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.
APCD Council Proposed Core Set of APCD Data Elements for Submission APCD Council Proposed Core Set of APCD Data Elements for Submission
As a result of work with the APCD TAP, the APCD Council has proposed the following core set of data elements for
submission of post-adjudicated healthcare claims data.
APCD Council Proposed CORE Submission Data Elements
In addition, APCD Council is engaged with the ASC X12 HIX
Transactions Special Appointed Committee that is addressing the requirements
for enrollment transactions. APCD Council is exploring the connection
between HIX enrollment transaction data and the business needs for eligibility
data for APCDs. The following proposed core set of data elements for submission of
APCD eligibility data was last updated in November 2011.
APCD Council Proposed CORE Submission Data Elements_Eligibility
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, in August 2011, the Accredited Standards Committee X12 (ASC
X12) and APCD Council announced an initiative to develop a Uniform
Medical Claims Payer Reporting Standard. We are pleased to annouce that in August 2012, the following PACDR guides were approved by ASC X12 and are now available at http://store.x12.org/store/new-releases :
1. The Post Adjudicated Claims Data Reporting: Professional Implementation Guide (005010X298)
2. The Post Adjudicated Claims Data Reporting: Institutional Implementation Guide (005010X299)
3. The Post Adjudicated Claims Data Reporting: Dental Implementation Guide (005010X300)
We would like to
thank the members of ASC X12, John Bock and Laurie Burkhardt (co-chairs
of the PACDR Special Appointed Committee), and all who helped
participate in the process.
National Council for Prescription Drug Programs (NCPDP) Collaboration
National Council for Prescription Drug Programs (NCPDP) Collaboration
NCPDP is a standards organization. They provide a place for industry
representatives to come together to solve problems, specifically in the
pharmacy services sector. General information about NCPDP and its processes is
available at http://www.ncpdp.org/about.aspx .
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; non-members must pay a fee. Further,
NCPDP members receive all the documents NCPDP publishes, have access to attend
quarterly work group meetings free of charge and can attend the annual
conference and educational programs at member rates. Membership information is
available at http://www.ncpdp.org/member_benefits.aspx .
For updates to NCPDP standards, any member or interested party may submit
requests for updates called a DERF (data element request form). The DERF
process and form is available at http://www.ncpdp.org/standard_changes.aspx .
There is a calendar on this page also which tells the date a DERF needs to be
submitted to be discussed at a quarterly work group meeting.
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, ADA, AMA, ASPE, Cigna, CMS, NAHDO,
Harvard Pilgrim Healthcare, Humana, Kaiser Permanante, Medco, NCSL, NCVHS, NGA,
United and the University of New Hampshire.
For a history of
TAP milestones and History of APCD Council Harmonization Efforts, October 2011 .
