Code of Massachusetts Regulations
129 CMR - HEALTH CARE QUALITY AND COST COUNCIL
Title 129 CMR 3.00 - Disclosure Of Health Care Claims Data
Section 3.02 - Definitions

The following words shall have the following meanings:

Applicant. An individual, group of individuals, or organization which formally requests the release of Health Care Claims Data in accordance with 129 CMR 3.03.

Board. The Council's Data Release Review Board established pursuant to 129 CMR 3.03.

Carrier. Any entity subject to the insurance laws and rules of Massachusetts, or subject to the jurisdiction of the commissioner of insurance that contracts or offers to provide, deliver, arrange for, pay for, or reimburse any of the costs of health services, and includes an insurance company, a health maintenance organization, a nonprofit hospital services corporation, a medical service corporation, third-party administrator or any other entity arranging for or providing insured health coverage.

CMS. The federal Centers for Medicare and Medicaid Services.

Council. The Health Care Quality and Cost Council established under M.G.L. c. 6A, § 16K.

Data Use Agreement. A document detailing restrictions on the disclosure and use of Health Care Claims Data.

Disclosure. The release, transfer, provision of, access to, or divulging in any other manner of information outside the entity holding the information.

Encryption. The use of an algorithmic process to transform data into a form in which there is a low probability of assigning meaning without use of a confidential process or key.

Health Care Claims Data. Information consisting of, or derived directly from, member eligibility information, medical claims, pharmacy claims, and all other data submitted by health care claims processors pursuant to 129 CMR 2.00.

Health Care Claims Processor. A third-party payer, third-party administrator, or carrier that provides administrative services for a plan sponsor.

Provider. A health care practitioner, health care facility, health care group, medical product vendor or pharmacy.

Public Use File. A health care data set which contains a selected number of variables as specified in 129 CMR 3.03(1).

Third-party Administrator. Any person or entity that, on behalf of a plan sponsor, health care services plan, nonprofit hospital or medical service organization, health maintenance organization or insurer, receives or collects charges, contributions or premiums for, or adjusts or settles claims on behalf of the residents of the state.

Third-party Payer. A health insurer, nonprofit hospital or medical services organization, or managed care organization or any other entity licensed in the Commonwealth of Massachusetts that pays for health care services or products.