Previously known as the Payer User Group (PUG)
It was brought to our attention by several payors as they prepare their systems for the new reporting requirements defined in 90-590 Chapter 247, Uniform Reporting System for Non-Claims Based Payments and Other Supplemental Health Care Data Sets, that the numbering scheme for data elements in Section 2. B, File Type NC, and File Type AC would be more efficient if MHDO retained the previous numbering version. We have made these revisions in Chapter 247 and can be found here. All previously approved requirements are red in Track Changes, and the new revisions to the numbering scheme are in orange. Notes have been added at the end of the NC and AC sections regarding these technical corrections made after formal adoption and will be incorporated into the rule when it is reopened for revision.
October 22, 2024:It was brought to our attention by several payors as they prepare their systems for the new reporting requirements defined in 90-590 Chapter 243, Uniform Reporting System for Health Care Claims Data Sets (effective for January 2025 data submissions), that clarifying language would be helpful in the following areas:
As requested, we have added clarifying language to the items listed above in the version of the rule provided here. All new requirements can be identified in track changes and the new clarifying language is also in track changes highlighted in blue. A note has been included that the Clarifying language has been added since the adoption of the changes in December 2023, or June 2024, at the request of the submitters. When Chapter 243 is reopened for proposed changes, we will incorporate the clarifying language.
July 11th Webinar Recording and Deck AvailableThe deck for the 7/11/24 webinar is available. Also the recording can be found on YouTube here: https://youtu.be/Ms1szW-DnoI?si=tMxGNW4zBv4tZJyc.
Informational Webinar July 11th at 1:00
The Maine Health Data Organization (MHDO) will host a webinar on Thursday, July 11th at 1:00 pm EST. The purpose of this webinar is to review changes to 90-590 Chapter 243, Uniform Reporting System for Health Care Claims Data Sets, and Chapter 247, Uniform Reporting System for Non-Claims Based Payments, and Other Supplemental Health Care Data Sets, that the MHDO board of directors adopted in December of 2023 and in early June 2024. These changes will go into effect January 2025. The documentation that incorporates all the changes to Chapter 243 (the changes approved in December 2023 and in June 2024) will be sent to you via e-mail prior to the webinar. In the interim, the changes that were adopted in Chapter 247 and in Chapter 243 (both the December and June changes) can be found on the MHDO Statutes and Rules page along with the final updated Rules documentation.
To attend this webinar, please register via this link: https://us06web.zoom.us/meeting/register/tZUpcOCsqTwsGdOMrTyGVlAMgBUIqgeTs6mf
Below is a summary of key changes, which will be discussed in further detail during the webinar.
Highlight of Key Changes to Chapter 243, Uniform Reporting System for Health Care Claims Data Sets
Highlight of Key Changes to Chapter 247, Uniform Reporting System for Non-Claims Based Payments and Other Supplemental Health Care Data Set/
If there are people in your organization who should be aware of this webinar and information, please email mhdohelp@hsri.org with the updated contact information and we will reach out to them. Note: A recording of the webinar will be posted here for reference.
Payer Data Webinar Recording and Deck AvailableThe deck for the 3/6/23 webinar is available. Also the recording can be found on YouTube here: https://youtu.be/mhbWl6nvsPY.
2/23/23 - Payer Data Webinar Scheduled for March 6th 2:00 - 3:00 pm ET
The MHDO Payer Data Portal collects and validates payer data required under both Rule Chapter 243: Uniform Reporting System for Health Care Claims Data Sets and Rule Chapter 247: Uniform Reporting System for Non-Claims Based Payments and Other Supplemental Health Care Data Sets. Maine Rule Chapter 247, which includes the collection of non-claims-based payments for primary care and behavioral health and aggregated, redacted claims-based payments for substance use disorder, was implemented in 2022 due to the requirements in LD 1196, now Public Law 2021, Chapter 603.
MHDO will host a webinar on Monday, March 6, from 2-3 PM ET to review the data submission and validation features of the MHDO Payer Data Portal, the resolution of common data submission issues and failures, and upcoming changes to Chapter 247. A recording of the webinar will be available for those who are unable to attend the session.
Effective January 31st, validation overrides will be reset in the MHDO Payer Data Portal. The purpose of the upcoming changes and activities in the portal is to evaluate 2023 data against all validation rules by resetting all existing Profile and Exemption Level validation rule overrides. These updates will ensure the accuracy and quality validation information within the MHDO Payer Data Portal. Detailed instructions are here.
NOTE: Data submitted on January 31st will not be validated until overrides are reset on February 1st.
1/18/23 - Annual Registration Updates Due by February 28thStarting February 1st, administrative users are required to update their registration information--including contacts, company summary, payer details and users (permissions)--in the MHDO Payer Data Portal. Detailed instructions are here. Annual registration updates must be completed between February 1st and February 28th. Although required annually, it is strongly recommended that administrators review and update the information as needed to ensure that communication with payers remains targeted and timely.
12/23/21 - Webinar Deck and Recording AvailableThe PowerPoint slides from the December 14, 2021 webinar are now available, as is the recording. The recording can be found on YouTube via this URL: https://youtu.be/BHqcthTLtlE.
