(1) “Administrator” means the Arkansas Center for Health Improvement;

(2) “AID” means the Arkansas Insurance Department;

(3) “All-payer claims database” or “APCD” means the database created and maintained by the Arkansas Healthcare Transparency Initiative, including the ongoing all-payer claims database project funded through the Arkansas Insurance Department, that receives and stores data from submitting entities;

(4) “APCD Council” means a federation of government, private, non-profit, and academic organizations focused on improving the development and deployment of state-based APCDs;

(5) “Arkansas Healthcare Transparency Initiative” or “Initiative” means the initiative established pursuant to Act 1233 of 2015 to create and maintain a database, including the ongoing all-payer claims database project funded through the Arkansas Insurance Department, that receives and stores data from submitting entities;

(6) “Arkansas Healthcare Transparency Initiative Board” or “Initiative Board” means the advisory board established under Act 1233 of 2015;

(7) “Arkansas resident” means an individual for whom a submitting entity has identified an Arkansas address as the individual's primary place of residence. For individuals covered by a student health plan, “Arkansas resident” means any student enrolled in a student plan for an Arkansas college or university regardless of his or her address of record;

(8) “Commissioner” means the person in charge of the Arkansas Insurance Department;

(9) “Covered individual” means a natural person who is an Arkansas resident and is eligible to receive medical, dental, or pharmaceutical benefits under any policy, contract, certificate, evidence of coverage, rider, binder, or endorsement that provides for or describes coverage;

(10) “Data” means information consisting of, or derived directly from enrollment files, medical claims files, dental claims files, pharmacy claims files, provider files and validation reports;

(11) “Data set” means a collection of individual data records and data elements that comprises the file types for an enrollment file, medical claims file, dental claims files, pharmacy claims file, and a provider file submitted quarterly, and in the format outlined in the DSG.

(12) “Data Submission Guide” or “DSG” means a document approved by the Commissioner in consultation with the Initiative Board, that sets forth the required data file format, data elements, code tables, edit specifications, thresholds required for a submission to be deemed complete, methods for submitting data, validation reports, exception processes, adjustment files, and other information associated with the submitting entities' reporting duties;

(13) “Dental claims file” means, as further defined in the DSG, a data file that contains service level remittance information for all paid and denied claims for each billed dental service for covered individuals including without limitation unique identifiers, geographic and demographic information but not direct personal identifiers; provider information and services rendered to a covered individual; charge/payment information; and clinical diagnosis/procedure codes. Claims and benefits not subject to this Rule will not be included in a dental claims file. The term may exclude certain data that is prohibited to release according to state or federal law;

(14) “Direct personal identifiers” means information relating to a covered individual that contains primary or obvious identifiers, such as the individual's name, street address, e-mail address, telephone number, and Social Security number. “Direct personal identifiers” does not include geographic or demographic information that would not allow the identification of a covered individual;

(15) “Enrollment file” means unique identifiers, demographic and geographic information relating to covered individuals;

(16) “HIPAA” means the Health Insurance Portability and Accountability Act, 42 U.S.C. Section 1320d - 1320d-8 and its implementing regulations, 45 C.F.R. Parts 160, 162 and 164, as may be amended;

(17) “Historical data” means a one-time data submission following submission of a test file and for a period commencing on January 1, 2013 and ending according to the data submission schedule in this Rule;

(18) “Medical claims file” means, as further defined in the DSG, a data file that contains service level remittance information for all paid and denied claims for each billed medical service for covered individuals including without limitation unique identifiers, geographic and demographic information but not personal identifiers; provider information and services rendered to a covered individual; charge/payment information; and clinical diagnosis/procedure codes. Claims and benefits not subject to this Rule will not be included in a medical claims file. The term may exclude certain data that is prohibited to release according to state or federal law;

(19) “Pharmacy claims file” means a data file containing service level remittance information from all paid and denied claims for each prescription for covered individuals including without limitation unique identifiers, geographic and demographic information but not personal identifiers; provider information; charge/payment information; and national drug codes. The term may exclude certain data that is prohibited to release according to state or federal law;

(20) “Provider file” means a data file that includes additional information as set forth in the DSG about the providers that are included in a medical claims file, dental claims file, or pharmacy claims file;

(21) “Submitting entity” means an entity that is subject to this Rule and its data reporting requirements;

(22) “Test file” means a data file, as further defined by the DSG, that includes a sample of service level remittance information for billed medical or dental services or prescriptions for covered individuals;

(23) “Unique identifier” means, as further defined in the DSG, an identifier that is guaranteed to be unique among all identifiers for covered individuals but does not include direct personal identifiers;

(24) “Validation report” means, as further defined in the DSG, a report from the submitting entity that provides aggregated information about a quarterly data submission to provide control totals and record counts.