Below are answers to commonly asked questions organized into six categories.
Q. What rule governs how MHDO releases data to the public?
A. MHDO Rule Chapter 120 governs the MHDO’s release of data to the public. You can find a copy of that rule on our Rules and Statutes page.
Q. How do I request data from MHDO?
A. You can find out how to request data on our Request Data or Reports page.
Q. What data can I request?
A. The Data Availability page lists the available data sets. It also shows the organization types that supply the data, the information contained in the data, and the time periods the data represent.
Q. What is the comment period and who can submit a comment?
A. The comment period is the period of time a data request is publicly posted for comment. The comment period allows the data providers and the public to review the data request and submit concerns about the data release to the MHDO. MHDO posts new data requests to its website, on its Current Data Request page, on the first business day of every week; MHDO also sends an electronic notification to the data providers who submit the data and other interested parties, notifying them of new data requests. The comment period is 30 business days after the request first appears on the MHDO website.
Q. How much does it cost to access data from MHDO?
A. MHDO’s data access fees can be found on our Pricing Information page.
Q. What is the difference between the APCD (All Payer Claims Data) data and the Hospital encounter data?
A. Payers submit claims data to the MHDO and hospitals submit hospital encounter data for all encounters inpatient and outpatient as well as for their provider based clinics.
The APCD contains health care claims paid for Maine residents by insurance companies licensed in Maine. It also includes Medicare claims paid for Maine residents and MaineCare (Maine Medicaid) claims. The submissions include files with member eligibility, medical claims, pharmacy claims, and/or dental claims information. These data contain information on the amounts that insurers paid for services. Please see the Data Availability page to see what types of entities submit data for each source and what data are available.
Hospital encounter data are submitted by hospitals and provider-based clinics in Maine. These submissions contain data for every service provided to each patient, regardless of how they were paid (commercial insurer, public, uninsured). However, these data do not include financial information on amounts billed or paid. Please see the Data Availability page to see what types of entities submit data for each source and what data are available.
Q. Does the MHDO data (APCD and hospital encounter) include patients who are uninsured and/or who paid for their care, or only data from payers?
A. Hospital encounter data does include patients who are uninsured but does not include payment information. The Maine APCD does not contain data on patients who are uninsured.
Q. What are the main differences between Level I and Level II data sets?
A. MHDO's Level I data sets are considered de-identified data which means the data elements do not directly or indirectly identify an individual patient and for which there is no reasonable basis to believe that data can be used to identify an individual patient.
MHDO’s Level II data sets are considered a limited data set which includes limited identifiable information specified in the HIPAA regulations. Level II data sets may only be used in ways that maintain individual anonymity.
For more information about which fields are included in the Level I and Level II data sets, refer to the Release Included Elements.
Q. I am interested in purchasing a Level II data set. Do I need to purchase both the Level I and Level II data sets to obtain all the releasable data fields available?
A. No, the Level II data set contains the data elements in Level I, so there’s no need to purchase both.
Q. Is it possible to obtain patient level and provider level data? Is this identified or de-identified data?
A. In the Level II data sets for both APCD and Hospital encounter data, de-identified patient data are available and each patient has a MHDO assigned unique identifier. Identifiable provider data is available for both the APCD and hospital encounter data. The APCD data dictionaries are available and provide details on the specific data elements. Some highlights of the provider data include facility name, facility code, geographic information, service provider state, data processing center code and a national provider identifier where appropriate. For the Hospital encounter data, a unique hospital or clinic is provided for each encounter with the name of the facility, geographic location, and de-identified ordering and performing provider. (Note we are working on preparing data dictionaries for the hospital encounter data which will be available in 2017.
Q. Once I’ve been approved to receive MHDO data, how will the data be sent?
A. When the data are ready to be released, you’ll receive an e-mail from MHDO's data vendor, NORC with the links to the data release files to be downloaded. We use the file sharing platform Accellion to ensure a secure file transfer. If you do not have an Accellion account, you’ll need to register for one.
The following instructions will be included in the e-mail:
To begin downloading the files you’ll need to click on one of the links. Because this is a secure download you will be asked to enter the address that received the e-mail. If you do not already have a download account, you will receive a second verification e-mail. Click on the link in that e-mail, choose a password, and you will then be able to authenticate and download the files.
Q. I received an email to download MHDO data, but I need one of my colleagues to download the data. Can I forward them the email?
A. No, the data transmittal email cannot be forwarded to others. Only original recipients are authorized to download the files. Please contact MHDO to modify the Data Custodian of your request if needed.
Q. How long will I have to download the data?
A. You have 90 days after receipt to download the data. If you need to access the data after this time you will need to contact MHDO to explain why you need extended access to the data files.
Q. What format are the data sets released in?
A. MHDO Data sets are released in fixed-width text (.txt) files. These can be imported on a variety of platforms and are widely recognized by data management and statistical analysis tools.
Q. Is there a way to link the APCD and Hospital encounter data sets together?
A. Not at this time as there are no direct data elements released in the data that would allow the linkage between the All Payer Claims Database (APCD) and the Hospital encounter data. The MHDO is exploring the feasibility and utility of linking these data sets internally and making available as a data set. We will provide updates on the MHDO website as more information becomes available.