12/14/21 - Payer Data Webinar 12/14/21 3:00 - 4:00 PM ETMHDO will host a webinar on Tuesday, December 14, from 3-4 PM ET to discuss and respond to questions regarding Chapter 243 file format changes, new elements and validations. MHDO will also review the requirements and timeline for Chapter 247 Uniform Reporting System for Non-Claims Based Primary Care Payment. A recording of the webinar will be available for those who are unable to attend the session.
On February 2nd, 2022, the MHDO will release an update to the MHDO Payer Data Portal that will include the latest revisions to 90-590 Chapter 243: Uniform Reporting System for Health Care Claims Data Sets. Please see the Basis Statement/Summary of Changes document and the Validation Rule Updates spreadsheet.
Join the 12/14/21 Webinar via Zoom Meeting:
Please note these important dates for the submission of Chapter 243 Claims Data.
| Task | Start Date | End Date |
|---|---|---|
| Payer Testing of Chapter 243 and validation rule changes in Payer Portal Test Site | 12/8/21 | 1/11/22 |
| Instructions regarding annual updates will be emailed | 1/24/22 | 1/28/22 |
| Last day files for any period will be accepted in the old Chapter 243 format | 1/31/22 | 1/31/22 |
| Files submitted on this day must be in the new format and will be held until and processed on 2/2/22 | 2/1/22 | 2/1/22 |
| Begin submissions of files in the new format (January 2022) - Annual override reset | 2/2/22 | 2/2/22 |
| Annual registration information updates are due | 2/28/22 | 2/28/22 |
| January 2022 data files are due in the new format | 2/28/22 | 2/28/22 |
If you have questions or concerns, please contact the Help Desk at mhdohelp@hsri.org or (866) 451-5876.
12/14/21 - Action Required: Testing of MHDO Chapter 243 and Validation Rule ChangesTesting of Chapter 243 and validation rule changes begins 12/8/21 in the MHDO Payer Data Portal Test Site. See these instructions for testing and the list of validation rule updates. Below are a few key reminders.
| Task | Start Date | End Date |
|---|---|---|
| Payer Testing of Chapter 243 and validation rule changes in Payer Portal Test Site | 12/8/21 | 1/11/22 |
| Instructions regarding annual updates will be emailed | 1/24/22 | 1/28/22 |
| Last day files for any period will be accepted in the old Chapter 243 format | 1/31/22 | 1/31/22 |
| Files submitted on this day must be in the new format and will be held until and processed on 2/2/22 | 2/1/22 | 2/1/22 |
| Begin submissions of files in the new format (January 2022) - Annual override reset | 2/2/22 | 2/2/22 |
| Annual registration information updates are due | 2/28/22 | 2/28/22 |
| January 2022 data files are due in the new format | 2/28/22 | 2/28/22 |
Testing of Chapter 243 and validation rule changes has begun in the MHDO Payer Data Portal Test Site. Click on the links here for the Instructions for Testing and for the Validation Rule Updates. Below are a few key reminders.
| Data Element # | Data Element Name |
|---|---|
| MC330 | In-Plan Network Indicator |
| PC110 | In-Plan Network Indicator |
| DC110 | In-Plan Network Indicator |
| Data Element # | Data Element Name |
|---|---|
| ME021 | Race 1 |
| ME022 | Race 2 |
| ME023 | Race 3 |
| ME024 | Hispanic Indicator |
| ME025 | Ethnicity 1 |
| ME026 | Ethnicity 2 |
| ME027 | Ethnicity 3 |
On February 3rd, 2021, the MHDO will release an update to the MHDO Payer Data Portal that will include the latest revisions to 90-590 Chapter 243: Uniform Reporting System for Health Care Claims Data Sets. Please see the MHDO Rules and Statutes page
for the the last proposed and final versions of Chapter 243, the summary of changes and click here for the
Validation Rule Updates
.
SAVE THE DATE: MHDO will host a webinar on Thursday, October 29, from 3-4 PM ET to discuss and respond to questions regarding file format changes, new elements and validations. A recording of the webinar will be available for those who are unable to attend the session.
Please note the important dates below. If you have questions or concerns, please contact the Help Desk at mhdohelp@hsri.org or (866) 451-5876.
| Task | Start Date | End Date |
|---|---|---|
| Payer Testing of Chapter 243 and validation rule changes in Payer Portal Test Site | 11/17/20 | 12/17/20 |
| Instructions regarding annual updates will be emailed | 1/29/21 | 1/29/21 |
| Last day files for any period will be accepted in the old Chapter 243 format | 1/29/21 | 1/29/21 |
| Files submitted in this period should be in the new format and will be held and processed on 2/3/21 | 1/30/21 | 2/2/21 |
| Begin submissions of new Chapter 243 formatted files (January 2021) - Annual override reset | 2/3/21 | 2/3/21 |
| Annual registration information updates are due | 2/28/21 | 2/28/21 |
| January 2021 data files are due in the new Chapter 243 format | 2/28/21 | 2/28/21 |
Starting February 6th, administrative users are required to update their registration information--including contacts, company summary, payer details and users (permissions)--in the MHDO Payer Data Portal. Refer to these detailed instructions. Annual registration updates must be completed between February 6th and February 28th. Although required annually, it is strongly recommended that administrators review and update the information as needed to ensure that communication with payers remains targeted and timely.
February 2020 Validation Override Resets Effective February 6th
Effective February 6th, validation overrides will be reset in the MHDO Payer Data Portal. In addition, several validation rules have been added or modified to accommodate changes to Chapter 243 and to further improve data quality. A summary of these changes can be found below.
NOTE: Data submitted from February 1 – February 5 will not be validated until overrides are reset and the revised validation rules go into effect on February 6th.
Testing of Chapter 243 and validation rule changes begins Monday, December 9th in the MHDO Payer Portal Test Site. See these payer instructions and this list of validation rule updates. Below are a few key reminders.
New Member Eligibility Data Elements
As a result of the question raised during the webinar, we want to confirm what is intended by the two new member eligibility (ME) fields. Data elements ME114 and ME115 are intended to capture information regarding the member’s effective date of coverage and the member’s cancellation date of coverage (if applicable), respectively.
| Date Element Number | Data Element Name | Description/Codes Sources |
|---|---|---|
| ME114 | Plan Begin Date | CCYYMMDD - Effective date of coverage; Date eligibility started for this member under this plan type |
| ME115 | Plan End Date | CCYYMMDD - Last continuous day of coverage (date eligibility ended) for this member under this plan. For open contracts, leave blank |
Examples
An individual enrolls in HMO plan in January 2020 and disenrolls in July 2020.
The January 2020 ME file will contain:
The July 2020 ME file will contain:
The same individual then enrolls in PPO plan in October 2020.
The October 2020 ME file will contain:
| Task | Start Date | End Date |
|---|---|---|
| Payer Testing of Chapter 243 and validation rule changes in Payer Portal Test Site | 12/9/19 | 1/17/20 |
| Instructions regarding annual updates will be emailed | 1/31/20 | 1/31/20 |
| Last day files for any period will be accepted in the old Chapter 243 format | 1/31/20 | 1/31/20 |
| Files submitted in this period will be held and processed on 2/5/2020 | 2/1/20 | 2/4/20 |
| Begin submissions of new Chapter 243 formatted files (January 2020) - Annual override reset | 2/5/20 | 2/5/20 |
| Annual registration information updates are due | 2/28/20 | 2/28/20 |
| January 2020 data files are due in the new Chapter 243 format | 2/28/20 | 2/28/20 |
If you have questions or concerns, please contact the Help Desk at mhdohelp@hsri.org or (866) 451-5876.
12/6/19 February 2020 Data Warehouse Portal UpateOn February 5th, 2020, the MHDO will release an update to the Maine Data Warehouse Portal that will include the latest revisions to 90-590 Chapter 243: Uniform Reporting System for Health Care Claims Data Sets.
Here are the validation rule updates, and the proposed rule and the summary of changes (adopted by the board 11/21/19) can be found on our Statute and Rules page.
MHDO’s annual payer registration updates will begin on February 5th, 2020, when the latest release goes into production.
Please note the important dates below.
| Task | Start Date | End Date |
|---|---|---|
| Payer Testing of Chapter 243 and validation rule changes in Payer Portal Test Site | 12/9/19 | 1/17/20 |
| Instructions regarding annual updates will be emailed | 1/31/20 | 1/31/20 |
| Last day files for any period will be accepted in the old Chapter 243 format | 1/31/20 | 1/31/20 |
| Files submitted in this period will be held and processed on 2/5/20 | 2/1/20 | 2/4/20 |
| Begin submissions of new Chapter 243 formatted files (January 2020) - Annual override reset | 2/5/20 | 2/5/20 |
| Annual registration information updates are due | 2/28/20 | 2/28/20 |
| January 2020 data files are due in the new Chapter 243 format | 2/28/20 | 2/28/20 |
If you have questions or concerns, please contact the Help Desk at mhdohelp@hsri.org or (866) 451-5876.
December 4, 2019 Webinar from 1-2 PM ET to discuss and respond to questions regarding Chapter 243 new file format changes, new elements and validations.A recording of the webinar will be available for those who are unable to attend the session
10/15/18 Testing of MHDO Chapter 243 and Validation Rule Changes Begin TodayTesting begins today, Monday, October 15th in the MHDO Payer Portal Test Site. Please follow these instructions for testing, and see the list of validation changes. Below are a few key reminders.
| Task | Start Date | End Date |
|---|---|---|
| Payer Testing of Chapter 243 format and validation rule changes in Payer Portal Test Site | 10/15/2018 | 11/15/2018 |
| Instructions regarding annual updates will be emailed | 2/1/2019 | 2/1/2019 |
| Last day files for any period will be accepted in the old Chapter 243 format | 1/31/2019 | 1/31/2019 |
| Files submitted in this period will be held and processed on 2/6/2019 | 2/1/2019 | 2/5/2019 |
| Begin submissions of new Chapter 243 formatted files (January 2019) - Annual override reset | 2/6/2019 | 2/6/2019 |
| Annual registration information updates are due | 2/6/2019 | 2/28/2019 |
| January 2019 data files are due in the new Chapter 243 format | 2/28/2019 | 2/28/2019 |
If you have questions, please contact Philippe Bonneau at philippe.bonneau@maine.gov or 207-287-6743.
09/11/18 Follow Up to August 2nd WebinarWe are providing a list of validation changes to be implemented with all Chapter 243 updates. As noted in the timeline below, you will have the opportunity to test these changes beginning on October 15th.
