data essential for the continued monitoring of health care cost trends, minimize the duplication of data submissions by payers to state entities, and promote administrative simplification among state entities in Massachusetts. Health care data and information submitted by Health Care Payers to CHIA is not a public record. No public disclosure of any health plan information or data shall be made unless specifically authorized under 957 CMR 5.00. Acronyms Frequently Used APCD All-Payer Claims Database – CHIA Center for Health Information and Analysis – CSO Computer Services Organization – DBA Delegated Benefit Administrator – DBM Dental Benefit Manager – DOI Division of Insurance – GIC Group Insurance Commission – ID Identification; Identifier – MA APCD Massachusetts’ Claims Database – NPI National Provider Identifier – PBM Pharmacy Benefit Manager – QA Quality Assurance – RA Risk Adjustment; Risk Adjuster – TME / RP Total Medical Expense / Relative Pricing – TPA Third Party Administrator – The File Types: DC Dental Claims – MC Medical Claims – ME Member Eligibility – PC Pharmacy Claims – PR Product File – PV Provider File – BP Benefit Plan Control Total File –
data essential for the continued monitoring of health care cost trends, minimize the duplication of data submissions by payers to state entities, and promote administrative simplification among state entities in Massachusetts. Health care data and information submitted by Health Care Payers to CHIA is not a public record. No public disclosure of any health plan information or data shall be made unless specifically authorized under 957 CMR 5.00. Acronyms Frequently Used APCD – All-Payer Claims Database CHIA – Center for Health Information and Analysis CSO – Computer Services Organization DBA – Delegated Benefit Administrator DBM – Dental Benefit Manager DOI – Division of Insurance GIC – Group Insurance Commission ID – Identification; Identifier MA APCD – Massachusetts’ Claims Database NPI – National Provider Identifier PBM – Pharmacy Benefit Manager QA – Quality Assurance RA – Risk Adjustment; Risk Adjuster TME / RP – Total Medical Expense / Relative Pricing TPA – Third Party Administrator The File Types: DC – Dental Claims MC – Medical Claims ME – Member Eligibility PC – Pharmacy Claims PR – Product File PV – Provider File BP – Benefit Plan Control Total File
v5-apcd-medical-claim-file-submission-guide-FINAL.docx