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Data Warehouse Portal

Portal: User Manual


MHDO Logo

Data Warehouse Portal

Portal: User Manual

USER MANUAL

REVISION HISTORY

Date Version Description Author
8/30/2013 1 User Guide Part 1 Initial Draft L. Candura
9/12/2013 1 User Guide Part 2 Initial Draft L. Candura
9/19/2013 2 User Guide Part 2 Corrected SFTP connection information,
enhanced file naming convention guidance
L. Candura
2/3/2014 3 Combined and Updated User Guide Part 1 and Part 2.
Enhanced SFTP instructions.
Added instructions for new Compliance Report
L. Candura
5/8/2014 4 Added additional information on file naming.
Revised screen shots to reflect changes the validation interface to accommodate validation rule changes.
Revised exemption rule screen shot and description to add in new Exemption Manager functionality.
L. Candura
6/5/2014 5 Added information about structural-level validations, submission period locking, and new definitions. L. Candura
8/6/2014 6 Updated information about Data Submission Locked validation. L. Candura
1/6/2015 7 Updated Submission History with new filters.
Updated Resolving Exemption and Profile-Level Issues sections with information about annual resets.
L. Candura
2/3/2015 8 Updated Payer Registration Update with info on Annual complete button.
Updated Validation Rules for City, SSN, and Diagnosis Codes.
L. Candura
4/7/2015 9 Updated Override Request screen.
Added Release Notes page.
L. Candura
7/22/2015 10 Updated File Testing Instructions L. Candura

Contents

  1. Overview
  2. Accessing the Data Warehouse Portal
  3. Registering Your Company
    Registration Instructions
  4. Setting Up User Accounts
    User Profiles
    Account Setup
  5. Reviewing and Updating Company Information
    Summary Section
    Payer Details Section
    Third-Party Submitters Section
    Payers Who Submit Claims on Behalf of Another Company
    Print-Friendly Formats
  6. Submitting Data Files
    Who Can Submit
    When to Submit
    Data Security and Storage
    Naming Files Before Compression and Encryption
    File Name Examples
    File Testing
    Compression and Encryption of Files
    Transferring Files
    Viewing Your Submission History
  7. Resolving Validation Issues
    Stuctural-Level Issues
    Exemption-Level Issues
    Ad Hoc-Level Issues
    Profile-Level Issues
    Overridden Status
    Files Success
  8. Reports
    Compliance Report
    Validation Report
  9. Definitions of Terms
  10. Troubleshooting
    User Manual
    Training Videos
    Sample Files
    Release Notes
    Help
    Compliance Help
    System Notifications

1. Overview

This manual aims to provide users of the MHDO Data Warehouse Portal with step by step instructions for using key features of the system.

As a healthcare claims processor, you're required to submit a completed healthcare claims data set to the MHDO for all your Maine resident members—on either a monthly or quarterly basis. The healthcare claims data set typically includes a member eligibility file and one or more claims files (medical, pharmacy, or dental).

The MHDO Data Warehouse Portal is the place to submit this data, and each healthcare claims processor—whether a healthcare claims payer, claims submitter, or both—receives an MHDO Data Warehouse Portal account.

See Rule Chapter 243 for a complete definition as to which entities must submit data and which data must be submitted: http://www.maine.gov/sos/cec/rules/90/90/590/590c243.docx

As part of the agency transformation MHDO has contracted with Human Services Research Institute (HSRI) and their partner NORC to build and maintain the portal. More information about each organization can be found on the MHDO website: https://mhdo.maine.gov/transformations.htm.

Portal Browser Requirements

The Portal is optimized to work with the following browsers. If you choose a browser other than one listed here, you may encounter problems while using the site, and the site’s pages may not display properly.

The following is a list of minimum required browser settings:


2. Accessing the Data Warehouse Portal

You can access the MHDO Data Warehouse Portal directly at https://mhdo.maine.gov/portal. You can also access it via the link on the right-hand side of the top navigation bar on the MHDO home page (mhdo.maine.gov ):

MHDO website home page


3. Registering Your Company

Pursuant to 90-590 Chapter 243, section 3(A), each healthcare claims processor must submit to the MHDO by December 31 of every year a registration form or an update indicating if healthcare claims are being paid for members who are Maine residents, and, if applicable, the type of files to be submitted in the following calendar year. It is the responsibility of the healthcare claims processor to resubmit or amend contact or enrollment information whenever changes occur. If your company conducts business of $2,000,000 or more worth of adjusted premiums or claims procesed per calendar year, you must register in the MHDO Data Warehouse Portal.

UPDATE 12/6/13: Waiver of Annual Registration Requirements for Payers Not Required to Submit Claims Data:

At its Dec. 5, 2013 meeting, the MHDO Board of Directors decided to suspend operation and requirement of Chapter 243 Section (2)(A)(9)(a) “but shall comply with the annual registration requirements of Section 3(A).”

