Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 243 - UNIFORM REPORTING SYSTEM FOR HEALTH CARE CLAIMS DATA SETS › Appendix 590-243-A - Maine Health Data Organization Source Codes

Current through 2024-29, July 17, 2024
(with references to specific MHDO data elements by
				  file type)
American Dental Association
Current Dental Terminology (CDT) Codes
(MHDO Data Element: DC032, MC055)
SOURCE: Current Dental Terminology (CDT) Manual
AVAILABLE FROM:
American Dental Association
211 East Chicago Avenue
Chicago, IL 60611-2678
ABSTRACT: The CDT contains the American Dental Association's
				  codes for dental procedures and nomenclature and is the nationally accepted set
				  of numeric codes and descriptive terms for reporting dental treatments.
American Medical Association
Current Procedural Terminology (CPT)
				  Codes
(MHDO Data Element: MC055)
SOURCE: Physicians' Current Procedural Terminology (CPT)
				  Manual
AVAILABLE FROM:
American Medical Association
515 North State Street
Chicago, IL 60654
ABSTRACT: A listing of descriptive terms and identifying
				  codes for reporting medical services and procedures performed by
				  physicians.
Accredited Standards Committee (ASC)
ASC X12 Directories
(MHDO Data Elements: CF003, CF015, DC003, DC011, DC012,
				  DC021, DC031, MC003, MC011, MC012, MC027, MC038, ME003, ME007, ME012, ME013,
				  PC003, PC025)
SOURCE: Complete ASC X12 005010 Standard
AVAILABLE FROM:
https://www.nex12.org/_
Data Interchange Standards Association, Inc. (DISA)
7600 Leesburg Pike Ste 430
Falls Church, VA 22043
ABSTRACT: The complete standard includes design rules and
				  guidelines, control standards, transaction set tables, data element dictionary,
				  segment directory and code sources. The data element dictionary contains the
				  format and descriptions of data elements used to construct X12 segments. It
				  also contains code lists associated with these data elements. The segment
				  directory contains the format and definitions of the data segments used to
				  construct X12 transaction sets.
Canada Post
Canadian Provinces
(MHDO Data Elements: CF033, DC015, DC028, DC049, DC056,
				  MC015, MC083, MC090, ME016, PC015, PC023)
Cities and ZIP Code
(MHDO Data Elements: CF032, CF034, DC014, DC016, DC027,
				  DC029, DC048, DC050, DC055, DC057, MC014, MC016, MC082, MC084, MC089, MC091,
				  ME015, ME017, PC014, PC016, PC022, PC024)
SOURCE: Canada Post
AVAILABLE FROM:
http://www.canadapost.ca/
Centers for Disease Control and
				  Prevention
HL7/CDC Race and Ethnicity Code Set
(MHDO Data Element: ME021, ME022, ME023, ME024, ME025,
				  ME026, ME027)
SOURCE: Race and Ethnicity Code Set
AVAILABLE FROM:
http://www.cdc.gov/nchs/data/dvs/Race_Ethnicity_CodeSet.pdf
Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30329-4027
ABSTRACT: The race and ethnicity code set to be used for
				  coding the race and ethnicity of members.
Centers for Medicare and Medicaid
				  Services
Health Care Common Procedural Coding
				  System
(MHDO Data Element: MC055)
SOURCE: Health Care Common Procedural Coding System
AVAILABLE FROM:
www.cms.gov/HCPCSReleaseCodeSets/
Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244-1850
ABSTRACT: HCPCS is the Centers for Medicare and Medicaid
				  Services (CMS) coding scheme to group procedures performed for payment to
				  providers.
Health Insurance Prospective Payment System
				  (HIPPS)
(MHDO Data Element: MC055)
SOURCE: Center for Medicare & Medicaid Services
AVAILABLE FROM:
http://www.cms.gov/Medicare/Medicare-fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/HIPPSCodes.html
Center for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244
ABSTRACT: Health Insurance Prospective Payment System (HIPPS)
				  rate codes represent specific sets of patient characteristics (or case-mix
				  groups) on which payment determinations are made under several prospective
				  payment systems. Case-mix groups are developed based on research into
				  utilization patterns among various provider types. For the payment systems that
				  use HIPPS codes, clinical assessment data is the basic input used to determine
				  which case-mix group applies to a particular patient. A standard patient
				  assessment instrument is interpreted by case-mix grouping software algorithms,
				  which assign the case mix group. For payment purposes, at least one HIPPS code
				  is defined to represent each case-mix group. These HIPPS codes are reported on
				  claims to insurers.
National Provider Identifier
(MHDO Data Elements: CF020, CF025, DC020, DC043, MC026,
				  MC077, MC086, MC108, MC115, MC121, PC021, PC048)
SOURCE: National Provider System
AVAILABLE FROM:
Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244-1850
ABSTRACT: The Centers for Medicare and Medicaid Services
				  developed the National Provider Identifier as the standard, unique identifier
				  for each health care provider under the Health Insurance Portability and
				  Accountability Act of 1996.
Place of Service Codes for Professional
				  Claims
(MHDO Data Element: DC030, MC037)
SOURCE: Place of Service Codes for Professional Claims
AVAILABLE FROM:
https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set
Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244-1850
ABSTRACT: The place of service code identifies the location
				  where the healthcare service was rendered.
International Country Codes
(MHDO Data Elements: ME109, MC093, MC094, MC329,
				  PC024A, PC109, DC109)
SOURCE:
https://www.nationsonline.org/oneworld/country_code_list.htm
ABSTRACT: The ISO country codes are internationally
				  recognized codes that designate each country and most of the dependent areas
				  with a two- or three-letter combination or a numeric code.
National Council for Prescription Drug
				  Programs
National Association of Boards of Pharmacy
				  Number
(MHDO Data Element: PC018)
SOURCE: National Association of Boards of Pharmacy Database
				  and Listings
AVAILABLE FROM:
www.ncpdp.org
National Council for Prescription Drug Programs
9240 East Raintree Drive
Scottsdale, AZ 85260-7518
ABSTRACT: A unique number assigned in the U.S. and its
				  territories to individual clinic, hospital, chain, and independent pharmacy
				  locations that conduct business at retail by billing third-party drug benefit
				  payors. The National Council for Prescription Drug Programs (NCPDP) maintains
				  this database under contract from the National Association of Boards of
				  Pharmacy. The National Association of Boards of Pharmacy is a seven-digit
				  numeric number with the following format SSNNNNC, where SS=NCPDP assigned state
				  code number, NNNN=NCPDP assigned pharmacy location number, and C=check digit
				  calculated by algorithm from previous six digits.
Uniform Healthcare Payor Data
(MHDO Data Elements: PC011, PC012, PC030)
SOURCE: NCPDP Uniform Healthcare Payor Data Standard
				  Implementation Guide
AVAILABLE FROM:
www.ncpdp.org
National Council for Prescription Drug Programs
9240 East Raintree Drive
Scottsdale, AZ 85260
ABSTRACT: This standard is intended to meet an industry need
				  to supply detailed drug or utilization claim information from adjudicated
				  claims that processors/payors or their clients report to States or their
				  Agents.
National Uniform Billing Committee (NUBC)
NUBC Codes
(MHDO Data Elements: MC020, MC021, MC023, MC036, MC054,
				  MC201, MC207, MC209, MC211, MC213, MC215, MC217, MC219, MC221, MC223, MC225,
				  MC227, MC229, MC231, MC233, MC235, MC237, MC239, MC241, MC243, MC245, MC247,
				  MC249, MC251, MC255, MC257, MC259, MC261, MC263, MC265, MC267, MC269, MC271,
				  MC273, MC275, MC277, MC279, MC281, MC283, MC285, MC287, MC289, MC291, MC293,
				  MC295, MC297, MC299, MC301)
SOURCE: National Uniform Billing Committee Official Data
				  Specifications Manual
AVAILABLE FROM:
National Uniform Billing Committee
American Hospital Association
155 N Wacker Drive
Chicago, IL 60606
ABSTRACT: This serves as the official source of information
				  for institutional health care billing. It contains all billing conventions and
				  codes, including form locators, data element descriptions, definitions,
				  reporting requirements, field attributes, approval and effective dates, and
				  revenue, condition, occurrence, and value codes.
National Uniform Claim Committee
Healthcare Provider Taxonomy Code Set
(MHDO Data Element: CF017, DC026, MC032,
				  MC113)
SOURCE: Washington Publishing Company
MAINTAINED BY: National Uniform Claim Committee
https://www.cms.gov/medicare/provider-enrollment-and-certification/medicareprovidersupenroll/taxonomy.html
AVAILABLE FROM: Washington Publishing Company
https://www.wpc-edi.com/products/code-lists/
ABSTRACT: The Healthcare Provider Taxonomy Code Set is a
				  hierarchical code set that consists of codes, descriptions, and definitions.
				  Healthcare Provider Taxonomy Codes are designed to categorize the type,
				  classification, and/or specialization of health care providers. The Code Set
				  consists of two sections: Individuals and Groups of Individuals, and
				  Non-Individual.
