Delaware Health Information Network

Delaware Health Care Claims Database

The Delaware Health Care Claims Database (HCCD), powered by DHIN, is the single largest repository of claims data Delaware has ever had.

The HCCD is Making Health Data More Useful

The HCCD collects healthcare claims, enrollment and provider data from Medicare, Medicaid and the seven largest commercial health insurers in the State of Delaware. For more information about the HCCD, please contact claimsinfo@dhin.org.

The HCCD can help lawmakers and decision-makers:

An Investigation into Opioid Prescriptions and
ED Events in Delaware 2016-2020

Over the past ten years, Delaware has implemented multiple programs to combat
drug abuse, particularly opioids, due to their rising prevalence in Delaware.

HCCD Data Submission Forms

Applications for Data Element Threshold and Product
Line and Line of Business Waiver

This document provides detailed information to reporting
entities about how to prepare and submit claims data to
the HCCD

How to Request Access to the HCCD

Please use this application to submit information
regarding your request for HCCD data or data access

This agreement addresses the terms and
conditions under which DHIN will release and the
requesting organization may obtain, use, and
disclose HCCD data specified in this Agreement

Business rules for reviewing data requests

4.6 After a decision is reached by the Committee, public
notice will be posted on the DHIN website that an application
for data access was received, by whom it was submitted and
for what purposes, and the decision of the Committee to
grant or deny the application. The final determination of the
Committee shall not be subject to appeal.

Commonly used HCCD terms

Mandatory Reporting Entities

  • All Health Insurers providing healthcare coverage to a Delaware resident; and
  • All Health Insurers that provide a Delaware State Group Health Insurance Plan, regardless of the state of residence of the member. This includes any entity that receives or collects charges, contributions, or premium for, or adjusts or settles, health claims for, any State employee or their spouses or dependents, participating in the State Group Health Insurance Program.

Health Insurer

The term Health Insurer is defined in § 4004 of Title 18 and includes insurers, third-party administrators (TPA), pharmacy benefits managers (PBMs), and other carve-out payers that offer a service benefit plan. Health insurer does not include providers of casualty insurance, as defined in § 906 of Title 18; providers of group long-term care insurance or long-term care insurance, as defined in § 7103 of Title 18; or providers of a dental plan or dental plan organization,
as defined in § 3802 of Title 18.

Covered Lives

The term covered lives includes all Delaware residents; members and their dependents for employersponsored coverage; and all members of the State Group Health Insurance program regardless of state of residence. Mandatory Reporting Entities with fewer than a total of 1,000 covered lives (across all lines of business) may request an exemption from data submission but are still required to complete the Annual Registration Form.

Commonly asked questions related to HCCD data submission

Wholly denied claims are not required to be included in HCCD submissions; although they can be included voluntarily. Wholly denied claims refer to claims in which all lines are denied.

However, if a claim is only partially denied (i.e. some claim lines are paid), then the entire claim must be submitted to the HCCD – including the denied lines. For this reason, Table B.1.F Claim Status of the DSG has been revised to include additional valid values. Information on partially-denied claims will assist in analyses of performed services and assist in claims versioning efforts.

All files submitted to the HCDD must be formatted as standard text files and must follow the format guidelines found in Section 5.1 of the DSG.

There are three sections for all four HCCD file types: the header, “detail”, and trailer sections. All three sections should be submitted in a single file, and all three sections should contain the name of the data column, delimited using the pipe character, followed by the row(s) of information, also delimited using the pipe character. Below is an abridged example of how a member eligibility file should be submitted to the HCCD. The example below is for a data submitter who only has two enrolled members during the reporting period (for example purposes only). The example below also has the section names underlined; these section names SHOULD NOT appear in the actual submission and are included for clarification purposes only.

 

Header Record Example

HD001 ǀ HD002 ǀ HD003 ǀ HD004 ǀ HD005 ǀ HD006

ME ǀ DE100 ǀ SubmitterName ǀ 010318 ǀ 310318 ǀ 3500

Detail Example

ME001 ǀ ME002 ǀ ME003 ǀ ME004 ǀ ME005 ǀ ME006 ǀ ME007…….

DE100 ǀ SubmitterName ǀ MM ǀ 2018 ǀ 03 ǀ 12092284 ǀ IND

DE100 ǀ SubmitterName ǀ MM ǀ 2018 ǀ 03 ǀ 13462537 ǀ FAM

Trailer Record Example

TR001 ǀ TR002 ǀ TR003 ǀ TR004 ǀ TR005 ǀ TR006

ME ǀ DE100 ǀ SubmitterName ǀ 010318 ǀ 310318 ǀ 140418

There is no prescribed format for the historic data Summary Report. The total number of members in each month of historic data can be provided to DHIN in whatever format is preferable for the Data Submitter (e.g. email, Excel document via sFTP, etc.).

As outlined in the Data Collection Regulation, dental claims are currently not required to be submitted to the HCCD. As such, all dental claim-related fields (such as ME020) are denoted as voluntary lines of business (“V”) in the Data Submission Guide. Behavioral health claims, however, fall under the definition of “Medical Claims” as per 16 Del.C. §10312(8), and therefore must be included in data submissions to the HCCD.

The Data Submission Guide applies to both Mandatory Reporting Entities and to Voluntary Reporting Entities. Some data elements pertain only to voluntary lines of business and are marked with a “(V)” in the “Required” column

For the most part, Employer Tax ID and Employer Group Name pertain to lines of business which are not required for HCCD submission (e.g. large group plans). Therefore, they are marked as (V).

However, these two fields do apply to State Group Health Insurance plans which are required to be submitted to the HCCD. In these cases, the assumption of DHIN is that coverage for state employees and retirees will flow through a separate data feed and will have a distinct plan ID, separate from the other lines of business. If that is correct, then ME032 and ME044 would in fact also be voluntary data elements. If that is not correct, and state employee/retiree data will be submitted in the same submission as all other lines of business, then ME032 and ME044 is a required data element.

There are currently five data elements marked as “TH” in the Data Submission Guide: MC107, PC019, MP013, MP014, and MP015. This is an error and will be corrected in the next version of the DSG. All data elements marked as “TH” should instead be marked as Required (“R”), and populated at the required threshold percentage.  

The Provider File should include information on all of the billing providers and rendering service providers with associated medical claims during the reporting period. That being said, DHIN understands that payers will not always have complete information on out-of-network providers and therefore, ask that as much information as possible be included for out-of-network providers, and all information be provided for in-network providers.

In instances where a single provider has more than one “entry” in a data submitters database (e.g. they serve as both billing and performing providers, they have multiple NPIs, etc.), the data submitter should report each provider entry separately. 

The History of the HCCD

The Delaware General Assembly passed legislation in FY16 authorizing the Delaware Health Information Network to develop a healthcare claims database.

The purpose of the HCCD is to facilitate data-driven, evidence-based improvements in access, quality, and cost of healthcare and to promote and improve the public health through increased transparency of accurate claims data and information.

View Findings; purpose; creation (delaware.gov)

§ 10311 The Delaware Health Care Claims Database

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