C.M.R. 90, 590, ch. 243 - UNIFORM REPORTING SYSTEM FOR HEALTH CARE CLAIMS DATA SETS

  1. § 590-243-1 - Definitions
  2. § 590-243-2 - Health Care Claims Data Set Filing Description
  3. § 590-243-3 - Submission Requirements
  4. § 590-243-4 - Standards for Data; Notification; Response
  5. § 590-243-5 - Voluntary File Submissions
  6. § 590-243-6 - Public Access
  7. § 590-243-7 - Extensions or Waivers to Data Submission Requirements
  8. § 590-243-8 - Compliance
  9. Appendix 590-243-A - Maine Health Data Organization Source Codes
  10. Appendix 590-243-B-1 - Maine Health Data Organization Header Record Specifications
  11. Appendix 590-243-B-2 - Maine Health Data Organization Trailer Record Specifications
  12. Appendix 590-243-C-1 - Maine Health Data Organization Member eligibility File Specifications
  13. Appendix 590-243-C-2 - Maine Health Data Organization Member Eligibility File Mapping to National Standards
  14. Appendix 590-243-D-1 - Maine Health Data Organization Medical Claims File Specifications
  15. Appendix 590-243-D-2 - Maine Health Data Organization Medical Claims File Mapping to National Standards
  16. Appendix 590-243-E-1 - Maine Health Data Organization Pharmacy Claims File Specifications
  17. Appendix 590-243-E-2 - Maine Health Data Organization Pharmacy Claims File Mapping to National Standards
  18. Appendix 590-243-F-1 - Maine Health Data Organization Dental Claims File Specifications
  19. Appendix 590-243-F-2 - Maine Health Data Organization Dental Claims File Mapping to National Standards
  20. Appendix 590-243-G-1 - Maine Health Data Organization Capitated Payments File Specification
  21. Appendix 590-243-G-2 - Maine Health Data Organization Capitated Payments 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.

Notes

C.M.R. 90, 590, ch. 243
EFFECTIVE DATE:
July 29, 2002
AMENDED:
June 2, 2003 - filing 2003-173
NON-SUBSTANTIVE CORRECTIONS: September 8, 2003 - formatting only
AMENDED:
February 28, 2006 - filing 2006-89
CORRECTION:
May 24, 2006 - restored item in Appendix C-1 under ME012, "34 Other Adult"
AMENDED:
April 15, 2009 - filing 2009-157
October 31, 2012 - filing 2012-295
May 27, 2014 - filing 2014-100
October 6, 2015 - filing 2015-183
March 13, 2017 - filing 2017-045
June 27, 2018 - filing 2018-111
December 22, 2019 - filing 2019-246
October 12, 2020 - filing 2020-217
November 15, 2021 - filing 2021-230
December 17, 2023 - filing 2023-249
6/25/2024 - filing 2024- 145

STATUTORY AUTHORITY: 22 M.R.S. §§8703(1), 8704(4), 8708(6-A) and 8712(2)

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