Code of Maine Rules
90 - INDEPENDENT AGENCIES
590 - MAINE HEALTH DATA ORGANIZATION (MHDO)
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
- 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
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)
The amended version of this chapter by filing 2023-249, eff. 12/17/2023 is not yet available.