Administrative Bulletin 12-15

114.5 CMR 22:00: Health Care Claims Data Release

May 24, 2012

The Division of Health Care Finance and Policy will make the changes specified below to the All Payer Claims Data to be released under 114.5 CMR 22.00. The Division will reclassify certain data elements from Public to Restricted; alter certain data elements by masking them to protect privacy; and designate certain data elements as not released. In addition, the Division will add data elements that are derived components of current data elements, and derived data elements to be used for linkage purposes. The following chart lists the changes by file type.

ELEMENT / DATA ELEMENT NAME / CHANGES
Product File
HD002 / Payer / Masked
PR001 / Product ID / Reclassified from Public to Restricted and Masked
PR002 / Product Name / Masked
PR003 / Carrier License Type / Masked
PR007 / Other Product Benefit Description / Masked
PR HD002 / PR001 / Payer / Product ID / Added to Public for Linkage Purposes and Masked
Derived by DHCFP / Unique Record ID / Added to Public and Restricted for Linkage Purposes
ELEMENT / DATA ELEMENT NAME / CHANGES
Member Eligibility File
ME001 / Payer / Masked
ME002 / National Plan ID / Masked
ME004 / Reported Eligibility Year / Not Released
ME005 / Reported Eligibility Month / Not Released
ME006 / Insured Group or Policy Number / Masked
ME014 / Member Birth Year / Added to Public
ME014 / Member Birth Month / Added to Restricted
ME014 / Member Date of Birth / Not Released
ME017 / Member ZIP Code (first 3 digits) / Added to Restricted
ME017 / Member ZIP Code / Not Released
ME031 / Special Coverage / Added to Restricted
ME036 / Health Care Home Number / Reclassified from Public to Restricted and Masked
ME037 / Health Care Home Tax ID Number / Masked
ME038 / Health Care Home National Provider ID / Masked
ME039 / Health Care Home Name / Masked
ME040 / Product ID Number / Reclassified from Public to Restricted and Masked
ME041 / Product Enrollment Start Date / Reclassified from Public to Restricted
ME042 / Product Enrollment End Date / Reclassified from Public to Restricted
ME046 / Member PCP ID / Masked
ME054 / Eligibility Determination Date - GIC Only / Not Released
ME056 / Last Activity Date - GIC Only / Not Released
ME057 / Member Year of Death / Not Released
ME057 / Member Date of Death - GIC Only / Not Released
ME060 / Employment Status - GIC Only / Not Released
ME065 / Date of Retirement - GIC Only / Not Released
ME075 / NewMMISID / Added to Restricted and Masked
ME077 / Members SIC Code / Masked
ME079 / Recipient Identification Number (MassHealth only) / Added to Restricted and Masked
ME080 / Recipient Historical Number (MassHealth only) / Added to Restricted and Masked
ME107 / CarrierSpecificUniqueMemberID / Masked
ME109 / Subscriber State or Province / Added to Public
ME110 / Subscriber ZIP Code (First 3 Digits) / Added to Restricted
ME110 / Subscriber ZIP Code / Not Released
ME117 / CarrierSpecificUniqueSubscriberID / Masked
ME899 / Record Type / Added to Public
ME001 / ME036 / Payer / Health Care Home Number / Added to Public for Linkage Purposes and Masked
ME001 / ME040 / Payer / Product ID Number / Added to Public for Linkage Purposes and Masked
ME001 / ME046 / Payer / Member PCP ID / Added to Restricted for Linkage Purposes and Masked
ME001 / ME076 / Payer / Member Rating Category / Added to Restricted for Linkage Purposes and Masked
ME001 / ME107 / Payer / CarrierSpecificUniqueMemberID / Added to Public for Linkage Purposes and Masked
ME001 / ME117 / Payer / CarrierSpecificUniqueSubscriberID / Added to Public for Linkage Purposes and Masked
