Overview All Payer Claims Database

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OverviewAll Payer Claims Database
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All-Payer Claims Dataset (APCD)

• Intended to simplify process by which payers
  submit claims data to various MA state agencies
• Contains details of medical, pharmacy and dental
  claims data for the majority of MA residents
• Available on a de-identified basis to state
  agencies, researchers and others for various
  purposes in the public interest
• Available on an identified basis to providers,
  provider organizations, public and private health
  care payers to carry out treatment and coordinate
  care among providers
• Chapter 224 specifies the following lowering
  total medical expense, coordinating care,
  benchmarking, quality analysis and other
  research, and administrative and planning
  purposes

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Administrative Simplification
Selected Data Elements in the APCD
CHIA for Total Medical Expense, Cost Trends and
Relative PricingNon Claims Payments, Payment
Arrangement Type
Connector/Risk Adjustment for ACAIndicator
Purchased thru HIX, Actuarial Value, Tobacco Use
Group Insurance Commission GIC ID
Health Policy CommissionTotal Medical Expense
Division of InsuranceNAIC Code
Connector and DOIMonthly Premium, Employer ZIP,
Family Size
Connector, DOI and GIC Market Category Code
Connector, CHIA and DOI Employer Contribution
All Payer Claims Data Base
Private and Public Payers
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Massachusetts Development of an APCD is
Consistent with a Growing National Trend
APCD Council Website Interactive State Map
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The APCD is ComprehensiveFiles and Selected
Elements
All-Payer Claims Database
Claims Files(n 3)
Member File
Provider File
Product File
Service/prescribing providerName, Tax ID, Payer
ID, NPI, Specialty code, City, State, Zip
code Billing ProviderName, payer ID, NPI
Personal Health Info (encrypted)Subscriber and
member names and social security numbers Patient
DemographicsAge, gender, relationship to
subscriber
Type of ProductHMO, POS, Indemnity Type of
ContractSingle person, family Coverage
TypeSelf-funded, Individual, Small group
Medical Claims Pharmacy Claims Dental
Claims Service Information Service and paid
dates, paid amount, admission
types, diagnosis and procedure information
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Data Available in the APCD

• Medical, pharmacy and dental services with dates
  of service beginning 2008
• Self insured plans beginning 2011
• Commercial insurance available now and public
  payers (Medicare and Medicaid) to be available
  June 2013
• Generally all MA residents with some excluded
  groups
• Uninsured/self pay
• Workers Compensation
• TriCare/VA
• Federal Employees Health Benefit Plan
• Small private insurers with less than 250,000 in
  annual premiums

• Available to state agencies prior to June
  2013.
• The Division is developing regulations
  concerning minimum data thresholds. Carriers with
  less than the minimum data threshold would not be
  required to submit data to the APCD.

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Privacy Concerns

• APCD is compliant with MA privacy laws
• Users accessing the APCD must certify they will
• Not attempt to re-identify individuals
• Maintain security
• Division will only release minimum data needed to
  meet users research/policy documented needs
• Public Use Data Elements (n 323)
• De-identified member and utilization data
  elements
• Generally available to all qualified users
• Restricted Use Data Elements (n 142)
• Patient month of birth, dates of service, zip
  code, etc.
• Only released to applicants based on intended use

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Accessing Data from APCD114.5 CMR 22.00

• Application process to ensure transparency while
  addressing privacy concerns
• Application includes rationale for
  sensitive/restricted data elements
• Public comment period
• Data Release Committee review/recommendation to
  CHIA Executive Director
• Includes participation by a wide variety of
  stakeholders (payers, providers, consumer groups,
  employers.) Committee members are specialists in
  public health research, privacy rights, data
  security, and health care data.
• CHIA Executive Director approves or denies
• User fees based on type of organization
  requesting data, intended uses and number of
  files requested

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Research Using APCD Data Recently Approved
Applications

• Studying the Impact of Health Policy on Health
  Outcomes
• Child Health Care Quality Measurement Core
  Measure Set Testing
• Evaluation of Mass in Motion and the Community
  Transformation Grants (CTGs)
• Examination of STD, HIV, and Viral Hepatitis
  Testing, Treatment, and Screening Trends in
  Massachusetts
• Utilization of Tobacco Treatment in
  Massachusetts to Quit Smoking
• The Effects of Fragmentation in Health Care

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For Further Information

• apcd.data_at_state.ma.us

Thanks for your interest in the MassachusettsAll
Payer Claims Database.