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10.25.06.00.htm 10.25.06.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 25 MARYLAND HEALTH CARE COMMISSION Chapter 06 Maryland Medical Care Data Base and Data Collection Authority: Health-General Article, §19-101, 19-103(c)3) (4) (7) and (8) 19-109(a)1) (6) and (7) 19-133, 19-134, and 19-137, Annotated Code of Maryland
10.25.06.01.htm 10.25.06.01. 01 Scope and Purpose.. These regulations establish appropriate methods for collecting and compiling Statewide data on selected health care services provided either under a Maryland contract or to Maryland residents by health care practitioners and facilities:A. From payors;. B. From third-party administrators;. C. From managed behavioral health care organizations;. D. From pharmacy benefit managers; and.
10.25.06.02.htm 10.25.06.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Adjudicated" means paid, resolved, or settled.. 2) “Behavioral health care services” means procedures or services rendered by a health care practitioner for the treatment of mental health or substance use disorders.3) "Capitated encounter" means a health care visit in which a health care practitioner or office facility provides a service pursuant to an agreement
10.25.06.03.htm 10.25.06.03. 03 Persons Designated to Provide Data to the Commission.. A. Reporting Entities. By December 31 of each year, the Commission shall make available a list of each payor, third-party administrator, pharmacy benefit manager, and managed behavioral health care organization meeting the criteria for designation as a reporting entity and who shall file the reports under this chapter in the following year.1) The Commission shall designate as a reporting entity each payor and thir
10.25.06.04.htm 10.25.06.04. 04 Process for Submitting Data.. A. The Commission shall provide each reporting entity with an annual update to the MCDB Submission Manual, and each current Manual update available, as specified in Regulation .15 of this chapter.B. Each reporting entity shall provide each of the following reports, if applicable:. 1) Professional Services Data Report;. 2) Pharmacy Data Report;. 3) Provider Directory Report;. 4) Institutional Services Data Report;. 5) Eligibility Data Report;.
10.25.06.05.htm 10.25.06.05. 05 Time Period for Submitting Data Reports.. A. Unless a different reporting time period is specified in the MCDB Submission Manual pursuant to §B of this regulation, each reporting entity shall submit to the Commission a complete set of the entity’s data for claims paid during each quarter of a calendar year in the form and manner described in Regulations .07―14 of this chapter within 2 months of the last day in the applicable quarter.B. Each reporting entity
10.25.06.06.htm 10.25.06.06. 06 Protection of Confidential Information in Submissions.. A. To assure that confidential records or information are protected, each reporting entity shall encrypt each of the following data elements in such a manner that each unique value for a data element produces an identical unique encrypted data element:1) Patient or enrollee identifier; and. 2) Internal subscriber contract number.. B. In order to maintain a consistent and unique identifier for each patient
10.25.06.07.htm 10.25.06.07. 07 Professional Services Data Report Submission.. A. Each reporting entity shall submit a professional services data report that provides the data for each fee-for-service and capitated encounter, including fee-for-service equivalents prices for capitated services, provided by a health care practitioner or office facility. This report shall include all health care services provided:1) To each Maryland resident insured by that entity under a fully insured or a self-insured contract
10.25.06.08.htm 10.25.06.08. 08 Pharmacy Data Report Submission.. A. Each reporting entity shall submit a pharmacy data report for each prescription drug encounter for services provided by a pharmacy located in or out of the State. This report shall include all pharmacy services provided to each Maryland resident insured under a fully insured contract or a self-insured contract, and to each non-Maryland resident insured under a Maryland contract.B. Each pharmacy data report shall contain the inf
10.25.06.09.htm 10.25.06.09. 09 Provider Directory Report Submission.. A. Each reporting entity shall submit a provider directory report detailing each health care practitioner or supplier that provided services to any enrollee of that reporting entity during the reporting period. This report shall contain information for each in-State Maryland practitioner or supplier, and for each out-of-State practitioner or supplier that has served a Maryland resident or a non-Maryland resident under a Maryland contract.