Derived by DHCFP / Unique Record ID / Added to Public and Restricted for Linkage Purposes
County of Member / Not Collected
Geocoded Member’s Address / Not Available
ELEMENT / DATA ELEMENT NAME / CHANGES
Medical Claims File
MC001 / Payer / Masked
MC002 / National Plan ID / Masked
MC003 / Insurance Type Code/Product / Reclassified from Public to Restricted and Masked
MC004 / Payer Claim Control Number / Masked
MC006 / Insured Group or Policy Number / Masked
MC013 / Member Date of Birth / Not Released
MC013 / Member Birth Year / Added to Public
MC013 / Member Birth Month / Added to Restricted
MC016 / Member ZIP Code (first 3 digits) / Added to Restricted
MC016 / Member ZIP Code / Not Released
MC017 / Date Service Approved (AP Date) / Reclassified from Public to Restricted
MC018 / Admission Month / Added to Restricted
MC018 / Admission Year / Added to Restricted
MC024 / Service Provider Number / Reclassified from Public to Restricted and Masked
MC025 / Service Provider Tax ID Number / Masked
MC026 / National Service Provider ID / Masked
MC059 / Date of Service - From Month / Added to Restricted
MC059 / Date of Service - From Year / Added to Restricted
MC060 / Date of Service - To Month / Added to Restricted
MC060 / Date of Service - To Year / Added to Restricted
MC068 / Patient Control Number / Masked
MC069 / Discharge Month / Added to Restricted
MC069 / Discharge Year / Added to Restricted
MC076 / Billing Provider Number / Reclassified from Public to Restricted and Masked
MC077 / National Billing Provider ID / Masked
MC079 / Product ID Number / Reclassified from Public to Restricted and Masked
MC080 / Reason for Adjustment / Reclassified from Public to Restricted and Masked
MC098 / Allowed amount / Reclassified from Public to Restricted
MC100 / Delegated Benefit Administrator Organization ID / Added to Restricted for Linkage Purposes and Masked
MC108 / Procedure Modifier - 3 / Added to Public
MC109 / Procedure Modifier - 4 / Added to Public
MC110 / Claim Processed Date / Added to Restricted
MC112 / Referring Provider ID / Reclassified from Public to Restricted and Masked
MC124 / Denial Reason / Reclassified from Public to Restricted and Masked
MC125 / Attending Provider / Reclassified from Public to Restricted and Masked
MC134 / Plan Rendering Provider Identifier / Reclassified from Public to Restricted and Masked
MC135 / Provider Location / Reclassified from Public to Restricted and Masked
MC137 / CarrierSpecificUniqueMemberID / Masked
MC138 / Claim Line Type / Added to Public
MC141 / CarrierSpecificUniqueSubscriberID / Masked
MC001 / MC024 / Payer / Service Provider Number / Added to Public for Linkage Purposes and Masked
MC001 / MC032 / Payer / Service Provider Specialty / Added to Public for Linkage Purposes and Masked
MC001 / MC076 / Payer / Billing Provider Number / Added to Public for Linkage Purposes and Masked
MC001 / MC079 / Payer / Product ID Number / Added to Public for Linkage Purposes and Masked
MC001 / MC080 / Payer / Reason for Adjustment / Added to Restricted for Linkage Purposes and Masked
MC001 / MC100 / Payer / Delegated Benefit Administrator Organization ID / Added to Public for Linkage Purposes and Masked
MC001 / MC112 / Payer / Referring Provider ID / Added to Public for Linkage Purposes and Masked
MC001 / MC124 / Payer / Denial Reason / Added to Restricted for Linkage Purposes and Masked
MC001 / MC125 / Payer / Attending Provider / Added to Public for Linkage Purposes and Masked
MC001 / MC132 / Payer / Service Class / Added to Public for Linkage Purposes and Masked
