Data Submission and Quality Standards Guide for Health Care Carriers' Claims Data Sets
Under 129 CMR 2.0, health insurance carriers must submit medical claims, eligibility and pharmacy data for fully insured Massachusetts residents to the Health Care Quality and Cost Council. On July 1, 2009, the Division of Health Care Finance and Policy assumed responsibility for receiving secure file transmissions, creating, maintaining and applying edit criteria; storing the edited data and creating analytical public use files. The data files produced from these submissions serve as the basis for cost and quality measures reported on the Health Care Quality and Cost Council’s website, My Health Care Options (www.mass.gov/myhealthcareoptions).The Council’s regulations state that the data may be used in research projects that serve the public interest.
As of July 1, 2009, this Data Submission and Quality Standards Guide (“DSG”) serves as the Statistical Plan required under 129 CMR 2.08. The purpose of this document is to provide data submitters with a consolidated source of information about the intake and edit process for these data sets. Some of the information in this document was originally contained in 129 CMR 2.09. This Data Submission and Quality Standards Guide also replaces the specifications formerly found in the HCQCC’s Data Dictionary and the previous edition of the Statistical Plan, both of which were prepared by the Maine Health Information Center in November 2007.
This DSG will be updated on an as needed basis or at least once per year by the Division. Notes, updates and known issues with the data tables will be noted on a table at the end of this document (Attachment 1). Please review the Attachment at least annually for references to changes within the document.
Data Submission and Quality Standards Guide for Health Care Carriers’ Claims Data Sets submitted under 129 CMR 2.00 (PDF) | Word
This information is provided by the Health Care Quality and Cost Council.