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.
Feedback has been positive. Crosswalks for long encrypted values, as well as accessing the data via secure download, has been well received.
The release of Maine 2013 Q3 APCD data that was scheduled for 12/31/13 has been delayed by a few days. In our efforts to improve the quality of our APCD data release we have made the decision to delay the release of the third quarter data (which will also include Anthem data for the first two quarters of 2013). We anticipate the data being available for you to access Monday January 6th.
One change you will notice is that the long encrypted values have been replaced with integers. Previously used values were linked prior to assigning replacement integers, bridging the gap across previous changes in encryption methods. Crosswalks to previously used values will be included in the release to ensure continuity.
We are pleased to report that our data consumers will now be able to receive files via secure download. Details will be emailed directly to our data users with open data requests.
MHDO makes available new and updated data quarterly. Historical data is available upon request.
The next scheduled release is March 31, 2014 and will include:
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|