MC001 / MC134 / Payer / Plan Rendering Provider Identifier / Added to Public for Linkage Purposes and Masked
MC001 / MC135 / Payer / Provider Location / Added to Public for Linkage Purposes and Masked
MC001 / MC137 / Payer / CarrierSpecificUniqueMemberID / Added to Public for Linkage Purposes and Masked
MC001 / MC141 / Payer / CarrierSpecificUniqueSubscriberID / Added to Public for Linkage Purposes and Masked
Derived by DHCFP / Final Version Flag / Added to Public
Derived by DHCFP / Unique Record ID / Added to Public and Restricted for Linkage Purposes
ELEMENT / DATA ELEMENT NAME / CHANGES
Dental Claims File
DC001 / Payer / Masked
DC002 / National Plan ID / Masked
DC003 / Dental Insurance Type Code/Product / Reclassified from Public to Restricted and Masked
DC005A / Version Number / Added to Public
DC006 / Insured Group or Policy Number / Masked
DC011 / Individual Relationship Code / Reclassified from Public to Restricted
DC013 / Member Birth Month / Added to Restricted
DC013 / Member Birth Year / Added to Public
DC016 / Member ZIP Code / Not Released
DC016 / Member ZIP Code (first 3 digits) / Added to Restricted
DC017 / Date Service Approved (AP Date) / Reclassified from Public to Restricted
DC018 / Service Provider Number / Reclassified from Public to Restricted and Masked
DC019 / Service Provider Tax ID Number / Masked
DC020 / National Service Provider / Masked
DC025 / Delegated Benefit Administrator Organization ID / Added to Restricted and Masked
DC042 / Product ID Number / Reclassified from Public to Restricted and Masked
DC044 / Billing Provider Tax ID Number / Masked
DC046 / Allowed Amount / Reclassified from Public to Restricted
DC056 / CarrierSpecificUniqueMemberID / Masked
DC057 / CarrierSpecificUniqueSubscriberID / Masked
DC001 / DC018 / Payer / Service Provider Number / Added to Public for Linkage Purposes and Masked
DC001 / DC025 / Payer / Delegated Benefit Administrator Organization ID / Added to Public for Linkage Purposes and Masked
DC001 / DC026 / Payer / Service Provider Specialty / Added to Public for Linkage Purposes and Masked
DC001 / DC042 / Payer / Product ID Number / Added to Public for Linkage Purposes and Masked
DC001 / DC056 / Payer / CarrierSpecificUniqueMemberID / Added to Public for Linkage Purposes and Masked
DC001 / DC057 / Payer / CarrierSpecificUniqueSubscriberID / Added to Public for Linkage Purposes and Masked
Derived by DHCFP / Final Version Flag / Added to Public
Derived by DHCFP / Unique Record ID / Added to Public and Restricted for Linkage Purposes
Service Provider Suffix / Not Collected by APCD
ELEMENT / DATA ELEMENT NAME / CHANGES
Pharmacy Claims File
PC001 / Payer / Masked
PC002 / Plan ID / Masked
PC003 / Insurance Type Code/Product / Reclassified from Public to Restricted and Masked
PC004 / Payer Claim Control Number / Masked
PC005A / Version Number / Added to Public
PC006 / Insured Group or Policy Number / Masked
PC011 / Individual Relationship Code / Added to Restricted
PC013 / Member Birth Year / Added to Public
PC013 / Member Birth Month / Added to Restricted
PC013 / Member Date of Birth / Not Released
PC016 / Member ZIP Code / Not Released
PC016 / Member ZIP Code (first 3 digits) / Added to Restricted
PC017 / Date Service Approved (AP Date) / Reclassified from Public to Restricted
PC018 / Pharmacy Number / Reclassified from Public to Restricted and Masked
PC019 / Pharmacy Tax ID Number / Masked
PC021 / National Pharmacy ID Number / Masked
PC032 / Date Prescription Filled / Reclassified from Public to Restricted
PC032 / Date Prescription Filled Month / Added to Restricted
