Review of the All-Payers Claims Database Common Data Layout

Date: December 9 2021

Summary:

Keywords: #archive

Bibliography

APCD Council, "APCD CDL." Institute for Health Policy and Practice, Feb. 01, 2021.

Table of Contents

• Harmonize claims collection effort across states

• Reduce burden of data submission

• ASCII files with variable field lengths and pipe delimited

- Member eligibility file
- Medical claims file
- Pharmacy claims file
- Dental claims file
- Provider file

• Maintain consistent person identifier across all files and databases

• Keep it person-centric

• The sum of all claim payments per data element is: total charge + paid + prepaid + co-pay + coinsurance or deductibles

- Could lead to ambiguity as exact variables differ among claim types

• Limited to only

- Member eligibility file
- Medical claims file
- Pharmacy claims file
- Dental claims file
- Provider file

Pros

Eligibility File

• Does contain information on employment status

• Does contain income information about members

Medical Files

• Sequence number seems to be the ID by which to link persons across tables

- This alongside names

Pharmacy Files

• Everything about a pharmacy is included

Cons

General

• Cash amounts, procedure codes, diagnosis codes, etc do not contain punctuation

- How do you get around ambiguity?

• Non-obvious on how to add nonstandard data types

Eligibility File

• Does not contain information about education level

• Standard requires subscriber confidential information

- SSN
- Name

• Does not contain information about income level for subscribers

- Not immediately apparent on how to classify subscribers across income
- How to do analysis of income vs cost of care?
	- Is cost of care fair for them?

Medical Files

• Payer claim control number (PCCN) seems to put a ratchet in the plans of versioning

• How often is it that patient modifiers are not useful?

How To Cite

Zelko, Jacob. Review of the All-Payers Claims Database Common Data Layout. https://jacobzelko.com/12092021200612-apcd-cdl. December 9 2021.

References:

Discussion: