Data Availability

Claims-APCD

Since 2003, MHDO has been collecting health care claims data per the requirements defined in Rule Chapter 243.

Who submits data to the MHDO?

The entities that are required to submit claims data include: insurance companies and third party administrators. There are eligibility threshold levels described in Rule Chapter 243 that have changed over the years. MHDO also receives data from the state’s Medicaid Program-MaineCare and Medicare data from CMS.

What's in the claims data?

Claims data submissions include files with member eligibility, medical claims, pharmacy claims, and/or dental claims information. Key highlights of some of the data elements are: detailed diagnosis, procedure, payment, and provider and geographical information. This spreadsheet contains the elements available in the various claims data sets. Releasable elements will vary depending on the data requested. Data dictionaries are also available with in-depth detail about what is contained in the claims data. In addition, reports that other data users have created are available as samples of possible analysis. The graphic below highlights the data that are available. When you select a date range, each graphic will adjust to display information for the data range selected.



Hospital Inpatient and Outpatient, Data Quality, and Hospital Financials

Who provides the data?

Since 1990, MHDO has been collecting hospital inpatient and outpatient encounter data per the requirements defined in Rule Chapter 241.

What's in the data?

All hospital inpatient and outpatient (including provider based clinics) encounters are available. Information about releasable data elements is available on the Hospital Encounters page under the Available Datasets heading. Key highlights of some of the data elements are: diagnosis, procedures performed, payer, hospital or clinic code, DRG, patient characteristics and geographical data. This spreadsheet contains the elements available in the various hospital encounter data sets. Releasable elements will vary depending on the data request. In addition, reports that other data users have created are available as samples of possible analysis. The graphic below highlights the data that are available. When you select a date range, each graphic will adjust to display information for the data range selected.



How do I request data?

The data request process can be found on our Request Data or Reports page. Please see details on different types of data requests and the process for the release of data.

Frequently asked questions

Please see our FAQs if you have additional questions.




© Maine Health Data Organization 2013