Implementation Timeline
| Task | Start Date | End Date |
|---|---|---|
| Proposed Validation Rule Changes Distributed | 9/17/2018 | 9/28/2018 |
| Instructions regarding testing will be emailed | 10/8/2018 | 10/12/2018 |
| Payer Testing of Chapter 243 format and Validation Changes | 10/15/2018 | 11/15/2018 |
| Instructions regarding annual updates will be emailed | 2/1/2019 | 2/1/2019 |
| Submissions during this period will be held (not validated) until new rules are in place and overrides are reset | 2/1/2019 | 2/5/2019 |
| Chapter 243 and Validation Rule Changes Deployed to Production - Annual override reset | 2/6/19 | 2/6/19 |
| Payers Complete Annual Registration Information Updates | 2/6/19 | 2/28/19 |
If you have questions or concerns, please contact the Help Desk at mhdohelp@hsri.org or (866) 451-5876.
08/13/18 Recording of August 2nd Webinar Now AvailableTo access the recorded webinar either click the link or go to URL https://youtu.be/A_QSuCLkjtU.
08/2/18 Webinar Re: New Rule Chapter 243 Slides AvailableToday's presentation can be downloaded in PDF or PowerPoint format. The recording will be available soon.
07/24/18 Webinar Re: New Rule Chapter 243The proposed changes to MHDO Rule Chapter 243, Uniform Reporting System for Health Care Claims Data Sets, were recently adopted by the MHDO Board. The MHDO will host a webinar on Thursday, August 2, 2018 from 1-2pm ET to review the changes and address questions. Please register for the webinar. If you are unable to attend, it will be recorded and posted here, approximately one week later.
01/29/18 Follow Up from 1/25/18 WebinarThe deck from Thursday's webinar is available now, and a recording will be available the week of February 5th for those who were unable to attend the session.
Test Portal and Availability:
https://mhdo.maine.gov/portal-test/
is available for optional “hands-on”
usage 1/25/18 - 2/2/18.
User Login: Use the same credentials you use to login to the production
portal. Contact the Help Desk if you experience issues.
Please review the important dates in the table below.
Note: The APCD Validation Changes spreadsheet provided 11/9/17 was revised 1/9/18. See the structural tab.
01/08/18 Register for the January 25, 2018 WebinarRegister for the webinar on Thursday, January 25, 2018 from 1-2 PM ET. This webinar is to introduce payers to the pre-production version of the new portal and to answer any questions regarding the new or revised validations.
11/09/17 Message Re: February 2018 Data Warehouse Portal Update from Karynlee Harrington, Acting Executive DirectorOn February 6, 2018, the MHDO will release an update to the Maine Data Warehouse Portal that will include a new user interface and several changes to validation rules (1 additional structural validation; 20 revised and 7 deleted/removed rules; see the APCD Validation Changes spreadsheet).
The new user interface will feature easier navigation, better administrative functionality and enhanced reporting for both submitters and system administrators. The new validation rules (grouped by file type) are expected to provide timelier feedback (regarding the percentage of records with incurred dates within/outside the current reporting period ) and improve data quality.
SAVE THE DATE: MHDO will host a webinar on Thursday, January 25, 2018 from 1-2 PM ET to introduce payers to the pre-production version of the new portal (optionally available for “hands-on” usage from January 25 through February 2, 2018) and to answer any questions regarding the new or revised validations. A recording of the webinar will be available for those who are unable to attend the session.
Lastly, MHDO’s annual payer registration updates will begin on February 6, 2018, when the latest release goes into production.
Please note these important dates.
| Activity | Start Date | End Date |
|---|---|---|
| Payer Webinar – Review validation changes and walkthrough portal interface changes | 1/25/2018 | 1/25/2018 |
| Test Portal available to payers to confirm login/access and to familiarize themselves with the new interface (optional). | 1/25/2018 | 2/2/2018 |
| Submissions during this period will be held (not validated) until new rules are in place and overrides are reset | 2/1/2018 | 2/5/2018 |
| New Portal and Validation Rule Changes Deployed to Production - Annual override reset | 2/6/2018 | 2/6/2018 |
| Payers Complete Annual Registration Information Updates | 2/6/2018 | 2/28/2018 |
If you have questions or concerns, please contact the Help Desk at mhdohelp@hsri.org or (866) 451-5876.
12/27/16 Reminder about Annual Updates, Validation Resets and ChangesSeveral important changes to the MHDO Data Warehouse Portal require action from payers starting February 8th. Below is a summary of the purposes and timelines for the upcoming activities.
The validation rule changes and validation resets will go into effect on February 8th for January 2017 data submissions. These updates will ensure the accuracy and quality of registration and validation information within the MHDO Data Warehouse Portal.
NOTE: In order to make the transition to the reset and updated validation rules are as seamless as possible, all data submitted from February 1 through February 7 will not be validated until overrides are reset and updated validation rules go into effect on February 8th. Submissions can be made from February 1 through February 7, but they will not be processed until February 8th.
9/19/16 Follow Up to April 20, 2016 CorrespondenceBelow was sent to Payors (as defined in Title 22 Chapter 1683)by Executive Director, Karynlee Harrington.
