New Mexico Administrative Code
Title 7 - HEALTH
Chapter 1 - HEALTH GENERAL PROVISIONS
Part 31 - STATEWIDE HEALTH CARE CLAIMS DATABASE
Section 7.1.31.9 - SUBMISSION OF CLAIMS DATA TO DATABASE
Universal Citation: 7 NM Admin Code 7.1.31.9
Current through Register Vol. 35, No. 18, September 24, 2024
A. All-payer claims database data providers:
(1) Data providers must
submit all available data and health information with necessary identifiers to
the database as described in the APCD-Common Data Layout (APCD-CDLT, Version
2.1 with errata, Copyright 2021 by APCD Council, National Association of Health
Data Organizations, the University of New Hampshire) within the time frames in
this rule and in accordance with procedures established herein.
(2) Any data provider used by an entity that
participates in the database such as a third-party administrator or pharmacy
benefit manager must provide claims data to the department or the data vendor
upon request of the entity.
(3) The
following plans or entities may voluntarily provide claims data to the database
within the time frames and in accordance with procedures established by the
department:
(a) Employer sponsored plans
subject to the Employee Retirement Income Security Act of 1974; and
(b) any governmental or tribal program or
facility that provides health care services to American Indians and Alaska
Natives.
(4) Health
insurance carriers that only offer the following excepted benefit coverages are
not required to report:
(a) specific
disease;
(b) accident or
injury;
(c) hospital indemnity and
other fixed indemnity;
(d)
disability;
(e) long-term care;
and
(f) vision coverage.
(5) Medicaid managed care
organizations provide claims data to the New Mexico human services division
(HSD), and who will then submit that data to the department of
health.
(6) Health insurance
carriers covering less than 500 individuals are not required to submit files to
the database but are required to report the number of individuals with coverage
during the previous year on March 1st.
B. Data submission procedures:
(1) The department shall:
(a) utilize an internet-based user interface
(or similar technology) that allows for secure submission and acceptance of
data submissions;
(b) perform
quality assurance and validation of all submitted data and provide feedback to
the data providers; and
(c) provide
data submissions procedures to data providers in a data submission guide that
is based on a current version of the APCD-Common Data Layout.
(2) Data submission frequency:
data shall be submitted at least monthly.
(3) Data providers shall make every effort to
initially submit complete, accurate, and valid data in the APCD-Common Data
Layout and shall correct all identified errors within the timelines established
by the department or its designee.
(4) An initial test submission of data may be
required.
(5) Data dating to
January 1, 2020 must be submitted initially.
(6) The department may sanction data
providers who do not comply with this rule.
(7) Data shall be submitted beginning January
1, 2023.
Disclaimer: These regulations may not be the most recent version. New Mexico 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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