Until further action of the MHDO Board of Directors, including rulemaking, healthcare claims processors that are excluded from filing healthcare claim data sets shall not have to register under Section 3(A).

Registration Instructions

To register through the MHDO Data Warehouse Portal, please follow these instructions.

New Companies

Go to the MHDO Warehouse Portal at https://mhdo.maine.gov/portal.

From the home page, select “Register new account.”

Review the list of existing companies in the drop-down list to ensure yours is not there before checking “My company is not listed above.” (See the following screenshot.)

Register New or Existing Company Screen, My company is not listed above checked

Next you’ll be asked to provide some information about your company. Select Company Type Screen

Registration: Company Contact Information Screen

Then you’ll be asked to provide your contact information. You will be assigned as the Administrative Contact for your company. User Contact Information Screen

And some information on the Compliance Contact for your company. You may select yourself as an existing user or enter information for a new user.
Compliance Officer Contact Information

Lastly, you’ll be asked a series of questions about the business your company does in the state of Maine and the types of claims your company will be submitting (or will be submitted on your behalf). You’ll also be asked to specify coverage details as appropriate.

Once you complete the information, your registration will be sent to MHDO for approval. After your registration has been approved, you’ll receive an email from portal@mhdo.maine.gov with your log-in information. After that, you can log in to the Portal and review and update your registration information at any time.


Setting Up User Accounts

This section provides an overview of the user profiles associated with the MHDO Data Warehouse Portal and explains how to set up accounts of each type.

User Profiles

Each user profile is associated with a specific set of responsibilities and a different level of access or permissions. Every user must have a unique email address.

Administrative Contact

Each company must designate at least one user as an Administrative Contact.

The Administrative Contact serves as the primary point of contact and is responsible for:

The Administrative Contact can:

Data Submitter

The Administrative Contact must designate users who will be submitting data.

A Data Submitter is responsible for:

A Data Submitter can:

User

The Administrative Contact must approve all users for the company.

A User can:

Account Setup

Users can gain access to the Portal in one of two ways, depending on their role. Administrative Contacts receive an email with their system login information once the MHDO has approved the company’s registration. Administrative Contacts can then add additional users who will be provided login information, or users can request to be added to the system.

Administrative Contact

If you’re the designated Administrative Contact for your company, you’ll receive an email from portal@mhdo.maine.gov with your log-in information after approval from MHDO. Your username is your email address and the email will contain a temporary password. Please check your Junk and Spam folders for these emails.

You can access the Portal at https://mhdo.maine.gov/portal.

Login to the Data Warehouse Screen

All Other Portal Users

To be added to the system, you can either request an account through the Portal or have your Administrative Contact add you as a user.

Requesting an Account

You can access the MHDO Warehouse Portal at https://mhdo.maine.gov/portal.

From the home page, select “Register new account.”

Select the company you’re associated with

Register New or Existing Company Screen, My company is not listed above unchecked and company selected

Click “Next,” and then enter your contact information on the following screen.

User Contact Information Screen

Once you enter your contact information, your request will be submitted to your company’s Administrative Contact for approval.

Adding a User From an Administrative Account

If you’re the Administrative Contact, you can add a new user by logging in to the Portal and selecting “Users” from the Registration menu. (See screenshot below.) You can also grant or revoke Administrative and Data Submitter Privileges here.

Registration Users Menu and Portal: Users List Screen

To add a new user click “Add.” Enter the user’s email address and click “OK.”

Add a User Screen

If the person already has a portal account, they’ll be added and will receive an email notification. If they’re a new user, you’ll need to provide additional information

User Contact Information Screen


5. Reviewing and Updating Company Information

Company contact information can be accessed from the Registration menu, at the Summary and Payer Details screens. This information must be reviewed and updated annually. If you’re the Administrative Contact, you can edit, add contacts, and manage third party submitters and on-behalf submissions. Other user types can edit their own information here.

In the Summary section, a company identifies the payer and provides other basic information about the business, such as the person responsible for each type of data submission to MHDO. The Payer Details questions provide information about what will be submitted to the data warehouse.

The Payer Details section serves as your contact and enrollment update, indicating if healthcare claims are being paid for members who are Maine residents and, if applicable, the types of coverage and estimated enrollment for the following calendar year.  It is the responsibility of the healthcare claims processor to resubmit or amend the form whenever changes occur that affect the data files, type(s) of business conducted, or contact information. Each healthcare claims processor must submit an update to this information by the end of February each year.

