31-53-40. Definitions.

As used in this article, the term:

“Administrator” means the administrator of the GAPCD.#

“Advisory committee” means the GAPCD Advisory Committee established pursuant to Code Section 31-53-41.#

“Claims data” means information included in an institutional, professional, or pharmacy claim or equivalent information transaction for a covered individual, including the amount paid to a provider of health care services plus any amount owed by the covered individual.#

“Direct personal identifiers” means information relating to a covered individual that contains primary or obvious identifiers, such as the individual’s name, street address, email address, telephone number, and Social Security number, but does not include geographic or demographic information that would prohibit the identification of a covered individual.#

“GAPCD” means the Georgia All-Payer Claims Database established pursuant to this article.#

“Submitting entity” means:#

1. (A)

   An entity that provides health or dental insurance or a health or dental benefit plan in the state, including without limitation an insurance company, medical services plan, hospital plan, hospital medical service corporation, health maintenance organization, or fraternal benefit society, provided that the entity has covered individuals and the entity had at least 1,000 covered lives in the previous calendar year;#

2. (B)

   The Department of Community Health in the administration of Medicaid fee-for-service claims and the State Health Benefit Plan;#

3. (C)

   Medicaid care management organizations;#

4. (D)

   A health benefit plan offered or administered by or on behalf of the federal government with the agreement of the federal government;#

5. (E)

   Any other entity providing a plan of health insurance or health benefits subject to state insurance regulation, including, but not limited to a third-party administrator or pharmacy benefits manager, provided that the entity had at least 1,000 covered lives in the previous calendar year;#

6. (F)

   An entity that contracts with institutions of the Department of Corrections to provide medical, dental, or pharmaceutical care to inmates;#

7. (G)

   Any other health benefit plan offered or administered by or on behalf of the state or an agency or instrumentality of the state;#

8. (H)

   The State Board of Workers’ Compensation; and#

9. (I)

   The Georgia Access to Medical Cannabis Commission.#

10. This term does not include an entity that provides health insurance or a health benefit plan that is accident-only, specified disease, hospital indemnity, long-term care, disability income, or other supplemental benefit coverage.