Delaware Administrative Code
Title 1 - Authorities, Boards and Commissions
100 - Delaware Health Information Network
103 - Delaware Health Care Claims Database Data Collection Regulation
Section 103-2.0 - Definitions

The following words, terms, and phrases, when used in this regulation, shall have the following meaning, and use of the singular shall include the plural, unless the context clearly indicates otherwise:

"Claims Data" means as defined in 16 Del.C. § 10312.

"Data Submission and Use Agreement" or "DSUA" shall mean the agreement between the HCCD Administrator and the Reporting Entity describing the specific terms and conditions for data submission and use. A template for the DSUA is Attachment B to this regulation.

"HCCD Administrator" shall mean the Delaware Health Information Network and its staff and contractor(s) that are responsible for collecting data submissions, providing secure production services and providing data access for approved users.

"Health Care Claims Database" or "HCCD" shall mean the database and associated technology components maintained by DHIN and authorized under 16 Del.C. Ch. 103, Subchapter II.

"Health Care Claims Database Committee" or the "Committee" shall mean the subcommittee established by the Delaware Health Information Network Board of Directors and governed by its by-laws that has the authority to determine when claims data should be provided to a Data Requester to facilitate the purposes of the enabling legislation, and such other duties as designated the DHIN Board of Directors consistent with the enabling legislation.

"Health care services" means as defined in 16 Del.C. § 10312.

"Health insurer" means as defined in 16 Del.C. § 10312.

"Mandatory Reporting Entity" means as defined in 16 Del.C. § 10312.

"Member" means individuals, employees, and dependents for which the Reporting Entity has an obligation to adjudicate, pay or disburse claims payments. The term includes covered lives. For employer-sponsored coverage, Members include certificate holders and their dependents. This definition includes all members of the State Group Health Insurance Program regardless of state of residence.

"Provider" means as defined in 16 Del.C. § 10312.

"Pricing information" means as defined in 16 Del.C. § 10312.

"Reporting Date" means as defined in 16 Del.C. § 10312.

"Reporting Entity" means either a Mandatory Reporting Entity or a Voluntary Reporting Entity.

"Required Claims Data" as authorized under 16 Del.C. § 10312 (8) shall mean the required data containing records of member eligibility, medical services claims and pharmacy claims as specified in the Submission Guide.

"Submission Guide" shall mean the document providing the specific formats, timelines, data quality standards and other requirements for claims data submission, incorporated as Addendum One to the DSUA. It shall be established and maintained as technical guidance document and substantively updated on an annual basis.

"Third Party Administrator" means as defined in 18 Del.C. § 102.

"Voluntary Reporting Entity" means as defined in 16 Del.C. § 10312.