This communication is a follow up to the communication I sent to you on April 20, 2016 regarding the non-enforcement of MHDO claims data submissions for the five-month period of March 2016-July 2016. As stated in the April 20th memo, payors that elected not to submit data during this five-month period are required to submit all applicable data for these months, as well as data for the months of August and September 2016 by October 31, 2016.
We expect your submissions to include your fully insured and self-funded non-ERISA claims data, as well as any voluntary self-funded ERISA claims data. Please note all data collected by the MHDO is treated as confidential and subject to the protections of Title 22, Chapter 1683 and released only in accordance with 90-590 CMR Chapter 120.
Below is submission guidance based on different scenarios:
As of October 31, 2016 we will reinstate our enforcement policy and procedures.
If you have any questions or concerns please contact me or Philippe.
I thank you in advance for your cooperation. - Karynlee
This communication is to inform you that the Maine Health Data Organization (MHDO) will take no action to enforce the data submission requirements under Rule Chapter 243, Uniform Reporting System for Health Care Claims Data Sets, for a five month period from the date of the United States Supreme Court decision in Gobeille v. Liberty Mutual (March 1, 2016).
Payors that choose not to submit data during this period must submit all March, April, May, June and July data by October 31. Please note: the data from the months of August and September are also due October 31 per the normal schedule. It is our hope that by September there will be more clarity with respect to data submission requirements in light of Gobeille.
Previous data submitted and data through February 2016 will be subject to enforcement per the requirements in Rule Chapter 243. Any outstanding files that were rejected or contain errors need to be corrected and or resubmitted in the proper format so that all files can be accepted with no failures.
We encourage (and we will continue to send automated reminders) those payors whose data is not affected by the Supreme Court decision to continue to submit data to the MHDO on the normal schedule.
Thank you in advance for your cooperation and please contact me with any questions.
Karynlee Harrington
1/22/16 - Reminder about Annual Registration Updates and Changes in the Portal-ACTION REQUIREDAs discussed during the October 20, 2015 Claims Data Submitter Group webinar, there are several important things happening in the MHDO Data Warehouse Portal starting February 3rd that require action from payers. Below is a summary of the purposes and timelines for the upcoming activities. Detailed instructions are are available as well.
The timelines for the upcoming changes and activities in the portal are:
The new file format, validation rule changes, and validation resets will go into effect on February 3rd for January 2016 data submissions. These updates will ensure the accuracy and quality of registration and validation information within the MHDO Data Warehouse Portal.
Note: In order to make the transition to the reset and updated validation rules as seamless as possible, all data submitted from February 1 through February 2 will not be validated until overrides are reset and updated validation rules go into effect on February 3rd. Submissions can be made from February 1 through February 2, but they will not be processed until February 3rd.
11/23/15 Message Re: Testing of Chapter 243 validation rule changes from Karynlee Harrington, Acting Executive DirectorAs a reminder, testing of the revised Chapter 243 layout and validation rule changes will end in the MHDO Data Warehouse Portal Test Site on Monday, November 30th.
To date only a few companies have utilized this testing opportunity. Instructions for testing, as well as updated validation rules are available.
Below are a few key reminders.
If you have questions, please contact Philippe Bonneau at philippe.bonneau@maine.gov or 207-287-6743. Thank you and happy holidays. Karynlee
10/28/15 Testing of Chapter 243 and validation rule changes begins todayTesting of Chapter 243 and validation rule changes begins today, October 28th in the MHDO Data Warehouse Portal Test Site. Please see the instructions for testing, as well as the updated validation rules . Please note there have been some slight modifications to the validation rules since they were first distributed on September 29th. These changes are noted in the spreadsheet. Below are a few key reminders.
| Task | Start Date | End Date |
|---|---|---|
| Test Portal Open for Payer Testing of New Chapter 243 Format and Validation Changes – Sample File Layout Available in Portal | 10/28/2015 | 11/30/2015 |
| Resolve issues identified in testing | 12/1/2015 | 1/31/2016 |
| Submissions during this period will be held (not validated) until new rules are in place | 2/1/2016 | 2/2/2016 |
| Production Portal Open - New Chapter 243 Format and Validations | 2/3/2016 | 2/3/2016 |
| Submissions of New Chapter 243 Format Files (January 2016 data) | 2/3/2016 | 2/29/2016 |
We are quickly approaching the testing period for changes to both the APCD file format requirements under 90-590 Chapter 243 and the APCD validation rules. The Maine Health Data Organization will be hosting a webinar to review these key changes October 20, 2015 from 3:00 to 4:00 PM ET. Here is the tentative agenda.
Please register for the webinar. If you are unable to attend, it will be recorded and posted on this page approximately one week later.
Key Notes:
The proposed changes to Chapter 243 were recently adopted by the MHDO Board. A copy
of the most recent draft proposal can be found on the
Rules and Statutes page
. Here is a link to view the
proposed validation changes.
If you have specific questions
that you would like us to address at the October 20th webinar please e-mail Philippe
Bonneau at Philippe.Bonneau@maine.gov.
Thank you and I look forward to connecting with you on the 20th. - Karynlee
9/25/15 ICD-10 Testing Update - email from Karynlee HarringtonThe official testing period of the new ICD-10 validations will end on September 30th. Below are a few key reminders and the location of testing instructions. Submission and validation of ICD-10 fields will begin in the production MHDO Data Warehouse Portal on November 4th.
