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
114.5 CMR 21.00 governs the reporting requirements for Health Care Payers to submit data and information to the Division in accordance with M.G.L. c. 118G. The regulations 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

The Division has posted Administrative Bulletin 10-14 pdf format of 1014.pdf clarifying the reporting requirements for private health care payers under 114.5 CMR 21.00. It is the Division'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 12-01 for data reporting submissions effective May 1, 2013
Medical Claims File Submission Guide
(Updated December 2012)		 PDF pdf format of apcd-medical-claim-file-submission-guide-2012-12-01.pdf file size 1MB / Word doc format of apcd-medical-claim-file-submission-guide-2012-12-01.doc  
Pharmacy Claims File Submission Guide
(Updated December 2012)		 PDF pdf format of apcd-pharmacy-claim-file-submission-guide-2012-12-01.pdf file size 1MB / Word doc format of apcd-pharmacy-claim-file-submission-guide-2012-12-01.doc  
Dental Claims File Submission Guide
(Updated December 2012)		 PDF pdf format of apcd-dental-claim-file-submission-guide-2012-12-01.pdf / Word doc format of apcd-dental-claim-file-submission-guide-2012-12-01.doc  
Member Eligibility File Submission Guide
(Updated December 2012)		 PDF pdf format of APCD Member Eligibility File Submission Guide 12-12-01 file size 1MB / Word doc format of APCD Member Eligibility File Submission Guide 12-12-01  
Product File Submission Guide
(Updated December 2012)		 PDF pdf format of APCD Product File Submission Guide 2012-12-01.pdf / Word doc format of APCD Product File Submission Guide 2012-12-01.doc  
Provider File Submission Guide
(Updated December 2012)		 PDF pdf format of APCD Provider File Submission Guide 2012-12-01.pdf / Word doc format of APCD Provider File Submission Guide 2012-12-01.doc  
Question and Answer Document
(Updated January 31, 2013)		 Excel xlsx format of MA_APCD_Admin_Bull_QA_20130131.xls (Note: This document will be routinely updated)
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 April 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 file size 1MB Zip File zip format of medical-claims.zip file size 1MB
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. file size 1MB 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 file size 1MB
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 file size 1MB 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 file size 3MB 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 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
 
Carrier Defined Lookup Table Form Excel 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 all 2013 TAG webinars: https://www3.gotomeeting.com/register/124465278. 

  • Next meeting: Tuesday, June 11, 2013 at 10:00 a.m.
    Please note the change in time

Past Meetings:


Archived meeting materials