Since 2003, MHDO has been collecting health care claims data per the requirements defined in Rule Chapter 243.
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.
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.
Since 1990, MHDO has been collecting hospital inpatient and outpatient encounter data per the requirements defined in Rule Chapter 241.
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.
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.
Please see our FAQs if you have additional questions.
The table below provides a summary of the data MHDO has available and the time period covered. Be sure to check our Data Release Schedules page for a more recent release that could be right around the corner.
|Data Set||Governing Rule||Who Provides the Data?||What's in the Data?||
(updated October 23, 2017)
|Claims - APCD||Chapter 243||
|Hospital Data||Chapter 241||Maine Hospitals||Since 1990, all services provided by hospitals and provider based clinics in Maine (includes historical information from the Maine Health Care Finance Commission).||
|Ch. 270 Quality Data||Chapter 270||Maine hospitals and Quality Improvement Organization (QIO)||
||Quality Data through March 2017|
|Hospital Financials||Chapter 300||Maine Hospitals||Since 1994, hospital audited financial statements. (2006 introduced standard reporting template for financial reporting).||Currently available are data through FY2016 (data is collected based on hospital fiscal year).|