Maine
Category
Title or Name of APCD System
- Maine Health Care Claims Database
Who Maintains the System
- Maine Health Data Organization
Website
Legal Authority
Investment
- $4-5 million across MHDO/MHDPC for hardware and staff time since 2002. Compliance and resubmissions for failed edits are time-intensive, especially at first. States that use a common format/harmonize with other states will reduce start-up and reporting
Submission Rules
Release Policy
Data Request Process
First Year APCD Collected Data
- 2003
APCD Snapshot
- Maine Health Data Organization, Maine Health Management Coalition and the Maine Health Info Center leveraged a voluntary aggregation pilot into a statewide initiative. Large employers needed cost data as well. Carriers were interested in a broader view of utilization across the system. Hospitals wanted a payment website.
Number of Commercial Sources of Claims Data
- 89
Sources and Status of APCD Data Collection
Payers
Commercial Payers
- Currently Collected
Third Party Administrators/Self-Funded
- Currently Collected
Medicaid
- Currently Collected
Medicare
- Currently Collected
Other
- Tables of payer homegrown diagnosis/procedure codes; taxonomy code/physicians
Types of Data Collected
Medical Claims
- Currently Collected
Eligibility
- Currently Collected
Dental
- Currently Collected
Pharmacy
- Currently Collected
Other
- Psuedo-claims for some uninsured
Primary Users/Uses
- Analyses of cost, quality, system utilization, episodes, and geographical differences.
Consumer Website
Contact Information
For more information please contact Karynlee Harrington at Karynlee.harrington@maine.gov.
Use Cases from the APCD Showcase
Displaying 1 - 5 of 8
| Use Cases | Category | Carriers | |
|---|---|---|---|
This study quantifies a major shift in locus of VA critical care, a likely outcome of expanded non-VA health insurance coverage that was previously called out, but the study was not designed to address the many issues raised by outsourcing so much ICU care, including questions about the coordination and continuity of post-ICU care for these patients with high-acuity conditions. The study adds to concerns about VA’s ability to oversee the quality of community care and gaps in the integration of VA-delivered and VA-purchased care. |
Consumers, Health Reform, Medicaid, Population Health, Providers | Medicaid | |
Colorado, Maine, Connecticut, and Washington—have collected and analyzed data on outpatient facility fee billing within their borders. This growing interest reflects several converging trends. Hospital outpatient utilization has increased substantially over the past few decades, and care delivered in HOPDs has generally become more expensive compared to similar care provided in non-hospital settings. |
Consumers, Providers, Researchers | Commercial | |
The objective of this study was to estimate trends in maternal opioid use disorder (OUD) and neonatal abstinence syndrome (NAS) in Maine using the most recent data available. |
Consumers, Insurance Department, Population Health, Researchers | Medicaid, Medicare | |
Despite the well-known association between hypertensive disorders of pregnancy and cardiovascular diseases, there are limited data on which specific cardiovascular diagnoses have the greatest risk profiles during the first 24 months after delivery. |
Population Health, Providers, Researchers | Commercial, Medicaid, Medicare | |
To estimate COVID-19 diagnosis prevalence and trends among pregnant and postpartum individuals in Maine by rurality and common pregnancy conditions. |
Consumers, Population Health, Researchers | Commercial |