At the start of the year, Admin Contacts must complete the required update. Please indicate you are done by clicking the “YYYY Annual Updates are Complete” button on the Payer Details page. After you click the Complete button the button will be disabled (see screenshot), but you can make edits at any time by clicking the save button.

Annual Updates Complete Button Disabled After Use

Summary Section

Once you’re logged in, go to the Registration menu and select “Summary.”

This screen provides a summary of company information including contacts. If you need to add additional contacts, you can do that here. Please carefully review and verify the information. If you are not an Administrative Contact, you will not be able to edit or add information in this section.

Portal: Company Summary Screen

Payer Details Section

Under the Registration menu go to “Payer Details.”

Only companies that are payers will enter information in this section; companies that are third party submitters would not be expected to enter this information.

Each type of claim you submit must include contact information for the person who has responsibility over that submission. If you are not the Administrative Contact, you will not be able to edit this.

Portal: Payer Details Screen

Third Party Submitters Section

Under the Registration menu, go to “Third Party Submitters.”

This section will only be used by Payers who have at least one other company submit on their behalf. This screen shows a list of all companies that are currently authorized to submit claims on your behalf. Administrative Contacts can add companies to this list; other users can view the companies’ pertinent information here.

Registration Third Party Submitters Menu and Portal: Third Party Submitters Screen

As mentioned above, Administrative Contacts can add or delete third party submitters from this list. When adding a third party submitter, the Administrative Contact can either select an existing company account (one already defined in the MHDO portal) or add a new company account.

To select an existing third party submitter, the Administrative Contact chooses it from the drop-down list:

Portal: Third Party Submitter Details Existing Screen

To set up a new company account, the Administrative Contact enters the company name and contact information as well as the name and email address of an individual at the submitting company. Once you submit this information, a registration email to be sent to the new user to prompt them to create a new password for this account. The new user will then be able to update or correct any of the new company’s information.

Payers Who Submit Claims on Behalf of Another Company

Under the Registration menu go to “On-Behalf Submissions.”

This section lists the companies your company submits on behalf of. Once you’ve selected companies to add to this list, you can view their pertinent information here.

To add a company, select an already registered company from the drop-down list. If the company you submit for is not listed, please contact them to ask them to register for an account (see Section 4: Registering Your Company).

Registration On-Behalf Submissions Menu and Portal: On-Behalf of Submissions Payers Screen

Print-friendly formats are available for all registration information. If you need to consult with others to verify your information or print a copy for your records, select “Print” under the Registration menu.

Registration Print Menu

Here’s an example of the print-friendly view:

Registration Print Screen


6. Submitting Data Files

Who Can Submit

Administrative Contacts or users designated by the Administrative Contact as a Data Submitter can submit data files. (You can find information about user roles in Section 5: Setting Up User Accounts.) See below for submission time frames.

When to Submit

Monthly Submitters: Data submissions are due by the last day of the following month (for example, February 2014 claims are due March 31, 2014).
Quarterly Submitters: Data submissions are due by the last day of the month following the end of the quarter (for example, January-March 2014 claims are due April 30, 2014).
If your company did not have any claims activity during the last period (month or quarter), please submit a file with a header and trailer record count of 0. If you have questions or concerns about your submission schedule or making a deadline please contact MHDO.

Submitting or Replacing Older Data

Submission periods are locked for data already released to end users (data are released every quarter). When submitters try to submit data for a locked period, a Submission Period Locked structural validation issue occurs. This issue must be resolved before all other validation issues.

File Details Screen

To resolve the validation issue users will need provide a reason for why missing, supplemental or replacement data for a locked period is being submitted. The system will determine if your file is an initial submission, replacement submission, or supplemental submission based on the file naming. If the data are less than a year old, the validation issue will be cleared as soon as the information is provided by the user. Submissions of data older than one year will require approval from MHDO before the issue will be cleared.

Resolve Data Submission Period Locked Issue Screen

Data Security and Storage

File Submission: Payers may submit via SFTP or via the Data Warehouse Portal (HTTPS).
Encryption: Information within the files is protected using file-level encryption rather than field-level encryption. Payers use commercially available, payer-approved file compression and encryption software rather than proprietary software created and distributed by the vendor.
Data Storage: All data are transferred directly to servers controlled by NORC, a nonprofit organization that specializes in secure data warehousing. Data are then validated and stored entirely within NORC’s secure data enclave.

