Common Data Layout
The number of states implementing All-Payer Claims Databases (APCDs) has increased steadily since 2007. With this growth, harmonization of state APCD collection has become increasingly important. The APCD Council has a long history of working with states and payers on these harmonization efforts, including drafting a common core set of APCD data elements in 2011. A more detailed history of APCD Council harmonization efforts can be found here.
In May of 2016, the APCD Council began working with states, their vendors, and the payer community to develop a draft APCD- Common Data Layout (CDL) for state APCDs. In June 2017, this group completed a review of the first version of the APCD-CDL™. While the process has not been determined, states and payers have agreed to review and make any necessary updates to the APCD-CDL™ on an annual basis. To request a copy of the APCD-CDL™ please complete the request form and return to firstname.lastname@example.org.
Development of the Common Data Layout for State APCDs (APCD-CDL™)
The Supreme Court decision in Gobeille v. Liberty Mutual Insurance Company ruled that self-insured employers cannot be mandated to submit to state All-Payer Claims Database (APCD) systems. This led to states attempting to identify alternate approaches to data collection. Among these approaches is the possibility of working with the United States Department of Labor (DOL) to determine if the DOL can use its authority to facilitate data collection. There is an assumption that if DOL were to require data submission to state APCDs, DOL would need to be able to refer to a uniform data set that all plans would submit. To date, no decision has been made by the DOL.
Development Process of the APCD-CDL™
In 2015, the Center for Healthcare Transparency (CHT) drafted a Model Data Submission Manual to support some of its work with Regional Data Intermediaries, which have business purposes that require administrative claims data, similar to APCDs. In an effort to standardize data collection for its Regional Data Intermediaries, CHT drafted a Model Data Submission Manual that incorporated references to the data standards maintained by National Council for Prescription Drug Programs (NCPDP) and ASC X12 Post Adjudicated Claims Data Reporting (PACDR). Given the historical experience with the development of the core set of data elements, the APCD Council worked with CHT in the process of reviewing this guide at the end of 2015.
With permission from CHT, the CHT Model Data Submission Manual was reviewed by APCD states, their vendors and the majority of national payers and some regional payers in meetings facilitated by the APCD Council, to identify a CDL for APCD efforts that meet current needs of the states. States conducted the first review of the CHT Model Data Submission Manual in order to develop a CDL and considered the business needs for the data elements proposed, and the utility for analysis. Payers were invited to comment on the draft developed by the states, and from May 2016 through March 2017 have participated in weekly calls with states to review every proposed field in the CDL. This has resulted in the current APCD-CDL™.
While the CDL defines the format for flat files submission, ASC x12 and NCPDP define the industry standards. More about those efforts, which are referenced in the APCD-CDL™, can be found here.
While the process is being finalized, states and payers have agreed to review and make any necessary updates to the CDL.
For more information or questions on the APCD-CDL™ and the process to develop it please email the APCD Council at email@example.com.