Reminders
If you have questions, please contact Philippe Bonneau at philippe.bonneau@maine.gov or 207-287-6743. Thank you. Karynlee
8/24/15 ICD-10 Testing Update- email from Karynlee Harrington 8/12/15As a result of payer and data user feedback we are making some modifications to a few of the validation codes lists being used to validate ICD-10 fields. The revised lists are less restrictive than the original set. Below is a summary of the key points:
ICD-10-CM Fields
These changes will be implemented and available for testing in the MHDO Data Warehouse Portal Test Site on Friday, August 14. A revised spreadsheet of validation rules and the testing instructions are available. The changes are reflected in the Lists tab of the spreadsheet.
Reminders:
Testing of the new ICD-10 validations will begin August 5th in the MHDO Data Warehouse Portal Test Site. Please see the instructions as well as the validation rules (Note: validation rules changed 8/12/15. See revised spreadsheet of validation rules) before you begin.
| Task | Start Date | End Date |
|---|---|---|
| Payer testing of new validation rules in designated payer test environment | 8/5/2015 | 9/30/2015 |
| Resolve issues identified in testing | 10/1/2015 | 10/30/2015 |
| Submissions during this period will be held (not validated) until new rules are in place | 11/1/2015 | 11/3/2015 |
| Begin submissions of ICD-10 fields (October data) | 11/4/2015 | 11/4/2015 |
A list of proposed validation rules for the ICD-10 fields are now available.
As discussed during last month’s PUG meeting there are several important things happening in the MHDO Data Warehouse Portal next month that require action from payers. Starting February 4th companies will need to update their registration within the portal and validation overrides will be reset.
We will be sending targeted communications with detailed instructions to Administrative Contacts and Data Submitters next week. Below is a high level summary of the purpose and timelines for the upcoming activities.Detailed instructions can be found here.
The purpose of the upcoming registration updates and validation override resets is to:
These updates will ensure the accuracy and quality of registration and validation information within the MHDO Data Warehouse Portal.
Timelines:
Annual registration updates are required to be completed between February 4th and February 28th. Although required only once annually, it is strongly recommended that portal users review and update company profiles, payer details and contact information as changes occur to ensure that communication with payers remains targeted and timely.
Validation Overrides will be reset, and updated validation rules will go into effect on February 4th for January 2015 data.
Please see the agenda and PowerPoint Presentation.
All data for the period of October 2014 forward is to be submitted in the new MHDO Chapter 243 format . October files (in the new format) are to be submitted in the production portal (https://mhdo.maine.gov/portal/) starting on November 6th.
Please contact the help desk at 866-315-7125 or mhdohelp@norc.org or Philippe Bonneau if you have any questions. Thank you!
Thank you to everyone who participated in the September testing period. While the official testing period will end today, September 30, 2014, the test portal will remain open and available for use until changes are moved to production. As a reminder, the Payer Test Instructions are still available.
All data for the period of October 2014 forward is expected to be submitted in the new Chapter 243 format. October files in the new format are only to be submitted in production portal (https://mhdo.maine.gov/portal/) starting on November 6.
Beginning November 6, 2014, regardless of data period, submissions
to the production portal will only be accepted in the new Chapter 243 layout. If
you have outstanding structural issues to resolve or missing data to submit for
data prior to October 2014 you are strongly encouraged to do so no later than November
5, 2014 since we will no longer accept the old format after that date.
Thank you.
Explicit directions can be found in the Payer Test Instructions. Please remember the site Will Not Be Available Until 9/2/14.
Sample text files which conform to the new APCD file format requirements of Chapter 243 are now available on the Data Warehouse Portal under the Resources Menu. These file formats will go into effect beginning with the submission of data for October 2014 and can be used to prepare files for the upcoming testing period which will begin September 2nd. Instructions for testing will be distributed by Friday, August 29th.
The video from the 7/31/14 meeting is now available under Training Videos within the Resources menu of the MHDO Data Warehouse Portal.
Just a quick reminder that the Maine Health Data Organization will be hosting a webinar for our Payer User Group July 31, 2014 from 2:30 to 3:30 PM ET. See the Agenda which also includes information to log into the webinar. You may review the Powerpoint document and the validation changes spreadsheet we will cover. I hope you can join us next week and look forward to the discussion.
Please e-mail Philippe Bonneau at Philippe.Bonneau@maine.gov with specific questions regarding the changes to Chapter 243 that you would like us to address during the July 31 webinar.
Karynlee Harrington, Acting Executive Director
From Karynlee Harrington, Acting Executive Director, Maine Health Data Organization:
How time flies! We are quickly approaching the testing period for the new APCD file
format requirements under 90-590 Chapter 243. The Maine Health Data Organization
will be hosting a webinar July 31, 2014 from 2:30 to 3:30 PM EST
for a Payer User Group meeting for the limited purpose of discussing recent Chapter
243 changes.
Tentative Agenda
July 31, 2014
2:30 p.m. - 3:30 p.m. EST
Additional details will follow soon. In the meantime, please e-mail Philippe Bonneau at Philippe.Bonneau@maine.gov with specific questions regarding the changes to Chapter 243 that you would like us to address during the July 31st webinar.