Naming Files Before Compression and Encryption

All transferred files are automatically associated with the proper account based on your credentials and the information in the header of the transferred files. However, it’s important that you name the files according to a specific standard to ensure that the file type and submission periods can properly be identified.
Example of a valid file name: C0756_201212ME01v01.txt
File names follow the same convention regardless of reporting frequency, and they’re made up of the following elements in the following order:

File Name Examples

Period ending in December 2012. One eligibility file and one resubmission of the same file:

C0756_201212ME01v01.txt
C0756_201212ME01v02.txt

Period ending in December 2012. Two medical files, neither of which are resubmissions:

C0756A_201212MC01v01.txt
C0756A_201212MC02v01.txt

Period ending in January 2013. One dental file with no resubmissions:

T0757_201301DC01v01.txt

Period ending in January 2013. One pharmacy file with no resubmissions:

T0750_201301PC01v01.txt

File Testing

Testing in the MHDO Data Warehouse Portal Test Site

Testing is available via the MHDO Data Warehouse Portal Test Site (https://mhdo.maine.gov/portal-test/). While this is a separate URL, the Payer Test Portal should work with your login. If you have any trouble, especially if you have recently changed your password on the production Portal, please contact the help desk (mhdohelp@hsri.org).

The test portal has all the functionality of the production portal with a few exceptions:

  1. The test site has a different color background to help you identify which site you are submitting to.
  2. Files can only be submitted via upload through the portal. SFTP transfers cannot be used.
  3. The test portal is not linked to the production data warehouse and therefore will only display information about files submitted through the test site. As a result the Reporting menu has been disabled.
  4. To reduce confusion, system notification emails will NOT be sent from the test portal. You will not receive an email once your file has been validated. You must recheck the test portal to see when processing and validation are complete.
  5. Any action that requires MHDO approval (ex. Exemption overrides and submissions for periods a year or more in the past) will not receive attention on the Payer Test Portal.

When we are planning major changes (new validations or changes to the file layout) to the production Portal, we will first release the changes to the MHDO Data Warehouse Portal Test Site for payer testing. This allows you to ensure your company is ready for the changes ahead of submission deadlines. We will send appropriate notice to users prior to initiating a test period for major changes.

If you would like to use the MHDO Data Warehouse Portal Test Site for testing outside of a formal test period by MHDO please notify the Help Desk. Files submitted to the test site will be periodically removed from the test site submission history. Please ensure that you always submit your production files to the correct portal.

Testing in the MHDO Data Warehouse Portal

If upcoming changes are deployed on the test site and you need to test files using the current setup of the system or file format, you can test in the MHDO Data Warehouse Portal. For example, your company recently moved to a new system and you want to test that you can still produce passing files for submission to MHDO next month. In three months MHDO will be changing the file layout and payers are currently testing the new layout in the MHDO Data Warehouse Portal Test Site. Because you want to test the current layout for submission prior the format change you should test in the production MHDO Data Warehouse Portal following the information below.

Test files submitted with the TEST header code need to be named as such, so they are not included in the data warehouse. Follow the naming conventions specified above, but use “TEST” as the payer ID. You can number the files, if needed, for example, TEST1, TEST2. The test file will be live until the evening site maintenance at 11:59 pm of the same day.

Period ending in December 2012, one eligibility file and one resubmission of the same file:

TEST_201212ME01v01.txt

TEST_201212ME01v02.txt

These files are only temporarily kept in the system and are for testing purposes only. Submitting overrides on these files is discouraged. The only way to track these files after 11:59 pm is via the file ID of the file with assistance from the Help Desk. Due to these factors, we recommend that this feature be used strictly for informational purposes to test your processes and not as an attempt to get a file into the “passed” status. If you are at the stage where you need to submit overrides, please submit a regular file with your full Payer ID.

Compression and Encryption of Files

To ensure the security of personally identifiable information and personal health information, and to reduce file transmission times, MHDO requires submitters to compress and encrypt all files before uploading. This file-level encryption ensures the confidentiality of all data submitted to the warehouse, not just certain sensitive fields. This compression and encryption can be accomplished by a number of industry standard tools, such as WinZip or 7-Zip, many of which may already be in use at your workplace.

Compression and Encryption Requirements:

Company Settings Menu and Encryption Password Screen

Transferring Files

Once your files have been compressed and encrypted, as outlined above, they need to be transferred to the MHDO Data Warehouse. Files can be transferred via the SFTP Process or via the MHDO Data Warehouse Portal.

SFTP Process

The SFTP process is designed primarily for users who want to set up an automated transfer of files. However, it’s available to any payer who wishes to make use of it. The MHDO Data Warehouse Portal has established an SFTP server to receive files. Payers may make use of any SFTP tool such as WinSCP, FileZilla, or the command line to connect to the server and send files.

Requesting an SFTP Account

To use the SFTP process, payers must first request an SFTP Account. Administrative Contacts and Data Submitters can make this request via the Account section of the MHDO Portal. (See the following screenshot.)

