Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 120 - RELEASE OF DATA TO THE PUBLIC › Appendix 590-120-A - DATA ELEMENTS RELEASED IN LEVEL I FILE- DE-IDENTIFIED DATA

Current through 2024-29, July 17, 2024
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:
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)
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
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
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)