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 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’ All-Payer Claims Database – NPI National Provider Identifier – PBM Pharmacy Benefit Manager – QA Quality Assurance – RA Risk Adjustment; Risk Adjuster – TME / RP Medical Expense / Relative Pricing – TPA 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 File –
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 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’ All-Payer Claims Database NPI – National Provider Identifier PBM – Pharmacy Benefit Manager QA – Quality Assurance RA – Risk Adjustment; Risk Adjuster TME / RP – Medical Expense / Relative Pricing TPA – 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 File
apcd-medical-claim-file-submission-guide.docx