Members of the MHDO Data User Group were asked to take part in a workgroup specific to the Payer Claims data. The MHDO wants to improve the collection and release of data as well as communications with partners to ensure their needs are met. The group will cover topics such as data quality issues, identifying high priority data elements, collection of alternative payment models, MHDO's proposed data subscription model, provider index, data submission rules, new data release rules, creating consolidated claims, linking hospital and claims data, and data dictionaries.
| Member | Affiliation |
|---|---|
| Adam Black | MMC |
| Gokhan Cakmakci | Maine Health |
| Roberta Gildart | EMHS |
| Judy Loren | Compass Analytics |
| Kim Murray | MMC |
| Becky Symes | ME Health Management Coalition |
| Deb Thayer | Muskie |
| Nina Underman | Maine Health |
Unfortunately the United States Supreme Court decision in Gobeille v. Liberty Mutual (March 1, 2016) has negatively impacted the submission of commercial claims data to MHDO. Several of our largest payers (who represent about 80% of our commercial claims data) notified the MHDO following the decision that they were suspending all data submissions to the MHDO until they worked out the technical and legal issues raised as a result of the decision.
In response to these concerns the MHDO sent a communication to the payers stating that the MHDO will suspend the enforcement of data submission requirements under Rule Chapter 243, Uniform Reporting System for Health Care Claims Data Sets, for a five month (March – July 2016) period.
We hope after this five month period we will all gain some clarity regarding the direction of claims submissions post Gobeille decision. During this interim period we will not be releasing updated commercial claims data. We will however release our updated Medicare (Q1 and Q2 2015) and MaineCare (Q1 2016) data the week of July 4th.
There are questions about the future of the commercial ERISA data in our APCD. The MHDO is committed and actively working on a solution that will minimize disruption and allow us to maintain a comprehensive claims database. We will continue to communicate updates at our data user group meetings. In the interim, please do not hesitate to contact me with any questions.
Meetings are usually held at the Muskie Wishcamper Center in Portland-unless notified otherwise. Time, room number, documents and details will be made available as each date approaches.
Next Meeting: