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")
[www.statecoverage.org]
(*authored by Patrick B. Miller, Denise Love, Emily Sullivan, Jo Porter, and Amy Costello)
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