Request SFTP Account Menu and Screen

Once your request has been received, you’ll receive an email from NORC’s secure download system (Accellion) containing two links to your account credentials.  These credentials consist of 1) a text file containing your username for the SFTP server, and 2) an RSA private key used to authenticate your connection. To automate the creation of SFTP accounts, MHDO generates a key-pair specifically for each payer and stores the public key on the SFTP server while providing the private key to the payer.  Thus no key exchange is necessary prior to connecting to the server.
Below we outline the process you’ll follow to submit your files via SFTP.

Key conversion for connecting with WinSCP and FileZilla

In order to connect with either WinSCP or FileZilla, you will first need to convert the generic RSA private key provided to you in the previous step to the proprietary format used by these programs.  This may be accomplished using the free PuTTYgen tool.  Below are instructions for the key conversion:

  1. Go to the following website to download PuTTYgen: http://www.chiark.greenend.org.uk/~sgtatham/putty/download.html
  2. Under For Windows on Intel x86, click on the puttygen.exe link and save it to your desktop.
  3. Double click it and choose “Run.”

  4. PuTTY Start Screen

  5. Go to the “Conversions” heading, and select “Import Key”.

    Import Key Function

  6. Browse to the key file you received from NORC that is named sftp_username_rsa and click “OK.” You will first have to change the file type to “All Files (*.*)” in order to see it.

    Browse for Private Key

  7. Once the key is imported, your screen should look like this:

    PuTTY Screen After Key Imported

  8. Click on “Save private key,” and save the file to your desktop. 

    Save Private Key

  9. You can now close PuTTYgen (and delete it from your machine).

Connecting with WinSCP

  1. Open WinSCP.

    WinSCP Start Screen

  2. Click “New,” and you’ll see a window like this:

    WinSCP Settings Screen

  3. Enter the following information in the fields:

    • Host name:  transfer.norc.org
    • Port number:  22
    • User name: This will be in the username.txt file that you downloaded; in this example, it’s “MHDO_Test”
    • Password:  (Leave this blank)
    • Private key file:  (Click on the ellipsis button, browse to the desktop, select the PPK you created with PuTTYgen)

    WinSCP Settings Screen With Settings Entered

  4. In the SFTP section, uncheck the box next to “Allow SCP fallback.” Then click “Save.”

    WinSCP Fallback Screen

  5. When it brings up the following window, leave the defaulted session name as is, and click OK.

    WinSCP Save Session

  6. To connect, click “Login.”

    WinSCP Login

  7. You will then be connected to the SFTP server and able to upload files by dragging them their location on your computer (left panel) to the SFTP folder (right panel) :

    WinSCP FTP Root

Connecting with FileZilla

  1. Open FileZilla.  You should then see this screen:

    FileZilla Start Screen

  2. Go to File, and select Site Manager.  The following window will come up:

    FileZilla Site Manager Screen

  3. Click on New Site, and name the new site “MHDO SFTP” (or a memorable name).

    FileZilla Name Session

  4. Enter the following information in the fields
    1. Host:  transfer.norc.org
    2. Port:  22
    3. Protocol:  SFTP – SSH File Transfer Protocol
    4. Login Type: Normal
    5. User: This will be in the username.txt file that you downloaded.  In this example, it is “MHDO_Test”.
    6. Password:  (Leave this blank)

      For example:

  5. Click ok, and you will see this screen:

    FileZilla Start After Settings Entered Screen

  6. Go to Edit, and then Settings. You will see this screen:

    FileZilla SFTP Settings

  7. Chose SFTP under the Select Page.

    FileZilla SFTP Add Keyfile

  8. Click Add keyfile, browse to the location of the private key file you generated using PuTTYgen, and select it.

  9. When it is done, it will populate the private keys field.

    FileZilla Keyfile Added

  10. Click OK to bring you back to the home screen.

  11. Click Quick Connect, and payers will then have access to the secure transfer area.

    FileZilla Root Connection

Submitting Via the MHDO Data Warehouse Portal

All Administrative Contacts and Data Submitters will also be able to submit files via the MHDO Portal by going to the Submission menu and selecting “Submit File.” Please note: If you submit for multiple companies, please make sure the correct company is listed in the right-hand side of the tool bar.

Submit File Menu Screen

A “New Submission” window will pop open in a new browser window. (See the following screenshot.) You will then be prompted to browse for the location of a file to upload.

New Submission Screen

The system will look at the selected file to ensure it has been encrypted, compressed, and named properly. Then it will ask you to confirm the payer ID and submission period as well as the file type, sequence, and version of the file. It is crucial to follow the naming conventions specified in Section 7: Submitting Data Files. If there’s an error in your file name, cancel the upload and rename the file before resubmitting.

Once the information is reviewed and confirmed, the file will be uploaded to the warehouse and validated. You can continue to add files until your submission is complete. Once you’re finished, you can select the “Done” button at the bottom of the data submission window.

