C.M.R. 90, 590, ch. 120, app 590-120-A

Current through 2024-51, December 18, 2024

Appendix 590-120-A - DATA ELEMENTS RELEASED IN LEVEL I FILE- DE-IDENTIFIED DATA

APCD Data includes: eligibility, claims, pharmacy and dental files (A.1)

Hospital Encounter Data includes Inpatient and Outpatient data files (A.2)

Level I Data sets also include Provider Database (APPENDIX A.3), Hospital Quality Data (APPENDIX A.4) and Non-Claims-Based Payments Data (APPENDIX A.5).

APPENDIX A.1 APCD Data Elements Medical Eligibility File Data Elements:

MHDO assigned Submitter ID Number/Name MHDO assigned Payer ID Number/Name Payer NAIC Year Month Coverage Level Code Member Gender Member State or Province Medical Coverage Prescription Drug Coverage Dental Coverage Primary Insurance Indicator Coverage Type Market Category Code Record Type Member Age (Calculated age for individuals 90 or over will be displayed as "90 or over".) MHDO assigned Record ID Number Medicare Coverage File ID Standardized Insurance Individual Relationship Code Standardized Insurance Type/Product Code Duplicate Indicator Coverage Period (Year + Month)

Medical Claims File Data Elements:

MHDO assigned Submitter ID Number/Name MHDO assigned Payer ID Number/Name Payer NAIC Claim Line Number Claim Version Number Individual Relationship Code Member Gender Member State or Province Priority (Type) of Admission or Visit Point of Origin for Admission or Visit Patient Discharge Status Type of Bill - Institutional Place of Service - Professional Claim Status Revenue Code Procedure Codes Procedure Modifiers Quantity Paid Amount Prepaid Amount Copay Amount Coinsurance Amount Deductible Amount Diagnosis-Related Group (DRG) DRG Version Ambulatory Payment Classification (APC) APC Version National Drug Code (NDC) Billing Provider Number Diagnoses (Principal, Admitting, Reason for Visit, External Cause of Injury, Other) Present on Admission Indicators MHDO assigned Record Type Member Age (Calculated age for individuals 90 or over will be displayed as "90 or over".) MHDO assigned Record ID Number Medicare Coverage File ID MHDO assigned Provider ID Number Standardized Insurance Type/Product Code Year Paid Year Incurred Quarter Paid Quarter Incurred Rendering Provider Specialty Rendering Provider City Name Rendering Provider State or Province Rendering Provider Zip Code Data Processing Center Code Rendering Provider Taxonomy Code Rendering Provider Country Service Facility Location Name Service Facility NPI Service Facility Location Address Service Facility Location City Service Facility Location State or Province Service Facility Location Zip Code Service Facility Number Attending Provider Specialty Attending Provider City Name Attending Provider State or Province Attending Provider Zip Code Operating Provider City Name Operating Provider State or Province Referring Provider Zip Code Referring Provider City Name Referring Provider State or Province Referring Provider Zip Code In-Plan Network Flag Pharmacy Eligibility File Data Elements: MHDO assigned Submitter ID Number/Name MHDO assigned Payer ID Number/Name Payer NAIC Year Month Coverage Level Code Member Gender Member State or Province Medical Coverage Prescription Drug Coverage Dental Coverage Primary Insurance Indicator Coverage Type Market Category Code Record Type Member Age (Calculated age for individuals 90 or over will be displayed as "90 or over".) MHDO assigned Record ID Number Medicare Coverage File ID Standardized Insurance Individual Relationship Code Standardized Insurance Type/Product Code Duplicate Indicator Coverage Period (Year + Month)

Pharmacy Claims File Data Elements:

MHDO assigned Submitter ID Number/Name MHDO assigned Payer ID Number/Name Payer NAIC Claim Line Number Individual Relationship Code Member Gender Member State or Province Claim Status Drug Code Drug Name New Prescription or Refill Generic Drug Indicator Dispense as Written Code Compound Drug Indicator Quantity Dispensed Days' Supply Paid Amount Ingredient Cost/List Price Postage Amount Claimed Dispensing Fee Copay Amount Coinsurance Amount Deductible Amount Patient Pay Amount Record Type Member Age (Calculated age for individuals 90 or over will be displayed as "90 or over".) Record ID Number File ID Standardized Member Gender Standardized Insurance Type/Product Code MHDO Assigned Pharmacy ID Number Year Paid Year Incurred Quarter Paid Quarter Incurred Prescribing Physician ID Number Submitter Code MHDO Assigned DPC Code Pharmacy Number Pharmacy Name National Pharmacy ID Number Pharmacy Location City Pharmacy Location State Pharmacy ZIP Code Pharmacy Country Name In-Plan Network Flag

Dental Eligibility File Data Elements:

Dental Claims File Data Elements:

MHDO assigned Submitter ID Number/Name MHDO assigned Payer ID Number/Name Payer NAIC Individual Relationship Code Member Gender Member State or Province Facility Type - Professional Claims Status CDT Code Procedure Modifiers Paid Amount Copay Amount Coinsurance Amount Deductible Amount Billing Provider Number Record Type Member Age (Calculated age for individuals 90 or over will be displayed as "90 or over".) MHDO assigned Record ID Number MHDO assigned Provider ID Number File ID Standardized Insurance Type/Product Code Year Paid Year Incurred Quarter Paid Quarter Incurred Rendering Provider Specialty MHDO Assigned DPC Code Service Provider Taxonomy Code Service Provider Country Service Facility Location Name Service Facility NPI Service Facility Location Address Service Facility Location City Service Facility Location State or Province Service Facility Location Zip Code Service Facility Number In-Plan Network Flag

