Frequently Asked Questions
Welcome to the APCD Council Frequently Asked Questions (FAQs) page. The purpose of this resource is to provide answers or direction regarding reocurring questions about APCDs or our organization. For information not answered here, please fill out a Request for Services , or peruse our publications.
1. How can I obtain state APCD data sets for my own analysis?
The APCD Council does not collect state claims data. Each state that allows for public release of their claims data has their own data release policy and process. States currently releasing data include: NH, ME, MA, OR, VT, and CO. Please visit our Data Request page or contact each state directly to find out more information about accessing a state's claims data. Each state contact can be found on our website.
2. What are All-Payer Claims Databases (APCDs)?
APCDs are large-scale databases that systematically collect health care claims data from a variety of payer sources which include claims from most health care providers.
3. How do I find an APCD in my area?
Our website's Interactive State Report Map provides information about APCDs across the U.S. By simply selecting a state, you can find information related to that state’s APCD system.
4. What is the process for developing an APCD system?
Conduct an inventory of the insurance market, access data, add and evaluate public payers, develop submission rules, manage data, and validate data. An extensive look at developing an APCD system is outlined in the APCD Council Development Manual.
5. What is the general timeline for building an APCD system?
The length of implementation (from time legislation with rules is passed onwards) can be a 6 – 12 month process. Release rules conversation takes the longest, so it’s advised to have that conversation early on in the development process.
6. Does the APCD Council provide consulting services to state interested in building APCDs?
Due to an increasing request for services, and to be able to serve you and your organization in a more timely manner, the APCD Council is asking that requests for presentations, informational calls, papers, and other deliverables, be submitted through the Request for APCD Council Services process. Requests are reviewed daily, and the most appropriate member of the APCD Council staff will respond to you.
7. Does the APCD Council collect the states’ claims data? How can I get the data?
The APCD Council does not collect state claims data. Each state that allows for public release of their claims data has their own data release policy and process. Please contact each state point of contact to find out more information about accessing a state's claims data.
8. Who has access to the data once the APCD is created?
The agency responsible for the APCD (e.g. Insurance Department, Health Department) is ultimately responsible for oversight of report production and controlling access to the APCD data according to well-defined data release policies and procedures. These policies and procedures protect privacy and prevent unauthorized usage. Agency staff will assure compliance to data access policies and interact with vendors and others to assure the website and reports are also in compliance. Typically, there is a multi-stakeholder committee managing data release requests.
States with data releases processes are detailed on our State Data Access page.
9. Can I use APCD Council documents in a presentation, in an article I’m writing, etc.?
Please review the APCD Council Attribution Policy before including APCD Council information in presentations, etc. Thank you!
10. How do we pay for these systems?
Public APCDs are typically funded by one or more of the following sources:
General appropriations (e.g. New Hampshire)
Fee assessments on public and private payers (health plans) and facilities (e.g. Vermont)
Medicaid match (e.g. Utah)
Data sales (e.g. Maine).
Other states developing APCDs are also considering additional support from foundations (e.g. Colorado) and one state is using federal Beacon Community Cooperative Agreement Program funds (e.g. Rhode Island). It has been discussed that states might be able to produce consolidated pay-for-performance or other value added services to help fund their efforts. Private, voluntary reporting initiatives generally rely on membership dues for core funding (e.g. Wisconsin).
11. How much will it cost to produce data sets/reports? Is there a return on investment from data sales?
Costs of report development can vary widely, depending on the type of report. Agencies with laws and policies that permit the release of standard de-identified and research APCD analytic files can generate revenues from the sales of these products, with the appropriate release agreements and research review approvals. These revenues provide a partial return on investment to offset data collection and preparation of the analytic files. Production of public reports typically are a cost to the agency and often are required as part of their core funding. These reports inform policies and yield a different kind of return on investment in terms of dollars saved and system improvements.
12. Why data collection standardization?
Standardization of data collection would ensure that states collecting the same data would do so in the same manner. A standardized data file submission would use an identical file structure (i.e., data element positioning and field lengths) in each state’s database, but would not require that every state collect data for each element.Each state is currently collecting data in a non-uniform approach by using different methods with different definitions. The form of developing APCDs is limiting the ability to share analysis and applications across states while raising costs for payers, especially those operating in multiple states, to submit data.
13. How is the mandate written?
A mandate is written to collect all insurance data for your states population (residence of states). Some specifically detail specific types (dental, etc) while other states write their mandate more broadly.
14. What can be done with the data?
The data provided by APCD can be essentially used in many aspects of rate setting as well as Patient-Centered Medical Homes (PCMH). PCMH is a program for organizing and improving primary care. Also, the data can be used for trending analysis and providing those who seek certain information with the answers they need. To find out more how people are using claims data, please visit the APCD Council's APCD Showcase.
15. How does my organization get on your vendor list?
To be added to the APCD Council vendor list, a vendor organizations must demonstrate that they have either responded to RFIs or RFPs related to providing all-payer claims database services to states or have ever provided APCD-related services to states.
16. How does the APCD address issues of recoding of claims, grievances and appeals, etc?
Claims are received by payers on a monthly basis and are released quarterly – adjustments are made in the next “refresh” of the data. One state, Utah, is managing claims in a different way. Whether or not we should be capturing post adjudicated only OR what was submitted and paid? TAP is seemingly saying both.
17. How have states approached self-insured member examples?
States have approached this mandate by including ERISA plans in mandates. This is a controversial issue in some states (VA), and not in others (MA). What does the ID or AG believe is the legal authority to collect? No challenges from an ERISA perspective. Attributed to state mandate where carriers have responded. Carriers have a hard time segregating that data.
18. How does the APCD connect with other things to serve our state population?
Health Information Exchanges (HIEs) have the potential to enhance, but not replace, existing administrative databases (such as APCDs) with clinical information for quality and outcomes reporting.
19. What is the privacy interplay between HIE and APCD in terms of people who opt out of HIE though they are intertwined in APCD?
Privacy will tie into your release rules (who gets what, when). If you bring claims data into HIE, would you have something in place to hide this data in the case of an opt-out? No immediate answer as far as best practice is concerned. Opting in and opting out conversation has been around HIE more so than APCD. In terms of APCD, it’s an opt-in model. You’re collecting all claims on all residence. The issue arises when you begin linkage efforts; states need to consider how linkage affects data integrated from APCD.
20. What are the difficulties in accessing behavioral/mental health/substance abuse data (42 CFR)?
States typically detail types of data to be collected by their systems in the data collection and data release rules. APCDs do not collect payments that take place outside insurance system (i.e. out of pocket stuff like acupuncture, massage, etc). For more information on Legislation and Rule Making please visit http://www.ncsl.org/portals/1/documents/health/ALL-PAYER_CLAIMS_DB-2010.pdf.
21. How can states document that a patient receiving services in a certain state is the same patient receiving services in another state (travel across state lines)? How do you identify the patient if there is no unified patient ID?
Provider number (NPI) – no suffix, no relationship code – states are addressing that by using manually resources take data from carriers and amalgamating it Patient number – states are not collecting full patient identifiers; NH gives piece of code to carriers to de-identify the patient, but when data leaves payer the patient information is encrypted again. There are still issues with idling patients who are moving from state to state which supports the creation of a unified patient ID. Also, just because you collect patient identifier doesn’t mean you need to release it.
22. In the midst of system change (i.e. the transition from ICD 9 to ICD 10, bundled payment models, etc.), how will changes affect current and future APCD efforts?
There needs to be an analytic understanding of the differences so you can cross walk data. APCD efforts need to ensure that policies aren’t created that affect data integrity.