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

Current through 2024-51, December 18, 2024

Appendix 590-120-B - DATA ELEMENTS RELEASED IN LEVEL II FILE- LIMITED DATA

Level II Limited Data includes the data listed in Appendix A, plus the data elements in Appendix B.

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

Hospital Encounter Data includes Inpatient and Outpatient and Emergency Department data files (B.2)

Level II Data sets also include Hospital Financial Data (B.3), Cancer-Incidence Registry Data (B.4), Vital Statistics Birth Data (B.5), and Vital Statistics Death Data (B.6)

APPENDIX B.1 APCD DATA ELEMENTS

Medical Eligibility File Data Elements:

Member County MHDO assigned replacement for subscriber's Social Security Number MHDO assigned replacement for member's contract number MHDO assigned replacement for member's Social Security Number MHDO assigned Member ID MHDO assigned Person ID Member Date of Birth Member Race Member Ethnicity Member City Member Zip Code Member FIPS Code

Medical Claims File Data Elements:

Member County Date Service Approved (AP Date) Admission Date Admission Hour Discharge Hour Date of Service From (Year/Month/Day) Date of Service Thru (Year/Month/Day) Discharge Date Month Paid Month Incurred MHDO Assigned Replacement for Payer's Claim ID MHDO assigned replacement for subscriber's Social Security Number MHDO assigned replacement for member's contract number MHDO assigned replacement for member's Social Security Number MHDO assigned Member ID MHDO assigned Person ID Member Date of Birth Member Race Member Ethnicity Member City Member Zip Code Member FIPS Code

Pharmacy Eligibility File:

Member County MHDO assigned replacement for subscriber's Social Security Number MHDO assigned replacement for member's contract number MHDO assigned replacement for member's Social Security Number MHDO assigned Member ID MHDO assigned Person ID Member Date of Birth Member Race Member Ethnicity Member City Member Zip Code Member FIPS Code

Pharmacy Claims File Data Elements:

Member County Date Service Approved (AP Date) Date Prescription Filled Month Paid Month Incurred MHDO Assigned Replacement for Payer's Claim ID MHDO assigned replacement for subscriber's Social Security Number MHDO assigned replacement for member's contract number MHDO assigned replacement for member's Social Security Number MHDO assigned Member ID MHDO assigned Person ID Member Date of Birth Patient Race Patient Ethnicity Member City Member Zip Code Member FIPS Code

Dental Eligibility File Data Elements:

Member County MHDO assigned replacement for subscriber's Social Security Number MHDO assigned replacement for member's contract number MHDO assigned replacement for member's Social Security Number MHDO assigned Member ID MHDO assigned Person ID Member Date of Birth Member Race Member Ethnicity Member City Member Zip Code Member FIPS Code

Dental Claims File Data Elements:

Member County Date Service Approved (AP Date) Date of Service From (Year/Month/Day) Date of Service Thru (Year/Month/Day) Month Paid Month Incurred MHDO Assigned Replacement for Payer's Claim ID MHDO assigned replacement for subscriber's Social Security Number MHDO assigned replacement for member's contract number MHDO assigned replacement for member's Social Security Number MHDO assigned Member ID MHDO assigned Person ID Member Date of Birth Member Race Member Ethnicity Member City Member Zip Code Member FIPS Code

APPENDIX B.2 HOSPTIAL ENCOUNTER DATA ELEMENTS

Hospital Inpatient Data Elements:

MHDO assigned replacement for Medical Record Number MHDO assigned Person ID Patient County Admission Date Admission Hour Discharge Date Discharge Hour Procedure Code Date(s) Patient Date of Birth Patient Race Patient Ethnicity Patient City Patient Zip Code Patient FIPS Code

Hospital Outpatient and Emergency Department Data Elements:

MHDO assigned replacement for Medical Record Number MHDO assigned Person ID Patient County Date of Service From Date of Service Thru Procedure Code Date(s) Patient Date of Birth Patient Race Patient Ethnicity Patient City Patient Zip Code Patient FIPS Code

APPENDIX B.3 HOSPITAL FINANCIAL DATA

Hospital financial data includes audited financial statements from the hospital and parent entity (if applicable). These financial statements include a balance sheet, income statement, statement of changes in net assets, and cash flow statements in PDF format.

APPENDIX B.4 CANCER-INCIDENCE REGISTRY DATA ELEMENTS

These data can be released once integrated with MHDO's claims or hospital data sets.

MHDO Assigned Person ID Date of Birth Address at Diagnosis; including

o City or Town of Residence

o County of Residence

o State of Residence

o Zip Code

o Registrant's FIPS Code

Sex/Gender Race Attending Physician Referring Physician Date of Diagnosis Topography of Cancer (ICD) Morphology of Cancer (ICD) Usual Occupation Usual Industry Stage of Disease at Diagnosis (AJCC coding system) Date of Admission Laterality Grade Spanish/Hispanic Origin Diagnostic Confirmation Summary Stage Date of First Course of Treatment (when available in the medical record) Type of First Course of Treatment (when available in the medical record)

APPENDIX B.5 VITAL STATISTICS BIRTH DATA ELEMENTS

These data can be released once integrated with MHDO's claims or hospital data sets.

MHDO Assigned Person ID Date of Birth Sex/Gender Race Hispanic Indicator Event Location

o City or Town

o County o State

o Zip Code

o FIPS Code

Registrant's Parent's(s')

o Date of Birth

o Sex/Gender

o Race

o Hispanic Indicator

o Residence City or Town

o Residence County

o Residence State

o Residence Zip Code

o Residence FIPS Code

APPENDIX B.6 VITAL STATISTICS DEATH DATA ELEMENTS

These data can be released once integrated with MHDO's claims or hospital data sets.

MHDO Assigned Person ID Date of Birth Sex/Gender Race Hispanic Indicator Residence City or Town Residence County Residence State Residence Zip Code Residence FIPS Code Event Location

o City or Town

o County

o State

o Zip Code

o FIPS Code

Cause of death ICD 10 code

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