APPENDIX A.2 Hospital Encounter Data Elements

Hospital Inpatient Data Elements:

MHDO Assigned Record ID MHDO Assigned Record Sequence Number MHDO assigned Payer ID Number/Name Payer NAIC Hospital Code Patient Gender Patient Age (Calculated age for individuals 90 or over will be displayed as "90 or over".) Priority of Visit (Type) Point of Origin of Admission (Source) Admitting Diagnosis Patient Hospital Service Area Patient Health Planning Area Patient State Admission Year Admission Quarter Discharge Year Discharge Quarter Patient Discharge Status MHDO Assigned Payer Code(s) Diagnosis Code(s) Procedure Code(s) MHDO-assigned Attending Provider Specialty Code MHDO-assigned Operating Provider Specialty Code Accommodations Revenue Code(s) Accommodations Units DRG and MDC Code(s) Length of Stay Estimated Birth Weight (< 30 Days Old) Ancillary Revenue Code(s) Total Number of Ancillary Revenue Code(s) MHDO assigned Attending Physician Code MHDO assigned Operating Provider Code Attending Physician Taxonomy Surgeon/Other Provider Taxonomy Hospital Outpatient and Emergency Department Data Elements: MHDO Assigned Record ID MHDO Assigned Record Sequence Number MHDO assigned Payer ID Number/Name Payer NAIC Hospital Code Location of Service Patient Gender Patient Age (Calculated age for individuals 90 or over will be displayed as "90 or over".) Patient State Hospital Service Area of Patient Health Planning Area of Patient Date of Service From (Year and Quarter) Date of Service Thru (Year and Quarter) Bill Type Patient Discharge Status Point of Origin Diagnosis Code(s) Procedure Code(s) Service Date(s) (Year and Quarter) MHDO-assigned Attending Provider Specialty Code MHDO-assigned Operating Provider Specialty Code MHDO assigned Payer Code(s) Revenue Code(s) Modifier(s) Number of Detail Records Units MHDO Assigned Emergency Department Indicator MHDO assigned Attending Physician Code MHDO assigned Operating Provider Code Attending Physician Taxonomy Surgeon/Other Provider Taxonomy

APPENDIX A.3 Provider DATABASE

The MHDO Provider Database includes relational and organizational information on health systems and facilities in Maine, including but not limited to hospitals, physician practices, specialty care practices, primary care practices, behavioral health service providers, chiropractors and MaineCare providers. These data can be accessed as standalone data files or can be joined to other MHDO data files that include provider information.

Data elements are:

Entity Name Entity ID Entity Type Facility National Provider Identifier (NPI) Facility On CompareMaine Entity Physical Address Entity Phone Number Entity Fax Number Entity Website Entity Hospital Service Area Entity County Entity Latitude Entity Longitude Entity Relationship Entity Last Updated Date Provider National Provider Identifier Provider ID Provider Prefix Provider First Name Provider Middle Name or Initial Provider Last Name Provider Suffix Provider Credential Provider Office Street Address Provider County Provider Phone Number Provider Fax Number Provider Website Provider NPI Last Update Date NPI Provider Enumeration Date NPI Provider Deactivation Date NPI Provider Deactivation Reason Code NPI Provider Certification Date NPI Provider Gender Provider Specialties Provider Employment Start Date Provider Employment End Date

APPENDIX A.4 Hospital Quality Data XE "APPENDIX A.4 Hospital Quality Data"

Hospital Quality Data includes the following data elements:

Healthcare Associated Infections (HAI)

Measure	Measure Overview	Numerator	Denominator
HAI-1	Central line catheter associated blood stream infection rate for intensive care unit patients	Number of infections	Number of central line days
HAI-2	Central line catheter associated blood stream infection rate for high-risk nursery patients All birth weight categories	Number of infections	Number of catheter days
HAI-6	Catheter-associated urinary tract infection rates	Number of infections	Number of catheter days
HAI-7	Surgical Site Infection rate for patients undergoing inpatient knee prosthesis (arthroplasty of knee) surgical procedures	Number of infections	Number of operative procedures
HAI-8	Surgical Site Infection rate for patients undergoing inpatient hip prosthesis (arthroplasty of hip) surgical procedures	Number of infections	Number of operative procedures
LabID Events
MRSA	Healthcare-associated Methicillin-Resistant Staphylococcus aureus (MRSA) bloodstream events (a MRSA event is a laboratory discovery of MRSA bacteria in a patient's blood sample)	Number of LabID events	Number of patient days
C.diff.	Healthcare-associated Clostridioides difficile (C.diff.) LabID events (a laboratory discovery of C.diff. bacteria in a patient's loose stool)	Number of LabID events	Number of patient days

Nursing Sensitive Indicators (NSI)

Measure	Measure Overview	Numerator	Denominator
NSPC1	Percentage of inpatients who have a hospital-acquired Stage 1 or greater pressure ulcer	Number of inpatients w/ Stage 2 or higher hospital acquired pressure ulcer	Number of inpatients in the prevalence study
NSPC2	Number of inpatient falls per inpatient day	Number of falls	Number of inpatient days
NSPC3	Number of inpatient falls with injuries per inpatient day	Number of falls with injury	Number of inpatient days

APPENDIX A.5 Non-Claims-Based Payments Data

Non-claims-based payments data includes the following aggregated data elements:

Insurance Type/Product Code Total Number of Members Total Member Months Total Dollars Non-Claims-Based Payments Total Dollars Non-Claims-Based Payments (Primary Care Only/Portion)

C.M.R. 90, 590, ch. 120, app 590-120-A