New Hampshire Frequently Asked Questions (FAQs)
for the Collection of Commercial Claims Data

  1. Why do we have to submit this data?
    To be in compliance with New Hampshire Chapter Ins 4000, The Uniform Reporting System for Health Care Claims (http://gencourt.state.nh.us/rules/ins4000.html). The Maine Health Information Center (MHIC) is an agent for the State of New Hampshire and is authorized to receive this data.


  2. What are the most common mistakes made when submitting data?
    Any of these can cause the submission to be rejected.

    a) Relationship code is wrong for ME012, MC011, PC011. HIPAA standards call for different code values for eligibility data vs. claims data. For example, the employee is coded as 20 in MC011 and as 18 in ME012.

    b) Product code is wrong for ME003, MC003, PC003. HIPAA standards call for different code values for eligibility data vs. claims data. For example, indemnity insurance is coded as IN in ME003 and as 15 in MC003.

    c) Low paid to charge ratio in claims data (MC063 : MC062). This is generally because the payer has failed to code the product as Medicare (MC003 = MA, MB) or failed to code the claim status as secondary (MC038 = 02).

    d) Claims unsupported by eligibility data. In general over 95% of the claims incurred for a given month should be supported by eligibility data submitted for that same month. This does not happen when the SSN or contract number is not reported exactly the same way in the eligibility file and in the claims file.

    e) Invalid and missing procedure codes. If a payer accepts local CPT codes and does not provide those codes and their associated descriptions to the MHIC, records with those local codes will be flagged as in error. If you make payments directly to members and you have no procedure code information, you must enter a dummy code in the CPT field (MC055). We recommend a code of MBR. If you pay for prescription drugs through the medical plan and no NDC code is available, you must enter a dummy code in the CPT field (MC055). We recommend a code of DRUGS. If you use codes other than those recommended, you must report those to us.

    f) Invalid diagnosis codes. Payers must report all valid characters of the ICD-9 diagnosis code. Some payers collect only the first 3 characters. This will cause the submission to fail. Decimal points are not to be included in the reported diagnosis code.

    g) Too many members associated with a single contract. This is generally an eligibility file problem caused by reporting the group or policy number in the contract field (ME009). When populated, ME009 should be unique for the subscriber. This field must not be submitted with all 9's, 0's, etc. If the subscriber's social security number is provided, this field should be blank.

    h) Average age over 65. It is highly suspicious to see a submission with an average age over 65 and the product code not set to Medicare. Such a submission will fail until corroborated or corrected by the payer.

    i) Missing provider information. Provider information is required for all medical claims. If payments are made to the member, something must be entered in the Provider Last Name field (MC030), in the provider specialty field (MC032) and in the service provider number field (MC024). All records must have a service provider number, service provider name and a service provider tax ID. Failure to provide this information will cause the submission to fail.

    j) Mixed signs in a single record. Positive dollar amounts are not to be preceded by a + sign. We expect all adjustment records with negative dollars amounts will have all dollar fields as well as the quantity or unit fields coded as negative. If your system adjudicates claims in such a way that a line item may have both negative and positive records, you will need to explain this to us or the submission may fail.

    k) Dates out of range. The HDR and TRL records specify the earliest and latest dates submitted in the file. For eligibility data this relates to Year and Month (ME004, ME005); for medical claims Date Service Approved (MC017); for pharmacy claims Date Service Approved (PC017). A submission with one or more records with one of these dates not included in the date range on the HDR and TRL records will be rejected.

    l) Invalid file format. A file submitted with -too few or too many data elements will be rejected. A file submitted with alpha data in a numeric field will be rejected. The Maine and New Hampshire data sets are very similar but the number of fields in the medical and eligibility files are different. New Hampshire has one less eligibility field and one more medical claims field than Maine does. If Maine formatted data is run through the NH encryption application, the encryption will fail. Similarly if NH formatted data is run through the Maine encryption application, that will fail.


