Standards

History

In 2010 and 2011, the APCD Council convened a Technical Advisory Panel (TAP) to build consensus around the APCD data collection standardization process. The APCD Council TAP included participants from the following organizations: Aetna, AHIP, AHRQ, ADA, AMA, ASPE, Cigna, CMS, NAHDO, Harvard Pilgrim Healthcare, Humana, Kaiser Permanante, Medco, NCSL, NCVHS, NGA, United and the University of New Hampshire.

To learn more about APCD standardization, please read our fact sheet Standardization of Data Collection in All-Payer Claims Databases. A timeline of the history of APCD Council harmonization efforts can be found here.

Since 2011, the APCD Council has promulgated a Proposed Core Set of APCD Data Elements (Proposed Core) for States to consider in building their APCD, as well as worked with several Data Standards Maintenance Organizations to develop implementation guides to support the collection of the Proposed Core.

APCD Council Proposed Core Set of APCD Data Elements

The APCD Council has proposed the following core set of data elements for submission of post-adjudicated healthcare claims data to state APCDs:

APCD Council Proposed CORE Set of Data Elements

Implementation Guides

ANSI Accredited Standards Committee (ASC) X12 Collaboration

In an effort to standardize reporting requirements for the states that collect APCD data, and to ease the burden for the payers that are required to submit the data, in August 2011, the Accredited Standards Committee X12 (ASC X12) and APCD Council announced an initiative to develop a Uniform Medical Claims Payer Reporting Standard.In August 2012, the following PACDR guides were approved by ASC X12 and are now available at http://store.x12.org/store/new-releases:

1. The Post Adjudicated Claims Data Reporting: Professional Implementation Guide (005010X298)

2. The Post Adjudicated Claims Data Reporting: Institutional Implementation Guide (005010X299)

3. The Post Adjudicated Claims Data Reporting: Dental Implementation Guide (005010X300)

In addition to the reporting required by state APCDs, the Guides support many other business needs for the reporting of Post-Adjudicated Claims Data (e.g. Medicaid encounter reporting).  Thus, the guides support the reporting of the Proposed Core Set of Data Elements (described above), as well as many other data elements that are not required by a state APCD.  That being said, the APCD Council recommends using the Proposed Core in conjunction with the Guides where state data collection rules direct the use of industry standards.

We would like to thank the members of ASC X12, John Bock and Laurie Burkhardt (co-chairs of the PACDR Special Appointed Committee), and all of the volunteers who participated in the process. If you are interested in being part of the data standards maintenance process (and informing development of future PACDR Guides), please contact amy.costello@unh.edu.

National Council for Prescription Drug Programs (NCPDP) Collaboration

In 2010, the APCD Council joined the NCPDP WG1 Post Adjudication Task Group to help draft what is now the Uniform Healthcare Payer Data Standard Implementation Guide Version 1.0.  Approved in October 2011 by the NCPDP Advisory Board, this standard was developed to support the reporting requirements for pharmacy claims data submission to states or their designees. The implementation of this standard provides administrative efficiencies and allows for an industry standard to be used for all entities sharing historical pharmacy healthcare data. 

To view published and public limited use standards, please visit the NCPDP Standards page at http://www.ncpdp.org/standards.aspx. NCPDP members can download standards for free; non-members must pay a fee. Further, NCPDP members receive all the documents NCPDP publishes, have access to attend quarterly work group meetings free of charge and can attend the annual conference and educational programs at member rates. Membership information is available at: http://www.ncpdp.org/member_benefits.aspx.

We would like to thank the members of the NCPDP workgroup, Annette Gabel and Lynne Gilbertson of NCPDP, and all of the volunteers who participated in the process.  If you are interested in being part of the data standards maintenance process (and informing development of future Guides), please contact amy.costello@unh.edu.