This process is designed to be used interactively. The file transfer will only continue while the web browser is open. The transfer process will be suspended if the transfer window or browser is closed.

Viewing Your Submission History

All files submitted via the SFTP process and the Portal can be viewed by going to the Submission menu and selecting “Submission History.”

Submission History Menu and Portal: Submission History Screen

You can filter the list using the Year, Type, or Status dropdowns. At the bottom of the screen, there are Print and Download features for your convenience.

Determining a File’s Status

Once a file has been uploaded to the data warehouse, its status will show as one of the following:

Please see the next section of this manual for information on validation issues.


7. Resolving Validation Issues

The validation system was designed to be user friendly, allowing Data Submitters to resolve many issues quickly and easily.

When a validation fails, an issue will be generated. Issues must be resolved before the file can be accepted. There are four types of validation issues: Structural, Exemption, Ad Hoc, and Profile. Each is defined below. All of the validation rules for each file type and structural-level validations across file types can be viewed under the Validation Rules menu.
Validation Rules Screen


In the future, the validation rules that were applied to the data will be made available to data users as part of the metadata. If there were exemption, ad hoc, or profile overrides for some or all of the records, they will know this and will be able to make informed choices on how they process the data.

After your files have been validated (within 24 hours of your submission) you’ll receive an email notification indicating whether your file has passed or has issues, and you can view any issues in the Validation Issues section of the Portal (under the Submission menu). Here, you’ll see a list of outstanding issues for all your data submissions. You can sort the information by any of the columns.

Validation Issues Screen


At the bottom of the screen, there are Print and Download features for your convenience.
Below you’ll find definitions and instructions for resolving each type.

Structural-Level Issues

Structural-level issues occur when the file fails to meet the required file format. Details about the file format requirements can be viewed in the Submission menu under “File Formats.” A list of structural-level validations is available under the Validation Rules menu. Structural-level validation issues must be resolved for a file to be accepted. They typically prevent the use or evaluation of the data.

File Formats Menu and Screen

The only way to resolve a structural-level issue is to correct the file format and resubmit the file. When you select “Resubmit,” you’re cancelling the original file.

Structural issues should always be resolved first. When a file contains structural issues (e.g., a field is too long) subsequent validations may be inaccurate. By resolving structural errors first, other validations can be successfully performed, and other issues may clear up as a result.

Resubmission Screen

Exemption-Level Issues

Exemption-level issues are generally related to fields required for “Prompt Payment of Clean Claims.” However, MHDO may agree to bypass certain validations on a submitter-by-submitter basis. These “exemptions” from default thresholds are typically limited to a set period of time, but exemptions can be made permanent at MHDO’s discretion.

Users can select “Override” from the list of validation issues for any Exemption Issue Type. The submitter may apply for an exemption (either for a one-time instance or a set duration of time) via the Portal. MHDO will review the exemption request and, if approved, clear the outstanding issue. On the Request Exemption screen (see the following screenshot) you will see the details of the issue and a history of exemption requests for the rule. You will need to specify the period of time for which you’d like the exemption request. If approved, any files submitted for that time under this profile will be exempt from the validation rule. The Start Period and End Period refer to the data submission period and not the date on which the submission was made. For example, if you are a monthly submitter and need an exemption for your May 2014 data you will need to request an exemption through May 31, 2014. If you are a quarterly submitter that needs an exemption for any of your second quarter data you will need to request an exemption through June 30, 2014. Next, you need to provide an explanation of cause. Here you should explain why you can’t meet the validation rule threshold. The request will be submitted to the MHDO for review and approval or rejection. Once the MHDO has made a decision to approve or deny the request, you’ll receive a system notification.

Request Exemption Screen

All requests will go through the same approval process with MHDO. At the start of a new year Exemption-level overrides will be reset. Many payers’ data has improved over the course of the year. If you need to continue your override into the next year, you can view a record of your overrides from past year either when requesting the override or by clicking “View Override” on an existing Exemption-level Override.

Ad Hoc-Level Issues

Users can select “Resolve” from the list of validation issues for any Ad Hoc Issue Type. Ad hoc-level issues are those that submitters may override during the data submission process but that MHDO does not allow to be set permanently in the submitter’s validation profile. Once the override is set, it will only be applied to that particular data submission.

Resolve Ad Hoc Issue Screen

Profile-Level Issues

Profile-level issue types represent validations that vary by book of business.

Users can select “Resolve” from the list of validation issues for any Profile Issue Type. On the Add Profile Override screen (see the following screenshot) you will see the details of the issue and a history of profile overrides for the rule. You will need to provide a reason for the override. Once the override is set, it will be applied to all files for the Validation Profile going forward.

