User Submission Guides
APCD FAQ - Updated July, 2011
Related Resources
APCD Regulations
Self-Insured Data Submissions
Public Hearing Information and Comments (2010)

 

All-Payer Claims Database User Submission Guides

User Submission Guides	Format	Edits
Medical Claims File Submission Guide	PDF  / Word  file size 1MB	Zip File  file size 1MB
Pharmacy Claims File Submission Guide	PDF  / Word  file size 1MB	Zip File
Dental Claims File Submission Guide	PDF  / Word	Zip File  file size 1MB
Member Eligibility File Submission Guide	PDF  / Word  file size 1MB	Zip File
Product File Submission Guide	PDF  / Word  file size 3MB	Zip File
Provider File Submission Guide	PDF  / Word	Zip File
Master List of File Edits (includes edits to Medical Claims, Dental Claims, Pharmacy Claims, Member Eligibility, Product File, and Provider File)	PDF  / Excel	Zip File
Carrier Defined Lookup Table Form	Excel  file size 2MB
APCD Submission FAQ	Zip File    APCD FAQ - Updated July, 2011 (PDF)  APCD Filing Requirements Summary (Excel)  Claims Voids and Replacements (PDF)  Member File Example (Excel)  Provider File Examples (Excel)
Overview of the Variance Request Process	Zip File    Memo to Payers - APCD Variance Review Update 11.10.10 (PDF)  Updated Memo to Payers - APCD Variance Review Process (PDF)

 

Related Resources

• National Association of Health Data Organizations (NAHDO)
  http://www.nahdo.org/

• APCD Council (formerly RAPHIC)
  http://www.apcdcouncil.org/

• APCDs from Other New England States
  • Vermont - The Vermont Healthcare Claims Uniform Reporting and Evaluation System (VHCURES)
     http://www.bishca.state.vt.us/health-care/health-insurers/vermont-healthcare-claims-uniform-reporting-and-evaluation-system-vhcure#VHCURES_Reports
  • New Hampshire - New Hampshire Comprehensive Health Care Information System -(CHIS)
    http://www.nhchis.org/index.html
  • Maine - Maine Health Data Organization ( MHDO)
    http://mhdo.maine.gov/imhdo/

 

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.
  
  
• Regulation 114.5 CMR 22:00 - Health Care Claims Data Release
  114.5 CMR 22.00 governs the disclosure of all member eligibility and claims data submitted by payers to the Division of Health Care Finance and Policy pursuant to 114.5 CMR 21.00 or pursuant to an interagency service agreement. The purpose of 114.5 CMR 22.00 is to make health care claims data available as a resource where such access serves the public interest while safeguarding the privacy rights of claims data subjects.

 

Self-Insured Data Submissions

The Division has posted Administrative Bulletin 10-14 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.

 

Public Hearing Information and Comments (2010)

See APCD Public Hearing and Comments from Monday, May 17, 2010

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This information is provided by the Division of Health Care Finance and Policy.