Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 120 - RELEASE OF DATA TO THE PUBLIC › Appendix 590-120-B - DATA ELEMENTS RELEASED IN LEVEL II FILE- LIMITED DATA

Current through 2024-29, July 17, 2024
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