Resolve a Profile Issue Screen


At the start of a new year Profile-level overrides will be reset. Many payers’ data has improved over the course of the year. If you need to continue your override into the next year, you can view a record of your overrides from past year either when requesting the override or by clicking “View Override” on an existing Profile-level Override.

Overridden Status

If a file has failed and multiple fields are showing a status of Overridden, this is simply an indicator that the field has a pre-existing exemption or profile override created by a user within the company. When you see this status in a file that has been shown to have failed the validation rules, focus on the fields that have a Failed status – those are the fields that need to be resolved for the file to be successfully submitted into the MHDO portal. The Overridden fields are shown for your reference.

File Success

Once the file has passed all validation rules, it will be loaded into the data warehouse. The file will show as having a status of “Passed” under your Submission History (See Section 7 for more detail). The status will change to “Released” after the data has been released to Data Users.


8. Reports

Compliance Report

All users who are either an Administrative Contact or Data Submitter can view the Compliance Report. To access the Compliance Report, go to the Reporting tab and select Compliance Report.

Reporting and Compliance Report Menu

Here you will see a summary of all files for the current calendar year and their status. All columns can be sorted by clicking on the column name. 

Compliance Details Screen

The Compliance Details page will also allow a user to filter on the year, suffix, and type of claim. Below is an explanation of each filter.

Company: This will list your company. If you are registered with multiple companies you will only be able to view the company you are currently logged in as.

Year: This will show a calendar year of data from January to December.

Suffix: This will show a particular suffix for the company or un-suffixed which is shown under the “-“.

Type: This will filter the type of file.

ME – Medical Eligibility

MC – Medical Claims

PC – Pharmacy Claims

DC – Dental Claims

Another field to note is the status field.  Claims will be in one of the following statuses.

Passed:
The file has passed all of the validations.  This file is compliant.

Missing:
The file has not been submitted.  This file is not compliant.

Failed:
The file has been submitted but still has outstanding validation issues.  This is not compliant.

Not Due:
The file is not due.

Actions

There are three actions available for submitted files and two for files not yet submitted. If the file has been submitted you can view the details of the file by selecting “Details”.

Action Buttons

The Detail tab will show what validation issues occurred and the status of each.   If a submission is compliant, the details will say “No issues” or all issues will have a status of “Overridden”.

File Details Screen
The Notes tab allows any user to enter and view notes. The notes are viewable by users from your company and MHDO.  However, after the note has been added, it can only be edited or deleted by the person who entered it.  To create a note, click New Note.

Compliance Notes Screen

When you click on the Edit tab, you get a window that has a free field Note box.  Then it has three buttons to Save, Cancel, or Delete the note.

Compliance Note Screen

The Extension tab shows contact information for making a request.

Compliance Extension Screen

The extension will appear in the Compliance Details page once it has been approved and entered by MHDO.

Validation Report

This section describes the Validation Report. The Validation Report provides a record of how your data have performed against the validation rules across all your submissions. Administrative Contacts and Data Submitters can view this information by selecting Validation Report under the Reporting tab; other users do not have the appropriate permissions to access it.

Validation Report menu screen

On the Validation Report page, you'll see a table with all the validation rules. For each rule, you'll see its ID, effective date, data Element, and Rule Name. Additionally, you'll see the issue type (Failure, Exemption, AdHoc, or Profile; Section 7: Resolving Validation Issues provides definitions of each) and the number of passed and overridden files. The effective date is the start and end date (month/year) for which the particular rule was active. You can download the table to a .csv file by pressing the Download button at the bottom of the page.

Validation Report Screen

You can filter the results by MHDO code, file type, and calendar year. Below is an explanation of each filter.

MHDO Code: This filter allows you to view the results by a particular company code. Un-suffixed codes are shown under the "-". If you're registered with multiple companies, you'll need to log in separately to view each.

File Type: This filter allows you to view results for a particular file type:

Year: This filter allows you to select a specific calendar year of data—from January to December.

Quarter: This filter allows you to select a specific quarter or all quarters in a given year.

To view additional information about a particular rule, select "Details" under the action column. This will bring you to the Rule Validation History screen.

The Rule Validation History shows the number of records broken out by file. If the file status is "Passed," there is no further information. However, if the file did not initially pass the validation rule, you can view the override.

Validation Rule Details

If you click on the View Override button, you can see the information for a specific file.

Validation Override


9. Definitions of Terms

Term

Definition

Ad Hoc-Level Issue Types

Submitters may override ad hoc-level rules during the data submission process; however, these may not be set permanently in the submitter’s validation profile.

Company

A legal entity with a unique MHDO-assigned payer code, Federal Employer Identification Number (FEIN), and/or National Association of Insurance Commissioners identifier (NAIC) and that is a healthcare claims processor (a payer, submitter, or both).

