Code of Massachusetts Regulations › 129 CMR - HEALTH CARE QUALITY AND COST COUNCIL › Title 129 CMR 3.00 - Disclosure Of Health Care Claims Data › Section 3.03 - Data Release Review Board and Review Procedures

Current through Register 1525, July 5, 2024
(1)
Public Use Files
. The Council shall create three public use files of the Health Care Claims Data, including the Member Eligibility (ME) data, Medical Claims (MC) data, and Pharmacy Claims (PC) data.
(a)
Level 1
. The Level 1 file includes the following Data Elements:
Data Element #
Data Element Name
ME003
Insurance Type
ME004
Year of Reported Eligibility
ME005
Month of Reported Eligibility
ME007
Coverage Level Code
ME012
Individual Relationship Code
ME013
Member Gender
ME016
Member State or Province
ME018
Medical Coverage -Yes/No
ME019
Prescription Drug Coverage -Yes/No
ME020
Race 1
ME021
Race 2
ME022
Other Race
ME023
Hispanic Indicator -Yes/No
ME024
Ethnicity 1
ME025
Ethnicity 2
ME026
Other Ethnicity
MC003
Insurance Type/Product Code
MC011
Individual Relationship Code
MC012
Member Gender
MC019
Admission Hour
MC020
Admission Type
MC021
Admission Source
MC022
Discharge Hour
MC023
Discharge Status Length of Stay (LOS)
MC027
Service Provider Entity Type Qualifier
MC031
Service Provider Suffix
MC034
Service Provider State
MC035A
Service Provider Country Name
MC036
Type of Bill -on Facility Claims
MC037
Site of Service -on NSF/CMS 1500 Claims
MC038
Claim Status
MC039
Admitting Diagnosis
MC040
E-Code
MC041
Principal Diagnosis
MC042
Other Diagnosis -1
MC043
Other Diagnosis -2
MC044
Other Diagnosis -3
MC045
Other Diagnosis -4
MC046
Other Diagnosis -5
MC047
Other Diagnosis -6
MC048
Other Diagnosis -7
MC049
Other Diagnosis -8
MC050
Other Diagnosis -9
MC051
Other Diagnosis -10
MC052
Other Diagnosis -11
MC053
Other Diagnosis -12
MC054
Revenue Code
MC055
Procedure 1 Code
MC056
Procedure 1 Modifier- 1
MC057
Procedure 1 Modifier -2
MC058
ICD-9-CM Procedure 1 Code
MC061
Quantity
MC065
Copay Amount
MC067
Deductible Amount
PC003
Insurance Type/Product Code
PC011
Individual Relationship Code
PC012
Member Gender
PC017
Date Service Approved (AP Date)
PC024A
Pharmacy Country Name
PC025
Claim Status
PC026
Drug Code
PC027
Drug Name
PC028
New Prescription
PC028A
Refill Number
PC029
Generic Drug Indicator
PC030
Dispense as Written Code
PC031
Compound Drug Indicator
PC033
Quantity Dispensed
PC034
Days Supply
PC037
Average Wholesale Price (AWP)
PC038
Postage Amount Claimed
PC039
Dispensing Fee
PC040
Copay Amount
PC042
Deductible Amount
(b)
Level 2
. The Level 2 file includes all the data elements in Level 1 plus the following data elements:
Data Element #
Data Element Name
ME001
Payer
ME002
National Plan ID
ME008
Encrypted Subscriber Unique Identification Number
ME009
Plan Specific Contract Number
ME010
Member Suffice or Sequence Number
ME011
Member Identification Code
Member Age in Years
Member Age in Months
ME015
Member City Name
ME017
Member ZIP Code
MC001
Payer
MC002
National Plan ID
MC004
Payer Claim Control Number
MC005
Line Counter
MC005A
Version Number
MC007
Encrypted Subscriber Unique Identification Number
MC008
Plan Specific Contract Number
MC009
Member Suffix or Sequence Number
MC010
Member Identification Code
MC014
Member City Name
MC015
Member State or Province
MC016
Member ZIP Code
MC017
Date Service Approved (AP Date)
MC018
Admission Date
MC022A
Discharge Date
Member Age in Years at Discharge
Member Age in Months at Discharge
MC024
Service Provider Number
MC025
Service Provider Tax ID Number
MC026
National Service Provider ID
MC028
Service Provider First Name
MC029
Service Provider Middle Name
MC030
Service Provider Last Name or Organization Name
MC032
Service Provider Specialty
MC033
Service Provider City Name
MC035
Service Provider ZIP Code
MC059
Date of Service -From
MC060
Date of Service -Thru
MC062
Charge Amount
MC063
Paid Amount
MC064
Prepaid Amount
MC066
Coinsurance Amount
(c) Level 3. The Level 3 file includes all the data elements in Level 2 plus the following data elements:
Data Element #
Data Element Name
ME006
Insured Group or Policy Number
ME014
Member Date of Birth
MC006
Insured Group or Policy Number
MC013
Member Date of Birth
PC006
Insured Group Number
PC013
Member Date of Birth