PC032 / Date Prescription Filled Year / Added to Restricted
PC043 / Prescribing ProviderID / Reclassified from Public to Restricted and Masked
PC047 / Prescribing Physician DEA Number / Reclassified from Public to Restricted and Masked
PC048 / Prescribing Physician NPI / Masked
PC049 / Prescribing Physician Plan Number / Masked
PC050 / Prescribing Physician License Number / Masked
PC056 / Product ID Number / Reclassified from Public to Restricted and Masked
PC059 / Recipient PCP ID / Reclassified from Public to Restricted and Masked
PC062 / Billing Provider Tax ID Number / Masked
PC064 / Date Prescription Written / Reclassified from Public to Restricted
PC064 / Date Prescription Written Month / Added to Restricted
PC064 / Date Prescription Written Year / Added to Restricted
PC065 / Coordination of Benefits/TPL Liability Amount - GIC Only / Not Released
PC067 / Medicare Paid Amount - GIC Only / Not Released
PC068 / Allowed amount / Reclassified from Public to Restricted
PC072 / Delegated Benefit Administrator Organization ID / Added to Restricted and Masked
PC107 / CarrierSpecificUniqueMemberID / Masked
PC108 / CarrierSpecificUniqueSubscriberID / Masked
PC001 / PC018 / Payer / Pharmacy Number / Added to Public for Linkage Purposes and Masked
PC001 / PC043 / Payer / Prescribing ProviderID / Added to Public for Linkage Purposes and Masked
PC001 / PC056 / Payer / Product ID Number / Added to Public for Linkage Purposes and Masked
PC001 / PC059 / Payer / Recipient PCP ID / Added to Public for Linkage Purposes and Masked
PC001 / PC072 / Payer / Delegated Benefit Administrator Organization ID / Added to Public for Linkage Purposes and Masked
PC001 / PC107 / Payer / CarrierSpecificUniqueMemberID / Added to Public for Linkage Purposes and Masked
PC001 / PC108 / Payer / CarrierSpecificUniqueSubscriberID / Added to Public for Linkage Purposes and Masked
Derived by DHCFP / Final Version Flag / Added to Public
Derived by DHCFP / Unique Record ID / Added to Public and Restricted for Linkage Purposes
ELEMENT / DATA ELEMENT NAME / CHANGES
Provider File
PV001 / Payer / Masked
PV002 / Plan Provider ID / Masked
PV003 / Tax Id / Masked
PV004 / Unique Physician ID Number
(GIC Only) / Not Released
PV005 / DEA ID / Masked
PV006 / License Id / Masked
PV007 / Medicaid Id / Masked
PV015 / Provider Birth Year / Added to Restricted
PV015 / Provider DOB Date / Not Released
PV035 / SSN Id / Masked
PV036 / Medicare Id / Reclassified from Public to Restricted and Masked
PV039 / National Provider ID / Masked
PV040 / National Provider2 ID / Masked
PV054 / Medical/Healthcare Home ID / Reclassified from Public to Restricted and Masked
PV056 / Provider Affiliation / Reclassified from Public to Restricted and Masked
PV001 / PV002 / Payer /
Plan Provider ID / Added to Public for Linkage Purposes and Masked
PV001 / PV029 / Payer / Provider Type Code / Added to Public for Linkage Purposes and Masked
PV001 / PV030 / Payer / Primary Specialty Code / Added to Public for Linkage Purposes and Masked
PV001 / PV042 / Payer / Secondary Specialty2 Code / Added to Public for Linkage Purposes and Masked
PV001 / PV043 / Payer / Secondary Specialty3 Code / Added to Public for Linkage Purposes and Masked
PV001 / PV044 / Payer / Secondary Specialty4 Code / Added to Public for Linkage Purposes and Masked
PV001 / PV054 / Payer / Medical/Healthcare Home ID / Added to Public for Linkage Purposes and Masked
PV001 / PV056 / Payer / Provider Affiliation / Added to Public for Linkage Purposes and Masked
Derived by DHCFP / Unique Record ID / Added to Public and Restricted for Linkage Purposes