Data Warehouse

The cloud-based collection of MHDO’s digital health data, including its All-Payer Claims Database (APCD).

Exemption-Level Issue Type

These issue types will generally be for fields required for “Prompt Payment of Clean Claims.” MHDO may agree to bypass certain validations on a submitter-by-submitter basis.

Exemption Request

A request from a company or subentity for relief from the obligation of a specific exemption-level Data Validation rule.

FEIN

Federal Employer Identification Number or the Federal Tax Identification Number; a unique nine-digit number assigned by the Internal Revenue Service to business entities operating in the United States.

File Type

Indicates the type of file: Member Eligibility, Medical Claims, Dental Claims, or Pharmacy Claims.

Initial File

File is the first submission for a given period and file type combination.

Issue

When a validation fails to pass.

Issue Type

Identifies the type of issue—Structural, Exemption-Level, Ad Hoc-Level or Profile-Level—that prevents a file from being accepted. Each validation has an associated issue type that will determine the options a data submitter has when a validation fails to pass.

Metadata

Information about the data, such as the validation rules applied and other contextual information about the submission. All data submitted to the Data Warehouse will have metadata associated with it.

MHDO-Assigned Payer Code

A code assigned by MHDO to uniquely identify healthcare claims payers and processors.

NAIC

A unique identifier assigned to each individual insurer by the National Association of Insurance Commissioners (NAIC).

Override

A process by which a validation can be bypassed.

Payer

An entity that is responsible for paying claims in the state of Maine and is legally responsible for submitting claims.

Payer Details

Information specific to a given payer, including information about submissions, contact information, and other information required by statute.

Submission Period Locked

Once a period (month or quarter) of data has been released to data users the period is locked. A data submitter will not able to submit a new or supplemental file, cancel or replace a passed file without providing a reason and approval from MHDO, depending how old the data is.

Portal

Website that functions as an entry point to the Data Warehouse.

Profile-Level Issue Types

Profile-Level Issue Types represent validations that may vary by subentity and, with an accompanying explanation, can be overridden by the data submitter via the MHDO Portal.

Replacement File

A file that is meant to fully replace a previously submitted and passed file.

Structural-Level Issue Types

The most serious issue type; these typically prevent the use or evaluation of the data and must be resolved before a file may be accepted. These must be fixed and the file must be resubmitted.

Subentity

The convention by which multiple sites, platforms, or systems submit on behalf of one company.

Submitter

An entity that submits claims to the Maine Health Data Warehouse.

Supplemental File

A file that is meant to supplement a previously submitted and passed file.

Threshold

The percentage of records that must pass a given validation.

User Account

An MHDO portal user account associated with a single individual.

Validation

An evaluation that is performed on data before it is allowed into the data warehouse (formerly referred to as “edits”).

Validation Issues

A list of issues generated when a file is validated.

Validation Profiles

A profile for a company or subentity that contains the set of validations that is applied to its data submission.

Validation Rules

The full list of validations.


10. Troubleshooting

There are multiple resources available to help you use the Data Warehouse Portal.  User Manuals, Training Videos, and FAQs are updated frequently and made available through the Portal, both before and after system login.

Login to the Data Warehouse Screen

User Manual

The most recent version of this manual is always available via the Portal. You can find it under Resources in the navigation bar:

User Manual Screen

Training Videos

Videos of training sessions are posted online within 48 hours in the Resources section. These videos cover registration and data submission.

Resources Training Videos Menu and Portal: Training Video Screen

Sample Files

Sample files are available for download to demostrate the format of fields to submit.

Sample Files Screen

Release Notes

Release Notes are available that detail major changes made to the portal or submission process.

Release Notes Screen

Help

The Help section of the Portal site contains both FAQs and Contact Information.

Frequently Asked Questions Screen

The Portal Help Desk is available for any technical/system issue you may encounter. Support is available during regular business hours (8 a.m. – 5 p.m. EDT, Monday – Friday) within two hours of request. You can use the Contact Form or the information below.

Toll-free Phone: (866) 451-5876

Email: mhdohelp@hsri.org

Contact Screen

Compliance Help

For compliance questions, contact Philippe Bonneau, Compliance Officer, MHDO: philippe.bonneau@maine.gov or (207) 287-6743.

Questions related to deadlines should also be directed to the Compliance Officer.

System Notifications

Periodically, MHDO sends notifications to system users (for example, to let them know that submitted files have been validated, an exemption request has been approved/or rejected, or that new users need to be approved). All system notification emails will come from portal@mhdo.maine.gov. This is an unmonitored email address and should not be replied to. For convenience, these notifications also appear when you log in to the portal. The Notification screen also serves as a communications center, displaying general system information such as upcoming deadlines and updated resource information. (See the following screenshot.)

Notifications Table Screen