10.25.06.10.htm 10.25.06.10. 10 Institutional Services Data Report Submission.. A. Each reporting entity shall submit an institutional services data report that reports all institutional health care services provided to each Maryland resident insured under a fully insured contract or self-insured contract, and each non-Maryland resident insured under a Maryland contract, whether those services were provided:1) By a health care facility located in-State or out-of-State; or.
10.25.06.11.htm 10.25.06.11. 11 Eligibility Data Report Submission.. A. Each reporting entity shall submit an eligibility data report that provides information on the characteristics of each enrollee that is a Maryland resident insured under a fully insured contract or a self-insured contract, and each enrollee that is a non-Maryland resident insured under a Maryland contract, for services covered under each policy or contract issued by the reporting entity that are subject to this chapter.
10.25.06.12.htm 10.25.06.12. 12 Plan Benefit Design Report.. Each plan benefit design report shall contain the information specified by the Commission in its annual update to the MCDB Submission Manual and be filed in a form and manner specified in the Manual.
10.25.06.13.htm 10.25.06.13. 13 Dental Services Data Report.. Each dental services data report shall contain the information specified by the Commission in its annual update to the MCDB Submission Manual and be filed in a form and manner specified in the Manual.
10.25.06.14.htm 10.25.06.14. 14 Non-Fee-for-Service Expenses Report.. Each non-fee-for-service expenses report shall contain the information specified by the Commission in its annual update to the MCDB Submission Manual and be filed in a form and manner specified in the Manual.
10.25.06.15.htm 10.25.06.15. 15 Report Submission Methods.. A. When a reporting entity collects more granular information than required under this chapter, the reporting entity shall provide a conversion table that describes how internal values are mapped to each required category.B. The MCDB Submission Manual shall contain technical specifications, layouts, required reports, and definitions for each reporting entity.1) The Commission shall provide an annual MCDB Submission Manual by Novembe
10.25.06.16.htm 10.25.06.16. 16 Request for an Extension of Time.. A. A reporting entity may request an extension of an additional 30 days time to provide the required data report.B. For a 30-day extension request to be considered by Commission staff, the reporting entity shall submit a written request to the Executive Director at least 30 days before the required submission date that includes:1) The extraordinary cause necessitating the extension request; and. 2) A proposed date, which is no more than 30 days
10.25.06.17.htm 10.25.06.17. 17 Request for an Annual Waiver or Format Modification.. A. Annual Waiver Request.. 1) When a reporting entity is not able to submit a data report as set forth in this chapter, the reporting entity shall file with the Commission by March 15 of the year for which a waiver is sought a written request for an annual waiver that shall include an explanation of why the reporting entity is not able to provide the data report, including any extraordinary circumstances.
10.25.06.18.htm 10.25.06.18. 18 Failure to File Data Reports.. A. A reporting entity that does not timely file a data report in compliance with the MCDB Submission Manual may be subject to monetary penalties as provided in COMAR 10.25.12.B. In accordance with COMAR 10.25.12.01C, a data report that is substantially incomplete or inaccurate is not timely filed within the meaning of §A of this regulation and may be subject to monetary penalties as provided in COMAR 10.25.12.
10.25.06.19.htm 10.25.06.19. 19 Summaries and Compilations.. The Commission shall develop public-use data, summaries, and compilations for public disclosure, pursuant to Health-General Article, §19-103(c)3) 19-109(a)6) and 19-134, Annotated Code of Maryland, in compliance with all applicable federal and State laws and regulations.
10.25.06.9999.htm 10.25.06.9999. Administrative History Effective date: January 15, 1996 (23:1 Md. R. 26). Regulation .06 amended effective October 7, 1996 (23:20 Md. R. 1423). Regulation .10A amended effective October 7, 1996 (23:20 Md. R. 1423) ―. Chapter revised effective March 9, 1998 (25:5 Md. R. 369). Regulation .01-1 amended effective October 18, 1999 (26:21 Md. R. 1629). Regulation .02 amended effective October 18, 1999 (26:21 Md. R. 1629).
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