United States Food and Drug
				  Administration
National Drug Codes
(MHDO Data Element: PC026, MC075)
SOURCE: National Drug Data File
AVAILABLE FROM:
http://www.fda.gov
or
http://www.accessdata.fda.gov/scripts/cder/ndc/default.cfm
U.S. Food and Drug Administration
Center for Drug Evaluation and Research
Division of Data Management and Services
10903 New Hampshire Avenue
Silver Spring, MD 20993
ABSTRACT: The National Drug Code is a coding convention
				  established by the Food and Drug Administration to identify the labeler,
				  product number, and package sizes of FDA-approved prescription drugs. There are
				  over 170,000 National Drug Codes on file.
United States Postal Service
States and Outlying Areas of the U.S.
(MHDO Data Elements: CF033, DC015, DC028, DC049, DC056,
				  MC015, MC083, MC090, ME016, PC015, PC023)
ZIP Code
(MHDO Data Elements: CF032, CF034, DC014, DC016, DC027,
				  DC029, DC048, DC050, DC055, DC057, MC014, MC016, MC082, MC084, MC089, MC091,
				  ME015, ME017, PC014, PC016, PC022, PC024)
SOURCE: United States Postal Service
AVAILABLE FROM:
https://www.usps.com
U.S. Postal Service
National Information Data Center
P.O. Box 9408
Gaithersburg, MD 20898-9408
Or
https://ribbs.usps.gov/index.cfm?page=address_manage_quality
Address Information Systems Products
National Customer Support Center
U.S. Postal Service
6060 Primacy Pkwy Ste 231
Memphis, TN 38119-5772
ABSTRACT: Provides names, abbreviations, and codes for the 50
				  states, the District of Columbia, and the outlying areas of the U.S. The ZIP
				  Code is a geographic identifier of areas within the United States and its
				  territories for purposes of expediting mail distribution by the U.S. Postal
				  Service. It is five or nine numeric digits. The ZIP Code structure divides the
				  U.S. into ten large groups of states. The leftmost digit identifies one of
				  these groups. The next two digits identify a smaller geographic area within the
				  large group. The two right-most digits identify a local delivery area. In the
				  9-digit ZIP Code, the four digits that follow the hyphen further subdivide the
				  delivery area. The two leftmost digits identify a sector which may consist of
				  several large buildings, blocks or groups of streets. The rightmost digits
				  divide the sector into segments such as a street, a block, a floor of a
				  building, or a cluster of mailboxes.
World Health Organization (WHO)
International Classification of Diseases,
				  10th Edition, Clinical Modification/Procedure Coding
				  System (ICD-10-CM/PCS)
(MHDO Data Elements: MC200, MC202, MC203, MC204, MC205,
				  MC206, MC208, MC210, MC212, MC214, MC216, MC218, MC220, MC222, MC224, MC226,
				  MC228, MC230, MC232, MC234, MC236, MC238, MC240, MC242, MC244. MC246, MC248,
				  MC250, MC252, MC254, MC256, MC258, MC260, MC262, MC264, MC266, MC268, MC270,
				  MC272, MC274, MC276, MC278, MC280, MC282, MC284, MC286, MC288, MC290, MC292,
				  MC294, MC296, MC298, MC300, MC302, MC303, MC304, MC305, MC306, MC307, MC308,
				  MC309, MC310, MC311, MC312, MC313, MC314, MC315, MC316, MC317, MC318, MC319,
				  MC320, MC321, MC322, MC323, MC324, MC325, MC326)
SOURCE: International Classification of Diseases,
				  10th Revision, (ICD-10-CM/PCS)
AVAILABLE FROM:
http://www.cdc.gov/nchs/icd/icd9cm.htm#9update
WHO Publications Center AUS
49 Sheridan Avenue
Albany, NY 12210
ABSTRACT: The International Classification of Diseases,
				  10th Revision, is used to report medical diagnosis
				  and inpatient procedures. ICD-10-CM is for use in all U.S. health care
				  settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3
				  to 5 digits used with ICD-9-CM, but the format of the code sets is similar.
				  ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10PCS uses
				  7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM
				  procedure coding. Coding under ICD-10-PCS is much more specific and
				  substantially different from ICD-9-CM procedure coding. The transition to
				  ICD-10 is occurring because ICD-9 produces limited data about patients' medical
				  conditions and hospital inpatient procedures. ICD-9 is 30 years old, has
				  outdated terms, and is inconsistent with current medical practice. Also, the
				  structure of ICD-9 limits the number of new codes that can be created, and many
				  ICD-9 categories are full.