Claims - The All Payer Claims Database (APCD)

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. Please see Rule Chapter 243 on our Rules and Statutes page for a complete definition of entities that must submit data and of the data that must be submitted.

Available Datasets

The elements available in the various data sets can be reviewed in the document APCD Release Elements.
In addition you may review the specific set of validations the claims data are measured against before the MHDO accepts into our database.
If you are interested in requesting data, our Request Data or Reports page has all the information you need.

5/2/17 - See the new MHDO Level II Data Release Documents, which replace the data dictionaries.

Recent Releases

Note: Release dates of claims data can be found on our Data Release Schedules page.

Q1-Q4 2016 APCD Data (MaineCare Q2-Q4 2016 & Medicare Q3-Q4 2015) were released May 1, 2017. Below are documents provided to users as part of the release.

Q1 2016 APCD Data (MaineCare and Medicare Q1 & Q2 2015) were released July 8, 2016. Below are documents provided to users as part of the release.

Q4 2015 APCD Data (Commercial and MaineCare) were released April 22, 2016. Below are documents provided to users as part of the release.

Q3 2015 APCD Data (Commercial and MaineCare) were released January 22, 2016. Below are documents provided to users as part of the release.

Q2 2015 APCD Data (Commercial, MaineCare and Medicare Q4 2014) were released November 6, 2015. Below are documents provided to users as part of the release.

Q1 2015 APCD Data (Commercial, MaineCare and Medicare Q1-Q3 2014) were released July 24, 2015. Below are documents provided to users as part of the release.

Q4 2014 APCD Data (Commercial and MaineCare) were released 5/1/15. Below are documents provided to users as part of the release.

Q3 2014 APCD Data (Commercial, MaineCare and Medicare Q4 2013) were released 1/16/15. Below are documents provided to users as part of the release.

Q2 2014 APCD Data (Commercial, MaineCare and Medicare Q3 2013) were released 10/24/14. Below are several documents provided to users as part of the release.

Q1 2014 APCD Data (Commercial and MaineCare) were released 8/5/14. As we continue to work on improving our documentation we provided users with several documents as part of the release.

APCD Data were 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.