All-Payer Claims Database

What are All Payers Claims Databases?

How To Use The APCD Comparison Map

APCDs are large-scale databases that systematically collect health care claims data from a variety of payer sources. These databases, typically created by a state mandate, generally include data derived from medical claims, pharmacy claims, eligibility files, provider (physician and facility) files, and dental claims from private and public payers. Payers include insurance carriers, third party administrators (TPAs), pharmacy benefit managers (PBMs), dental benefit administrators, Medicaid, Children's Health Insurance Program (CHIP), Medicare, Medicare Part D, Federal Employees Health Benefits (FEHB), and TRICARE.


APCD systems collect data from the existing transaction systems in place to pay health care claims, thus leveraging data from within the insurance claims and reimbursement system. The information typically collected in an APCD includes patient demographics, provider demographics, clinical, financial, and utilization data. Because of the difficulties associated with the collection of certain information, most states implementing APCD systems have typically excluded a number of data elements, such as denied claims, workers' compensation claims, and services provided to the uninsured.

(Referenced from "All-Payer Claims Databases: An Overview for Policymakers") External Link [www.statecoverage.org]

(*authored by Patrick B. Miller, Denise Love, Emily Sullivan, Jo Porter, and Amy Costello)

1.

The highlighted States on the list contain APCD metadata in USHIK. Select a State to view individual APCD metadata for that State or select multiple States for a side by side comparison of APCD metadata.
how to use apcd step one illustration

2.

After completing your selection, click the [Show Data Elements Related To States]. USHIK will run and display a metadata comparison of both the APCD Council metadata (if available for that State) and the State Legislation's APCD metadata.
how to use apcd step two illustration

3.

The results will contain the metadata associated with the APCD council metadata specifications and any metadata associated with the selected States.
how to use apcd step three illustration

4.

By selecting two or more data elements from this display and clicking on [Compare Data Elements] USHIK will display an in-depth comparison of the selected metadata attributes for these data elements.
how to use apcd step four illustration

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