From Karynlee Harrington, Acting Executive Director, Maine Health Data Organization:
As the formal approval process for Chapter 243 nears completion, we are taking the
opportunity to provide payers with an update to the MHDO Chapter 243 timeline for
testing. If you have questions, please contact me or Philippe Bonneau at 207-287-6743
or philippe.bonneau@maine.gov.
| Task | Start Date | End Date |
|---|---|---|
| MHDO Board reviews and provisionally approves adoption of rule changes. Final approval pending approval from the Attorney General's Office (expected by end of May). | 5/1/2014 | 5/1/2014 |
| Notify Payers of Chapter 243 Validation Revisions | 7/15/2014 | 7/15/2014 |
| Payer Testing of new Chapter 243 format and validations in designated test environment | 9/1/2014 | 9/30/2014 |
| Resolve issues identified in testing | 10/1/2014 | 10/31/2014 |
| Deploy new Chapter 243 format and validations to Portal | 11/5/2014 | 11/5/2014 |
| Begin submissions of new Chapter 243 format files (October 2014 data) | 11/6/2014 | 11/6/2014 |
Background:
All claims data submitted to the MHDO (through our Portal) are evaluated against
a set of rules before they are allowed into our data warehouse. As you may remember,
when we first released the validation rules for the new MHDO Portal we promised
that we would assess how the validations are working in the system and against the
data. After six months of data had been submitted through the Portal we began this
assessment. Note the assessment included the deployment of the Validation Reports
in the Portal so Administrative Contacts and Data Submitters could view the results
of the validations against their data. Our assessment included reviewing all Profile,
Exemption and Ad Hoc Level validation rules. With respect to each rule, the following
options were possible: 1) do not change; 2) eliminate the rule, 3) lower the threshold;
or 4) modify the rule logic.
Results:
Changes to the validation rules, by file type, are presented in this
validation summary spreadsheet
. Based on our assessment of the 310 current
Profile, Exemption and Ad Hoc Level validation rules, we are eliminating 30 (9.7%)
validation rules, lowering 101 (32.7%) thresholds and modifying the logic of 23
(7.4%) rules. We have not added any new validations or made validations more stringent,
but there were some validations that weren’t working correctly that have been fixed.
These fall into the category of modifying rule logic.
Implementation and Timeline:
II. Naming Files:
There are some payers that are submitting duplicate healthcare claims data files
with the same name to the Portal. When the version numbers in the file names are
not properly incremented, duplicate files are created. Unfortunately, this causes
confusion regarding which file submissions are valid. In order to eliminate the
confusion we are adding a new structural validation rule to check for duplicate
file names on submission. Duplicate file names will result in structural failures
that must be resolved by renaming and resubmitting the files. The rules for naming
files, particularly resubmissions can be found at: https://mhdo.maine.gov/portal/Home/UserManual#naming.
The Revision of the Draft Proposed Rule Chapter 243 is now posted on our Rules and Statutes page. Also available is the HealthCost Project Abstract.
We are still accepting survey responses: If you have not yet completed the warehouse portal satisfaction survey , please take a moment to do so. We value your feedback!
1/30/14 - The deadline for completing the survey has been moved to February 4th. If you have not yet completed the survey, please take a moment to do so. We value your feedback.
1/17/14 - In order to continue to improve our Portal and service to you we have prepared a satisfaction survey. The information you provide will help us with future enhancements.
Survey responses will be shared on the February 6th webinar.
At the MHDO December 5, 2013 Board of Directors meeting, the Board made the decision 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, health care claims processors that are excluded from filing health care claim data sets shall not have to register under Section 3(A).
If you are a monthly submitter your October 2013 claims must be submitted by November 30, 2013. If you have questions or concerns about this deadline please contact Philippe Bonneau, Compliance Officer, Maine Health Data Organization at philippe.bonneau@maine.gov or 207-287-6743.
The Portal Help Desk will be closed Thursday November 28th and Friday the 29th for Thanksgiving.
If you are a monthly data submitter your September 2013 claims
must be submitted by October 31, 2013.
If you are a quarterly data submitter your 2013 third quarter (July,
August, and September) claims must be submitted by October 31, 2013.
If you have questions or concerns about these deadlines please contact Philippe Bonneau, Compliance Officer, MHDO at philippe.bonneau@maine.gov or 207-287-6743.
It has been a week since we opened our new portal and we hope your experience has been positive during this transitional time. Please read further to see a reminder about an important upcoming date and data submission tips that you may find helpful when submitting your data and dealing with validation issues.
The User Guide Part 2 has been updated with additional guidance for file naming and updates to the SFTP information. You can find the User Guide on the Portal at: https://mhdo.maine.gov/portal/ under the Resources tab.
The User Guide is available in the Portal under “Resources”, along with the Training Video and transcript from Wednesday’s training.
Administrative Contact
If you are your company’s Administrative Contact you should have received a system
email from: portal@mhdo.maine.gov with your login credentials. Please check your
junk and spam filters if you did not receive an email. If you did not receive it,
please contact the Portal Help Desk.
Other Users
If you are not your company’s Administrative Contact, please refer to the User Manual
for more information about requesting an account from your Administrative Contact
or you can wait until you receive an invitation from your Administrative Contact.
