Maine has collected health insurance claims information in its APCD since 2003. The APCD currently holds claims from commercial insurance carriers, third party administrators (TPAs), pharmacy benefit managers (PBMs), dental benefit administrators, MaineCare(Maine Medicaid), and CMS (Medicare).
Health care claims processors must submit periodically (typically monthly) to the MHDO, a completed health care claims data set for all members who are Maine residents. The submissions include files with member eligibility, medical claims, pharmacy claims, and/or dental claims information.
See Rule Chapter 243 for a complete definition of what entities must submit data and what data must be submitted.
MHDO makes available new and updated data quarterly. Historical data is available upon request.
Q3 2014 APCD Data was released 1/16/15. Below are documents provided to users as part of the release.
Q2 2014 APCD Data was released 10/24/14. This included Commercial Claims for Q2 2014 as well as Medicare Q3 2013. Below are several documents provided to users as part of the release.
Q1 2014 APCD Data was released 8/5/14. This included Commercial Claims and MaineCare data. As we continue to work on improving our documentation we provided users with several documents as part of the release.
APCD Data was released 7/1/14. This release included Q3 2013 (including the backfill data for previous quarters), Q4 2013, and historical refresh files. The release notes are available for this release as well.
Details for all data elements available in the APCD can be found in the Data Element Release Schedule.
Below are documents with data element details for each file submission type.
|Dental Claims||Dental Eligibility|
|Dental Provider||Dental Provider Master|
|Medical Claims||Medical Eligibility|
|Medical Provider||Medical Provider Master|
|Pharmacy Claims||Pharmacy Eligibility|
|Pharmacy Provider||Pharmacy Provider Master|
|Code - CPT||Code - Diagnosis|
|Code - Payer||Code - Provider Specialty|