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  file size 1MB | 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 GuidePDF 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  file size 1MBZip File zip format of    medical-claims.zip  file size 1MB
Pharmacy Claims File Submission GuidePDF pdf format of    apcd_pharmacy_claim_file_submission_guide_12-2010.  / Word doc format of    apcd_pharmacy_claim_file_submission_guide_12-2010.  file size 1MBZip File zip format of    pharmacy-claims.zip
Dental Claims File Submission GuidePDF doc format of    apcd_pharmacy_claim_file_submission_guide_12-2010.  file size 1MB / Word doc format of    apcd_dental_claim_file_submission_guide_12-2010.do  Zip File zip format of    dental-claims.zip  file size 1MB
Member Eligibility File Submission GuidePDF pdf format of    apcd_member_eligibility_file_submission_guide_12-2  / Word doc format of    apcd_member_eligibility_file_submission_guide_12-2  file size 1MBZip File zip format of    member-eligiblity.zip
Product File Submission GuidePDF zip format of    member-eligiblity.zip  / Word doc format of    apcd-product-file-submission-guide-10-2010.doc  file size 3MBZip File zip format of    product-file.zip
Provider File Submission GuidePDF 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 FormExcel xls format of    carrierdefinedlookuptableform.xls  file size 2MB
 
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. The webinar registration link for these TAG webinars: https://www3.gotomeeting.com/register/124465278.

  • Next Meeting: Tuesday, May 13, 2014

    register now button

Past Meetings: