90-590 C.M.R. ch. 241, § 1 - Definitions

Unless the context indicates otherwise, the following words and phrases shall have the following meanings:

A. Attending Provider. Attending Provider is the individual who has overall responsibility for the patient's medical care and treatment reported in this claim.

B. Billing Provider. Provider submitting the bill.

C. Designee. "Designee" means an entity with which the MHDO has entered into an arrangement under which the entity performs data collection, validation and management functions for the MHDO and is strictly prohibited from releasing information obtained in such a capacity if the information is not authorized for release by the MHDO.

D. Carrier. "Carrier" means an insurance company licensed in accordance with 24-A M.R.S.A., including a health maintenance organization, a multiple employer welfare arrangement licensed pursuant to Title 24-A, chapter 81, a preferred provider organization, a fraternal benefit society, or a nonprofit hospital or medical service organization or health plan licensed pursuant to 24 M.R.S.A. An employer exempted from the applicability of 24-A M.R.S.A., chapter 56-A under the federal Employee Retirement Income Security Act of 1974, 29 United States Code, Sections 1001 to 1461 (1988) is not considered a carrier.

E. External Causes Codes. "External causes codes" in ICD-10 are codes designed to provide data for injury research and evaluation of injury prevention strategies. These codes capture how the injury or health condition occurred (cause), the intent (unintentional or accidental; or intentional, such as suicide or assault), the place where the event occurred, the activity of the patient at the time of the event and the person's status (e.g. civilian, military).

F. Hospital. "Hospital" means any acute care institution required to be licensed pursuant to 22 M.R.S.A., chapter 405.

G. Hospital Inpatient Data. "Hospital inpatient data" pertains to the information generated at the time of discharge which is associated with patients who are provided with room, board, and continuous nursing service based on a physician's written order in an area of the hospital where patients generally stay more than twenty-four hours.

H. Hospital Outpatient Data. "Hospital outpatient data" pertains to the data generated for any patient visit that is not considered an inpatient admission, at any department of the hospital, regardless of its physical location. Hospital Outpatient Data also includes services provided by specialty groups or primary care practices when the hospital owns the data.

I. MHDO. "MHDO" means the Maine Health Data Organization.

J. M.R.S.A. "M.R.S.A." means Maine Revised Statutes Annotated.

K. National Provider Identifier (NPI). The unique identification number assigned to the provider

L. Operating Physician. Operating Physician is the individual with the primary responsibility for performing the surgical procedures(s).

M. Rendering Provider. The Rendering Provider is the person or company (laboratory or other facility) who rendered the care.

N. Third-party Administrator. "Third-party administrator" means any person licensed by the Maine Bureau of Insurance under 24-A M.R.S.A., chapter 18 who, on behalf of a plan sponsor, health care service 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 residents of this State.

Notes

90-590 C.M.R. ch. 241, § 1