Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 590 - MAINE HEALTH DATA ORGANIZATION › Chapter 241 - UNIFORM REPORTING SYSTEM FOR HOSPITAL INPATIENT DATA SETS AND HOSPITAL OUTPATIENT DATA SETS › Section 590-241-1 - Definitions

Current through 2024-29, July 17, 2024
Unless the context indicates otherwise, the following words
				  and phrases shall have the following meanings:
A.
Attending Provider
. Attending
				Provider is the individual who has overall responsibility for the patient's
				medical care and treatment reported in this claim.
B.
Billing Provider
. Provider
				submitting the bill.
C.
Designee
. "Designee" means an entity with which the MHDO has
				entered into an arrangement under which the entity performs data collection,
				validation and management functions for the MHDO and is strictly prohibited
				from releasing information obtained in such a capacity if the information is
				not authorized for release by the MHDO.
D.
Carrier
. "Carrier" means an
				insurance company licensed in accordance with 24-A M.R.S.A., including a health
				maintenance organization, a multiple employer welfare arrangement licensed
				pursuant to Title 24-A, chapter 81, a preferred provider organization, a
				fraternal benefit society, or a nonprofit hospital or medical service
				organization or health plan licensed pursuant to 24 M.R.S.A. An employer
				exempted from the applicability of 24-A M.R.S.A., chapter 56-A under the
				federal
Employee Retirement Income Security Act of 1974
,
				29 United States
				Code, Sections 1001 to
				1461
				(1988) is not considered a carrier.
E.
External Causes Codes
.
				"External causes codes" in ICD-10 are codes designed to provide data for injury
				research and evaluation of injury prevention strategies. These codes capture
				how the injury or health condition occurred (cause), the intent (unintentional
				or accidental; or intentional, such as suicide or assault), the place where the
				event occurred, the activity of the patient at the time of the event and the
				person's status (e.g. civilian, military).
F.
Hospital.
"Hospital" means
				any acute care institution required to be licensed pursuant to 22 M.R.S.A.,
				chapter 405.
G.
Hospital
				Inpatient Data
. "Hospital inpatient data" pertains to the information
				generated at the time of discharge which is associated with patients who are
				provided with room, board, and continuous nursing service based on a
				physician's written order in an area of the hospital where patients generally
				stay more than twenty-four hours.
H.
Hospital Outpatient Data
.
				"Hospital outpatient data" pertains to the data generated for any patient visit
				that is not considered an inpatient admission, at any department of the
				hospital, regardless of its physical location. Hospital Outpatient Data also
				includes services provided by specialty groups or primary care practices when
				the hospital owns the data.
I.
MHDO
. "MHDO" means the Maine Health Data Organization.
J.
M.R.S.A.
"M.R.S.A." means
Maine Revised Statutes Annotated
.
K.
National Provider Identifier
				(NPI)
. The unique identification number assigned to the
				provider
L.
Operating
				Physician
. Operating Physician is the individual with the primary
				responsibility for performing the surgical procedures(s).
M.
Rendering Provider
. The
				Rendering Provider is the person or company (laboratory or other facility) who
				rendered the care.
N.
Third-party Administrator
. "Third-party administrator" means any
				person licensed by the Maine Bureau of Insurance under 24-A M.R.S.A., chapter
				18 who, on behalf of a plan sponsor, health care service plan, nonprofit
				hospital or medical service organization, health maintenance organization or
				insurer, receives or collects charges, contributions or premiums for, or
				adjusts or settles claims on residents of this State.