Massachusetts
Category
Title or Name of APCD System
  • Massachusetts All-Payer Claims Database
Who Maintains the System
  • Massachusetts Center for Health Information and Analysis
Website
Legal Authority
Statute
Submission Rules
Release Policy
First Year APCD Collected Data
  • 2009
APCD Snapshot
  • In 2009, the Division of Health Care Finance and Policy (CHIA’s predecessor agency) began to collect detailed claims data from payers following earlier preliminary efforts. The project charter established the goal of administrative simplification: making the database a central resource for all state agencies needing claims-level data to support their missions. This focus was important to secure the support of the insurance carriers who would be submitting data to the MA APCD. While implementation of the MA APCD would require significant resource investment by the carriers, it would also reduce the proliferating—and sometimes conflicting—requests for carriers to submit data to different state agencies. The charter also called for enhancing the data to facilitate analysis and making the database widely available: to the public to help inform policy, to consumers to support health care purchasing decisions, and to physicians to support care management and coordination. Responsibility for the MA APCD was transferred to CHIA in November 2012 following its creation earlier that year.
Number of Commercial Sources of Claims Data
  • 52
Sources and Status of APCD Data Collection
Payers
Commercial Payers
  • Currently Collected
Third Party Administrators/Self-Funded
  • Currently Collected
Medicaid
  • Currently Collected
Medicare
  • Currently Collected
Other
  • Collection of Product and Provider files
    *Self-funded claims are Voluntary
Types of Data Collected 
Medical Claims
  • Currently Collected
Eligibility
  • Currently Collected
Dental
  • Currently Collected
Pharmacy
  • Currently Collected
Primary Users/Uses
  • 1. Cost analysis
    2. Enrollment monitoring
    3. Facilitation of administrative simplification by serving as the central repository of health care claims data for Massachusetts state government agencies
    4. Academic research
State Specific Resources
Contact Information

Use Cases from the APCD Showcase

Displaying 6 - 10 of 27

Use Cases Category Carriers
Provider networks for pulmonary hypertension in Massachusetts: Implications for improving referrals to expert care
This case study found significant gaps in connections to expert care, even among providers caring for patients at risk for pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension, which may be driven in part by limited provider experience, geographic barriers, and disconnected providers and care networks. Multifaceted strategies may be needed to improve referral rates for patients with pulmonary hypertension.
 Consumers, Medicaid, Population Health, Providers Commercial, Medicaid, Medicare
Guideline-Concordant Care and Clinician and Clinic Characteristics for Patients With Schizophrenia
This case study finds that for patients with schizophrenia in Massachusetts, psychiatric nurse practitioners and mental health clinics delivered care quality comparable to psychiatrists, while primary care providers lagged on psychosocial services and psychotherapy but performed better on diabetes screening — suggesting expanded use of advanced practice providers is promising, though guideline-concordant care remains low across all provider types.
 Medicaid, Providers, Researchers Commercial, Medicaid
Curbing the Growing Fragmentation of Veterans’ Health Care
This study quantifies a major shift in locus of VA critical care, a likely outcome of expanded non-VA health insurance coverage that was previously called out, but the study was not designed to address the many issues raised by outsourcing so much ICU care, including questions about the coordination and continuity of post-ICU care for these patients with high-acuity conditions. The study adds to concerns about VA’s ability to oversee the quality of community care and gaps in the integration of VA-delivered and VA-purchased care.
 Consumers, Health Reform, Medicaid, Population Health, Providers Medicaid
Medicaid Accountable Care Model Designs and Maternal Health Measures
In this study, both Medicaid ACO models were associated with improved outcomes, but with some differences between models, suggesting that states should consider how to best optimize model designs to improve care and outcomes for pregnant and postpartum patients when designing or redesigning their programs.
 Medicaid, Population Health Medicaid
Recommendations for Prevention and Control of Influenza in Children, 2025–2026: Technical Report
This technical report summarizes recent influenza seasons, morbidity and mortality in children, vaccine effectiveness, and vaccination coverage, and provides detailed guidance on vaccine storage, administration, and implementation. The report also provides a brief background on inactivated (non-live) and live attenuated influenza vaccines, available vaccines for the 2025–2026 influenza season, vaccination during pregnancy and breastfeeding, diagnostic testing for influenza, and antiviral medications for treatment and chemoprophylaxis. Strategies to promote vaccine uptake are emphasized
 Population Health Commercial