59B-9.037. Header Record  


Effective on Monday, January 1, 2018
  • 1The 2first record in the data file shall be a header record containing the information described below.

    18(1) Transaction Code. Enter Q for a calendar quarter report. A required field.

    31(2) Report Year. Enter the year of the data in the format YYYY.

    44(3) Report Quarter. Enter the quarter of the data, 1, 2, 3 or 4, where 1 corresponds to the first quarter of the calendar year, 2 corresponds to the second quarter of the calendar year, 3 corresponds to the third quarter of the calendar year, and 4 corresponds to the fourth quarter of the calendar year.

    100(4) Data Type. Enter AS10-3 for Ambulatory Data and Emergency Department Data. A required entry.

    115(5) Submission Type. Enter I or R where I indicates an initial submission of a data file or resubmission of a data file prior to certification and R indicates a replacement submission of previously certified patient data where resubmission has been requested or authorized by the Agency. A required entry.

    165(6) Processing Date. Enter the date that the data file was created in the format YYYY-MM-DD where MM represents numbered months of the year from 1 to 12, DD represents numbered days of the month from 1 to 31, and YYYY represents the year in four digits.

    212(7) AHCA Facility Number. Enter the identification number of the ambulatory center as assigned by the Agency for reporting purposes. A valid identification number must contain at least eight digits and no more than 10 digits.

    248(8) Medicare Number. Enter the Medicare number of the facility as assigned by Centers for Medicare & Medicaid Services (CMS). A valid identification number must contain seven (7) numeric digits. A required field.

    281(9) Organization Name. Enter the name of the ambulatory center that performed the ambulatory services represented by the data, and which is responsible for reporting the data. All questions regarding data accuracy and integrity will be referred to this entity. Up to a forty character field.

    327(10) Contact Person Name. Enter the name of the contact person at the ambulatory center. Submit name in the Last, First format. Up to a twenty-five character field.

    355(11) Contact Person Telephone Number. The area code, business telephone number, and if applicable, extension for the contact person. Enter the contact person telephone number in the numeric format (AAA)XXX-XXXX-EEEEE where AAA is the area code, and EEEEE is the extension. Blank fill if no extension.

    401(12) Contact Person Email Address. The email address of the contact person.

    413(13) Contact Person Street or P.O. Box Address. Enter the Street or Post Office Box address of the contact person. Up to a forty character field.

    439(14) Mailing Address City. Enter the city of the address of the contact person. Up to a twenty-five character field.

    459(15) Mailing Address State. Enter the state of the address of the contact person using the U.S. Postal Service state abbreviation in the format XX. Use the abbreviation FL for Florida.

    490(16) Mailing Address Zip Code. Enter the numeric zip code of the address of the contact person in the format XXXXX-XXXX. Blank fill if no extension.

    516Rulemaking Authority 518408.15(8) FS. 520Law Implemented 522408.061, 523408.062, 524408.063 FS. 526History–527New 1-1-10, 529Formerly 53059B-9.018, 531Amended 10-1-15, 1-1-18.