Q. Do you have data dictionaries for the non-APCD files such as hospital encounter outpatient and inpatient data sets?
A. Not as this time, however data dictionaries for our hospital encounter data will be available in 2017.
Q. Where can I go to see which data elements are included in the APCD?
A. The APCD data dictionaries are available on our MHDO Claims Data Dictionaries page.
Q. Are APCD data dictionaries the same across all payers (e.g., commercial, MaineCare and Medicare)?
A. Yes, the data dictionaries apply to all claims records regardless of payer.
Q. Does your medical claims database include both professional and facility claims?
A. Yes, both professional and facility claims are included in the Maine APCD.
Q. Do I need to request the Practitioner Identifiable data elements if I am looking to identify a hospital as a provider in the APCD data?
A. No, you do not need to receive the Practitioner Identifiable data elements to identify a hospital. A facility table is provided in both the Level I and Level II data releases. The table allows data users to link the hospital identifier in the data and determine the claim lines associated with each hospital.
Q. Does the APCD contain denied claims?
A. No, the MHDO data submission rule specifically excludes denied claims from all medical, pharmacy, and dental claims file submissions.
Q. What is the difference between the APCD claims datasets and the eligibility data sets?
A. Claims data sets include:
Eligibility data sets include:
For more information, please view the data dictionaries.
Q. Will the information provided include carriers that cover employer groups who reside in Maine?
A. The Maine APCD includes all payors as defined by MHDO with greater than $2,000,000 of adjusted premiums or claims processed per calendar year. Please see the Data Availability page to determine if a specific payer would be included in the requested dataset. . Note: As a result of the Gobeille v. Liberty Mutual decision (March 1, 2016) submission of claims data for self-funded ERISA plans is no longer a State requirement. However, we are accepting these data submissions on a voluntary basis.
Q. Does the All Payer Claims Database (APCD) include Medicare Advantage?
A. Yes, the MHDO receives Medicare Part C claims data also referred to as Medicare Advantage Plans. There is a flag in the claims that identifies Medicare plans administered through commercial payers. We have separated these from Medicare plans administered by the government. Therefore, you can determine which claims were Medicare Advantage claims.
Q. Does the APCD Pharmacy Claims include all payers (i.e., MaineCare, Medicare, and private insurance)?
A. The APCD includes pharmacy claims data from the private insurance companies and from Medicare Part D plans (outpatient Prescription Drug Insurance). Part D is provided only through private insurance companies that have contracts with the government.
Q. In the APCD, is there any kind of identifier that we can use to follow an individual across insurers and over time? Are encoded beneficiary identifiers the same across all parts of the data, and would it be possible to see claims of the same individual when they switch from a commercial plan into Medicare/Medicare HMO?
A. Every claim and eligibility record is assigned a MHDO de-identified member number to allow the tracking of de-identified individuals across time and between payers; however, due to variations in how payers supply eligibility information, sometimes the same individual may be assigned more than one MHDO de-identified member number. In general, the Medicare data includes eligibility data that allows us to assign a de-identified member number consistently The Medicare Advantage data are not always submitted with consistent member eligibility data. This is also an issue with pharmacy claims, where a number of plans only provide a contract number that cannot be tied to an individual in the medical claims. For Medicare Part A and B claims data administered by the government, we receive only medical claims. For Medicare Advantage plans, we receive both pharmacy and medical claims.
Q. What geographical identifiers are available in the APCD data? From the data dictionary, it seems that for both plan members and providers, city name, state/province, and ZIP code are available. Could you confirm this?
A. The geographical data elements available in the APCD data are as follows for both providers and de-identified individuals:
Geographical information related to city, state and zip has to be specifically requested and justified during the data request process.
Q. Using the claims information, I need to be able to track the exact health insurance plan for each submitted claim. What are the plan identifiers in your data?
A. The APCD data includes a field which indicates the payer and product type (HMO versus PPO, etc.) but not the specific plan identifier. The claims file has the claim filing indicator code and the eligibility file has the insurance type code which can be referenced in ASCx12.
Q. In the Hospital data, does Emergency Department data include both Inpatient and Outpatient data sets?
A. Yes, Emergency Department (ED) data is a subset of the Hospital for both the Inpatient and Outpatient data sets. The ED data follows the same format as the Outpatient Hospital data. It is processed with the Inpatient and Outpatient data and is available for the same time periods as these datasets.
Q. Where can I go to see what data elements are included on the Hospital data sets?
A. You can find the list of data elements included in MHDO’s Hospital data on our Hospital Data page.
Q. What diagnosis fields are available in the current Rule Chapter 241 layout for the Hospital data?
A. In the current version of Rule Chapter 241, amended on November 22, 2015 the diagnosis fields that are available are Version 040 which has one principal diagnosis, one admitting diagnosis code, two external injury codes, and eight other diagnosis codes (ICD-9); the versions 050 and 060 layout has one principal diagnosis code, one admitting diagnosis code, two external injury codes, and eight other diagnosis codes (ICD-10).
Q. Does the Hospital data include uninsured patients’ diagnoses? In other words, would the uninsured patients’ data be the same as all other patients’ data except that there would be no payment information?
A. Services rendered to the uninsured are reported in the Hospital Encounter Inpatient and Outpatient data. Patients with no insurance appear with “self-pay” indicated as the primary “payer.” The hospital encounter data excludes all financial data.