These resources provide information for people interested in
learning about how different states define the rules for what can and
should be collected in an all-payer claims database. States currently
define those rules differently, but work is underway to harmonize those
rules. For more information about the work being done to harmonize the
rules for data collection, please send an email to amy.costello@unh.edu.
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 or on our Publications page.
ANSI Accredited Standards Committee (ASC) X12 Collaboration 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, the Accredited Standards Committee X12 (ASC
X12) and APCD Council announced a new initiative to develop a Uniform
Medical Claims Payer Reporting Standard. The annoucement is available here .
Post-Adjudicated Claims Data Reporting (PACDR) Meeting Information
On
October 6, 2011 the Accredited Standards Committee X12 (ASC X12), the
All-Payer Claims Database Council (APCD Council) and the National
Association of Health Data Organizations (NAHDO) hosted their inaugural
meeting to discuss the strategy for developing the Uniform Medical
Claims Payer Reporting Standard, at the ASC X12 Standing Meeting in
Pittsburgh, PA. The press release is available here .
Going forward, ASC X12N has established an X12 Special Appointed
Committee (SAC) for the Post-Adjudicated Claims Data Reporting (PACDR)
implementation guides. All X12N members
are invited to participate in the SAC. Interested
parties should send an email to info@disa.org , with the subject “PACDR”. APCD Council has
confirmed that NAHDO state members may
join X12 (and have access to “Central Desktop”, the X12 virtual workspace, and
participate in the workgroup discussions) under the organizational NAHDO
membership.
National Council for Prescription Drug Programs (NCPDP) Collaboration
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 will provide administrative efficiencies and allow 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. To become an NCPDP member, please visit the NCPDP Membership page at http://ncpdp.org/membership.aspx .
APCD Council Technical Advisory Panel (TAP)
APCD Council Technical Advisory Panel (TAP)
In 2010, the APCD Council convened a Technical Advisory Panel
(TAP) to build consensus around the APCD standardization process. The APCD
Council TAP includes participants from the
following organizations: Aetna, AHIP, AHRQ, ASPE, Cigna, CMS, NAHDO,
Harvard Pilgrim Healthcare, Humana, Kaiser Permanante, Medco, NCSL,
NCVHS, NGA, United and the University of New Hampshire
As requested by the APCD Council TAP, the
code sets for non-X12 data elements are presented in the following
spreadsheets for both eligibility and medical files.
For X12 data elements, please consult the X12 implementation guides (available: http://store.x12.org/ ) for the most current information about the code sets.
If
your organization would like to propose changes to the non-X12 data
elements, the APCD Council is willing to provide a forum to discuss the
proposed changes with other states. If your organization would like to propose a change to an X12 data element (270, 271, 835, 837), please contact X12 (www.x12.org ) to initiate the appropriate change request through the ANSI-based X12 process.
