APCD Regulations
Self-Insured Data Submissions
User Submission Guides
User Guide for QA Profile Reports 
APCD FAQ
Technical Advisory Group (TAG)


 APCD Regulations

Regulation 114.5 CMR 21.00 - Health Care Payer Claims Data Submission
This regulation governs the reporting requirements for health care payers to submit data to CHIA. The regulation also govern the submission of data and other information concerning the costs and utilization of health care in Massachusetts and set forth the requirement for and format of the submission of data by payers.

Administrative Bulletin 13-04: Health Care Payers Claims Data Submission - Changes to Guidelines (Effective May 9, 2013)


 Self-Insured Data Submissions

Administrative Bulletin 10-14 pdf format of 1014.pdf
clarifies the reporting requirements for private health care payers under 114.5 CMR 21.00. It is CHIA's position that the claims data submission requirements for self-insured plans are not preempted by federal law. Therefore, payers must submit the required claims data for self-insured claims and information.


 All-Payer Claims Database User Submission Guides

User Submission Guides
Format
Edits
 The following files pertain to Administrative Bulletin 13-02 and 13-04 for data reporting submissions effective November 1, 2013
Benefit Plan Control Total File Submission Guide
(Added June 2013)
PDF pdf format of apcd-benefit-plan-control-total-file-submission-guide
| Word docx format of apcd-benefit-plan-control-total-file-submission-guide
 
Medical Claims File Submission Guide
(Updated June 2013)
PDF pdf format of v3.1_apcd-medical-claim-file-submission-guide-2013-06
| Word docx format of v3.1_apcd-medical-claim-file-submission-guide-2013-06.docx
 
Pharmacy Claims File Submission Guide
(Updated June 2013)
PDF pdf format of v3.1_apcd-pharmacy-claim-file-submission-guide-2013-06
| Word docx format of v3.1_apcd-pharmacy-claim-file-submission-guide-2013-06
 
Dental Claims File Submission Guide
(Updated June 2013)
PDF pdf format of v3.1_apcd-dental-claim-file-submission-guide-2013-06.pd
| Word docx format of v3.1_apcd-dental-claim-file-submission-guide-2013-06.do
 
Member Eligibility File Submission Guide
(Updated June 2013)
PDF pdf format of v3.1_apcd-member-eligibility-file-submission-guide-2013
| Word doc format of v3.1_apcd-member-eligibility-file-submission-guide-2013
 
Product File Submission Guide
(Updated June 2013)
PDF pdf format of v3.1_apcd-product-file-submission-guide-2013-06
| Word docx format of v3.1_apcd-product-file-submission-guide-2013-06
 
Provider File Submission Guide
(Updated June 2013)
PDF pdf format of v3.1_apcd-provider-file-submission-guide-2013-06
| Word docx format of v3.1_apcd-provider-file-submission-guide-2013-06
 
Question and Answer Document
(Updated January 31, 2013)
Excel xlsx format of MA_APCD_Admin_Bull_QA_20130131.xls
(Note: This document will be updated as needed)
Total Medical Expenses Reporting in APCD Update
(Updated February 2013)
PDF pdf format of APCD TME Carrier Memo General Final 130205.pdf
| Word docx format of APCD TME Carrier Memo General Final 130205.doc
 
 The following files pertain to data reporting submissions through October 2013
Medical Claims File Submission Guide PDF pdf format of apcd_medical_claim_file_submission_guide_12-2010.p
/ Word doc format of apcd_medical_claim_file_submission_guide_12-2010.d
Zip File zip format of medical-claims.zip
Pharmacy Claims File Submission Guide PDF pdf format of apcd_pharmacy_claim_file_submission_guide_12-2010.
/ Word doc format of apcd_pharmacy_claim_file_submission_guide_12-2010.
Zip File zip format of pharmacy-claims.zip
Dental Claims File Submission Guide PDF pdf format of apcd_dental_claim_file_submission_guide_12-2010.pd
/ Word doc format of apcd_dental_claim_file_submission_guide_12-2010.do
Zip File zip format of dental-claims.zip
Member Eligibility File Submission Guide PDF pdf format of apcd_member_eligibility_file_submission_guide_12-2
/ Word doc format of apcd_member_eligibility_file_submission_guide_12-2
Zip File zip format of member-eligiblity.zip
Product File Submission Guide PDF pdf format of apcd-product-file-submission-guide-10-2010.pdf
/ Word doc format of apcd-product-file-submission-guide-10-2010.doc
Zip File zip format of product-file.zip
Provider File Submission Guide PDF pdf format of apcd-provider-file-submission-guide-12-2010.pdf
/ Word doc format of apcd-provider-file-submission-guide-12-2010.doc
Zip File zip format of provider-file.zip
 

Master List of Version 2 File Edits
(includes edits to Medical Claims, Dental Claims, Pharmacy Claims, Member Eligibility, Product File, and Provider File)

PDF pdf format of master-list-of-file-edits.pdf
/ Excel xls format of master-list-of-file-edits.xls
Zip File zip format of master-list-of-file-edits.zip
Preliminary List of Version 3 File Edits
(includes edits to Medical Claims, Dental Claims, Pharmacy Claims, Member Eligibility, Product File, Provider File and Benefit Plan Control Total File)
Excel xlsx format of master-list-of-file-edits-prelim-version-3.xlsx
 
 
Carrier Defined Lookup Table Form Excel xls format of carrierdefinedlookuptableform.xls
 
Zip File zip format of master-list-of-file-edits.zip
Overview of the Variance Request Process

Zip File zip format of overview-of-variance-request-process.zip

 
User Guide for QA Profile Reports
-  Phase 1: Quality and Completeness
DRAFT June 25, 2012
PDF pdf format of apcd-qa-user-guide.pdf
| Word doc format of apcd-qa-user-guide.doc
APCD Submission FAQ

 


 Payer Technical Assistance Group (TAG) Webinar

(Second Tuesday of each month)

CHIA invites health care payers to participate in monthly Technical Assistance Group (TAG) webinars from 2:00 to 3:00 p.m. EST on the second Tuesday of each month. The 1-hour meeting is used to support payers with technical reporting issues. 

  • Next Meeting: Tuesday, September 9, 2014

    register now button

Past Meetings:

  • Tuesday, August 26, 2014 - Massachusetts All-Payer Claims Database: Technical Assistance Group (TAG) Substance Abuse Denial Study