Code of Maine Rules
90 - INDEPENDENT AGENCIES
590 - MAINE HEALTH DATA ORGANIZATION
Chapter 243 - UNIFORM REPORTING SYSTEM FOR HEALTH CARE CLAIMS DATA SETS
- Section 590-243-1 - Definitions
- Section 590-243-2 - Health Care Claims Data Set Filing Description
- Section 590-243-3 - Submission Requirements
- Section 590-243-4 - Standards for Data; Notification; Response
- Section 590-243-5 - Voluntary File Submissions
- Section 590-243-6 - Public Access
- Section 590-243-7 - Extensions or Waivers to Data Submission Requirements
- Section 590-243-8 - Compliance
- Appendix 590-243-A - Maine Health Data Organization Source Codes
- Appendix 590-243-B-1 - Maine Health Data Organization Header Record Specifications
- Appendix 590-243-B-2 - Maine Health Data Organization Trailer Record Specifications
- Appendix 590-243-C-1 - Maine Health Data Organization Member eligibility File Specifications
- Appendix 590-243-C-2 - Maine Health Data Organization Member Eligibility File Mapping to National Standards
- Appendix 590-243-D-1 - Maine Health Data Organization Medical Claims File Specifications
- Appendix 590-243-D-2 - Maine Health Data Organization Medical Claims File Mapping to National Standards
- Appendix 590-243-E-1 - Maine Health Data Organization Pharmacy Claims File Specifications
- Appendix 590-243-E-2 - Maine Health Data Organization Pharmacy Claims File Mapping to National Standards
- Appendix 590-243-F-1 - Maine Health Data Organization Dental Claims File Specifications
- Appendix 590-243-F-2 - Maine Health Data Organization Dental Claims File Mapping to National Standards
- Appendix 590-243-G-1 - Maine Health Data Organization Capitated Payments File Specification
- Appendix 590-243-G-2 - Maine Health Data Organization Capitated Payments File Mapping to National Standards
Current through 2024-38, September 18, 2024
SUMMARY: This chapter contains the provisions for filing health care claims data sets from all third-party payers, third-party administrators, Medicare health plan sponsors and pharmacy benefits managers.
The provisions include:
Identification of the organizations required to report;
Establishment of requirements for the content, format, method, and time frame for filing health care claims data;
Establishment of standards for the data reported; and
Compliance provisions.
STATUTORY AUTHORITY: 22 M.R.S. §§8703(1), 8704(4), 8708(6-A) and 8712(2)
Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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