  3. We have a Medicare supplemental product that covers only the member responsibility for Medicare covered services. Are we supposed to report data for those members?
    No. Medical eligibility and claims data are not to be reported for members who have only supplemental coverage. However, if the policy also pays for non-covered Medicare services, the eligibility and claims data are to be submitted.


  4. What data is being encrypted and how will it get encrypted?
    The member identifiable specific data fields/elements will be encrypted by an encryption software package that can be downloaded from the website. The software program will encrypt the Subscriber and Member SSNs and the Subscriber Contract Number. Only these three fields will be encrypted. Additionally, software will compress, password protect and rename the file. You must not encrypt these fields before passing them through the encryption software. If you do not pass the actual SSN's or Subscriber Contract Number through the encryption application, you will be required to re-submit the data.


  5. There is something wrong with the encryption software. I can't get it to work. What should I do?
    1. Download the sample data files from the web site and run those through the encryption software. If this does not work, email us at nhdata@ncdms.org.

    2. Check your data for imbedded asterisks in the data values. These must be enclosed in double quotes.

    If the above do not correct the problem, email us at nhdata@ncdms.org.


  6. Whom do I contact if I am having Upload problems?
    For general transmission questions or for Web Upload questions please contact nhwebadmin@ncdms.org


  7. What is the transmission time frame for the data?
    According to the rule, monthly submitters must file the data by the last day of the month for the previous month's activity. Therefore, on October 31 data for September must be submitted.


  8. What if our system uses "Home Grown" or local claim processing/CPT codes to pay certain types of claims? What do you want us to do if these codes are longer than the 5 digits that are defined in the file layout?
    Following HIPAA standards, eventually all "Home Grown"/local processing codes should be eliminated from your systems. Until that point in time we will accept local CPT codes. You must submit an Excel spreadsheet with all local codes and their descriptions to nhinfo@ncdms.org before submitting your medical claims data or your submission may fail.


  9. What if we have a data value that is longer than the maximum length specified in the rule?
    Send an email to nhinfo@ncdms.org indicate the file type, the data element number, the data element name, the maximum length specified in the rule, and the maximum length you need to submit. We will follow up with instructions as to whether the field should be truncated or if we can accommodate the longer length. If you submit data with a data element length greater than specified in the rule, your submission may fail.


  10. What if some of the data being requested is not available to us to send to you?
    In general, all data elements that can have an appropriate blank/null value have been identified in the layouts for the individual files. However, we understand that there are limitations within different processing and data warehouse structures. According to the data collection rule, any required data elements you receive must be submitted. You may notify us annually of any data elements you are unable to supply. We will discuss the situation with you and, pending approval by NH State officials, make the necessary accommodations. The accommodations will be in place for one year and must be renewed annually.


  11. Why did my file fail with an "invalid relationship code" error?
    One of the frequent problems that we found in many payers was with the coding of individual relationship code fields (ME012, MC011,PC011). These code values are different between file types for the same member because of HIPAA coding specifications that were followed. Please pay close attention to any of the coded fields.


  12. We bundle our approved claims on a weekly basis and cut/send one combined check to the provider each week or month. What date do you want to see in the Date Service Approved fields (MC017, PC017) (i.e., The date the claim was approved for payment or the actual check paid/cut date)?
    What should be listed in the Date Service Approved fields is the date on which the claim was approved for payment. In most processing systems known as the AP (Accounts Payable) Date.


  13. We have an "Employee +1" premium rate that can be used to cover both a subscriber and spouse or a subscriber and dependent/child. What value should we use, ECH, ESP or FAM in the coverage level code in the eligibility file?
    If you can not distinguish between two adults or one adult plus a child then the "Employee +1" rate should be coded as "FAM". If after reviewing the definitions you would like assistance in clarifying what codes should be mapped to your system specific values please contact nhinfo@ncdms.org.