Portal Help Desk
Email: mhdohelp@norc.org
Toll-Free Phone: (866) 315-7125
It is hard to believe that we are weeks away from going live with our new ETL claims platform. I want to thank all of you that have been engaged in the process from the beginning. Your feedback has been instructive and has ultimately helped us build a system that is more responsive and efficient.
Those of you who have been involved in the beta testing process or the Payer Users Group may already be aware of many of the following items. For others, this may be your first introduction to our new system. This message provides a summary of some of the key activities that will be occurring over the next few weeks as we gear up for the go live date. This development effort is all part of MHDO’s agency transformation effort that we rolled out in February. Please continue to visit this page for timely updates and direction.
We are opening the new MHDO Data Warehouse Portal in two stages.
Stage 1: Starting August 28th, the MHDO Data Warehouse Portal will open for company registration. We will be preloading existing company information into the portal and will be sending out usernames and passwords to your company’s Administrative Contact. This information will allow the Administrative Contact to log into the system to set up their registration and add additional system users.
Note: The Portal will require an assignment of an Administrative Contact. The Administrative Contact is responsible for:
The new data validations (formally referred to as “edits”) will also be available in the Data Warehouse Portal in stage 1-You will be able to review data validations and set up your company validation profiles.
Stage 2: Starting September 12th, users can begin to submit their July and August 2013 files using the new system. Note: July and August 2013 files are due by the end of September 2013. File submissions thereafter will follow the normal submission schedule.
Important Dates, Activities and Training Sessions:
User Account Set-up – Administrative Contact
In order to setup user accounts we need you to identify one user as the Administrative Contact for your company by COB, Monday, August 26th. Please send the person’s name and email address to: MHDO@hsri.org.The Administrative Contact person you identify will receive their credentials via email to sign-in to the portal the afternoon of Wednesday, August 28th. The Administrative Contact will be responsible for adding additional users as needed. You will also have the ability to register additional Administrative Contacts. If you participated in Phase 4 testing, you can skip this step and continue to use the accounts setup during testing.
Portal Registration System User Training - Wednesday, August 28th 1:00-2:00 PM EST This training session will be conducted via a webinar and is available for all system users. If you are unable to join this training session or would like more information, a training video and user manual will be made available. Please use the link below to register for this event by close of business, Tuesday, August 27th. Those who are registered for the training session will be e-mailed a copy of the User Manual the day of the training.
Data Submission and Validation System Training – Thursday, September 12th 1:00-2:00 PM EST This training will be available for all system users who will be submitting or validating data in the system. Data submissions can be either uploaded through the portal or through a SFTP connection. The information needed to establish an SFTP connection for data submission, including how to obtain an encryption password, will be distributed at this time. Once data are submitted through either method, interactive validation reports will be made available through the portal. If you are unable to attend this training or would like more information, a training video and user manual will be made available. Please use the link below, prior to 9/12/13 1:00 PM EST, to register for this event.
System Help Desk - Opens Thursday, August 28th
Starting on August 28th, a MHDO Data Warehouse help desk will open for any technical issues that system users may encounter.
Information about the New System:
Details about the Data Submission/Transfer Process:
Below is information about the new process of transferring data to MHDO for the new data warehouse. As a reminder this process will not require you to install new software on your computer.
Compression and Encryption of Files
In order to ensure the security of personally identifiable information and personal health information that is submitted to the MHDO Data Warehouse and to reduce file transmission times, MHDO will be requiring submitters to compress and encrypt all files before uploading to the warehouse. This file-level encryption will ensure the confidentiality of all data that is 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 which already may be deployed within submitters’ infrastructure. Submitters will no longer be expected to run a custom MHDO-provided application to perform encryption.
Compression and Encryption Requirements:
Transfer Options
Once the files to be submitted have been compressed and encrypted, as outlined above, they need to be transferred to the data warehouse for validation and load. There are two ways that files can be transferred: the SFTP Process and via the MHDO Portal.
SFTP Process
The SFTP process is designed primarily for users who want to set up an automated transfer of files, however, it is available for 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 third-party SFTP tool (such as WinSCP or FileZilla) to send files.
In order to use the SFTP process, payers will have to request an SFTP ID. This request can be initiated via the Account section of the MHDO Portal. Once a request is received, an email with links to securely download their account credentials will be sent back to the requester. This will be reviewed in the training session.
All files transferred will be automatically associated with the proper account. However, it is important that the files be named according to a standard naming convention to ensure that the file type and submission periods can properly be discerned. Details of this naming convention will be provided in the user manual and during the training session.
Connection Information for SFTP Server
Data Upload for transferring claims data via MHDO Data Warehouse Portal
All users will also be able to submit files via the MHDO Portal by going to the “New Submission” menu option. They will then be prompted to enter the location of the file to upload. The file will then be uploaded to the warehouse and validated.
This process is designed to be used interactively. The file transfer will only continue while the web browser is kept open. The transfer process will be suspended if the transfer window or browser is closed, so it may be most appropriate for smaller files.
With your guidance, over the last few months we have addressed the following:
2/6/14 meeting
7/24/13 meeting
5/8/13 meeting
4/24/13 meeting
4/10/13 meeting
3/27/13 meeting