Payer Data Reporting: Total Medical Expenses (TME) and Alternative Payment Methods (APM)

Report Resources

• TME-APM Data Specification Manual (PDF) | Word
  
  
• TME-APM Data Reporting Template and Data Example (.xlsm file)
  
  
• Medical Pharmacy Codes (.xlsx file)
  
  
• Commercial Partial Gross Up Revised Methodology (PDF) | Word
  
  

• Provider Groups and OrgID List (Excel)
  
  
• Massachusetts Zip Codes (Excel)
  
  
• CHIA Submissions User Agreement
  
  
• CHIA Submissions User Guide (PDF) | Word
  
  

• Related Regulation and Administrative Bulletins

Submission Deadline
for 2023

Overview

M.G.L. c. 12C, § 10 requires the Center for Health Information and Analysis (CHIA) to collect certain information from both private and public health care payers in the Commonwealth. Payers must submit data annually in accordance with regulation 957 CMR 2.00.  This regulation governs the methodology and filing requirements for health care payers to calculate and report:

• Health Status Adjusted Total Medical Expenses (TME)
  
  
• Alternative Payment Methods (APM)

TME-APM for 2024 Reporting

All TME-APM data will be submitted by using a pre-formatted Excel template. Reports are required to be submitted through https://chiasubmissions.chia.state.ma.us, CHIA’s web-based transaction service. For more information on this transaction service, please see CHIA Submissions and INET Questions and Answers. Please refer to the CHIA Submissions User Guide for information specific to TME and APM reporting.

Filing Application

For more information on filing deadlines and regulatory guidance, please refer to Regulation 957 CMR 2.00 (Payer Data Reporting) and the latest Administrative Bulletins.

Questions

For questions specifically related to TME-APM reporting, please email Molly Bailey at molly.bailey@chiamass.gov. Please include the subject line "TME-APM Submission."