Answers to common questions about adopting and using the All-Payer Claims Database Common Data Layout (APCD-CDL™), for states starting a new APCD and for existing APCDs considering a transition.
For New APCDs
Do you have access to the implementation guides for healthcare industry standards?
The APCD-CDL references these guides throughout, so you will need them to implement it:
- X12 Post-Adjudicated Claims Data Reporting Implementation Guides (referenced in the medical claims and dental claims file layouts)
- X12 Eligibility and Enrollment Implementation Guides (referenced in the eligibility file layout)
- NCPDP Uniform Healthcare Payer Data Standard Implementation Guide (referenced in the pharmacy claims file layout)
How do I access the code sets referred to in Appendix H?
- CPT procedure codes (licensed through the AMA)
- HCPCS procedure codes (maintained by CMS)
- ICD-10 procedure codes (available through CMS)
- ICD-10 diagnosis codes (available through CMS)
- X12 external code sets
- UB-04 reference tables
Other code sets are listed in Appendix H of the APCD-CDL.
Does your APCD legislation or administrative rule refer to the APCD-CDL?
If so, consider writing your rule so that it adopts the most recent version of the APCD-CDL without requiring new rulemaking each time.
This makes it easier to update your data submission guide each time the APCD-CDL is updated.
What should a health data organization do if its APCD legislation or rules prohibit collecting direct identifiers or personally identifiable information, or require certain hashing or encryption?
Hashing identifiers should not be an issue in using the APCD-CDL, because the APCD-CDL describes the format of the files to be created. Before submitting the files, the submitter can run them through a hashing application.
Work with your vendor to understand hashing and encryption options.
For Existing APCDs
Why should I transition to the APCD-CDL?
- Several states have committed to using the APCD-CDL. By transitioning, you may be able to participate more fully in sharing analytic code with other APCD-CDL states.
- When you use the same format as other APCD-CDL states, you can more easily share information about data quality issues.
- You can incorporate the APCD-CDL by reference in your data submission guide (DSG) and leave updates and maintenance to NAHDO and the APCD Council.
- If the Department of Labor follows through on recommendations to use the APCD-CDL for collecting self-insured data, you will be positioned to take in that data too.
- It's easier on your data submitters. Today, submitters must update multiple state submission layouts, usually all at the end of the year. With the APCD-CDL, they make each change once and use it across APCDs, which makes revisions easier and faster to implement.
How do I include the APCD-CDL in my data submission guide (DSG)?
- Incorporate it by reference, with an appropriate citation to the APCD-CDL version you adopt.
- If you refer to the APCD-CDL in your DSG, you may also copy its content into your DSG. Do not remove or reorder the APCD-CDL's data elements. You may add information about the data elements, such as whether each is required or situational, or the thresholds you expect.
What if I need to collect data elements that are not in the APCD-CDL?
- Bring suggested additions to the APCD-CDL Data Maintenance Committee by submitting a Data Maintenance Request. For questions about adding data elements, e-mail apcd@nahdo.org.
- If an element can't be added through the Data Maintenance Request process, we recommend appending it to the end of the file, or developing a companion guide that describes the additional data elements and business rules.
May I include notes about thresholds alongside the APCD-CDL content in my data submission guide?
Yes. Some APCDs add columns to describe expectations for each field, such as:
- Required or situational
- Percentage of records to be populated (thresholds)
You could also use a companion guide to describe this information.
How do I map my current data submission guide to the APCD-CDL?
Your vendor may be able to help. Many vendors have experience crosswalking the APCD-CDL to state data submission guides.
How do I switch to a new code set for the same data element?
In some cases this can be difficult, because the same code may be used with a different meaning. Your vendor may be able to help.
How long does the transition take?
It depends partly on how close your current data submission guide is to the APCD-CDL format.
It may also depend on how many national versus local payers are in your market. Because several states have adopted the APCD-CDL, most national submitters may be able to transition more quickly than local or smaller submitters.
Should I transition incrementally?
Some states have changed their data submission guides to align more closely with the APCD-CDL. Adopting the code sets used in the APCD-CDL is one example.
Work with your vendor to decide how best to make changes to your data submission guide.
What about my Medicaid fee-for-service program and managed care submitters?
Many existing Medicaid programs have their own submission guides, which usually start with the state's commercial standard and add Medicaid-specific data elements of interest to the state.
If your Medicaid program needs data elements that are not in the APCD-CDL, you can:
- Bring them to the APCD-CDL Data Maintenance Committee for consideration, using the Data Maintenance Request form.
- Create a supplemental data file for the additional Medicaid data elements.
- Work with your data vendor. Many vendors can receive Medicaid data in a different format from what commercial submitters use.
Does Medicare offer data extracts in APCD-CDL format?
Not at this time.
Have a question that isn't answered here? E-mail apcd@nahdo.org.