge dates (72 hours prior to admission date is allowed). 1/1/2000 1270 PX#3 Both Secondary Procedure is a required field. 1/1/2000 3240 PX#3 Both Secondary Procedure does not correspond to accepted values. 1/1/2000 5040 PX#3 Both Secondary Procedure is gender specific and does not match the Sex specified. 1/1/2000 1280 PX#3DT Both Secondary Procedure Date is a required field. 1/1/2000 2080 PX#3DT Both Secondary Procedure Date does not correspond to a valid date (mmddyyyy). 1/1/2000 4090 PX#3DT Inpatient Secondary Procedure Date occurs outside the allowed boundaries of the admission and discharge dates (72 hours prior to admission date is allowed). 1/1/2000 1050 RACE Both Race is a required field. 1/1/2000 3040 RACE Both Race does not correspond to accepted values. 1/1/2000 3250 RECUR Both Recurring Patient Flag must be either "Y" or left blank. 1/1/2000 3260 RECUR Inpatient Recurring Patient Flag can only be specified for Outpatients. 1/1/2000 OHA Data Dictionary Data Validations, Updated 10/14/14 Page 47 of 48

1250 REVCHG Both Revenue Charge is a required field. 1/1/2000 8760 REVCHG Both Revenue Charge must be greater than zero. 1/1/2014 1220 REVCODE Both Revenue Code is a required field. 1/1/2000 3210 REVCODE Both Revenue Code does not correspond to accepted values. 1/1/2000 8500 REVCODE Both Duplicate Revenue Codes are not permitted per encounter. 1/1/2014 1170 SERVCODE Both Place of Service is a required field. 1/1/2000 3190 SERVCODE Both Inpatient Place of Service does not correspond to accepted values. 1/1/2000 3192 SERVCODE Both Outpatient Place of Service does not correspond to accepted values. 1/1/2000 1040 SEX Both Sex is a required field. 1/1/2000 3030 SEX Both Sex does not correspond to accepted values. 1/1/2000 1150 TC Both Total Charges is a required field. 1/1/2000 2095 TC Inpatient Total Charges must be greater than zero. 1/1/2000 2096 TC Outpatient Total Charges must be greater than or equal to zero. 1/1/2000 8510 TC Both Sum of all Revenue Charges should be equal to the Total Charges. 1/1/2014 8600 UNITSERV Both Units of service is a required field. 1/1/2014 8610 UNITSERV Both Units of service must be greater than zero. 1/1/2014 8620 UNITSERV Both Units of service must be numeric. 1/1/2014 OHA Data Dictionary Data Validations, Updated 10/14/14 Page 48 of 48