All Payer Claims Database (APCD)

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What is the Virginia All Payer Claims Database (APCD)?

The Virginia APCD is a database resource that provides actionable information to employers, insurers, providers, public health practitioners, health policymakers, researchers, and consumers to improve the quality, cost, and accessibility of healthcare in the Commonwealth. The APCD contains paid claims from commercial health insurance companies, the Department of Medical Assistance Services (DMAS), and the Centers for Medicare and Medicaid (CMS) Medicare Fee for Service (FFS). For more information, click here.

Why does Virginia need an APCD?

Most information regarding healthcare delivery is currently limited to individual doctors, hospitals, or health plans, resulting in a narrow view of the healthcare system. The APCD provides both the data and the analytic tools necessary for creating a more accurate, complete picture of healthcare in Virginia. This system-wide view enabled by the APCD facilitates a data-driven, evidence-based understanding of healthcare. Enlightened by expenditure patterns and operational and performance measurements of the healthcare system, all industry stakeholder groups can make better informed decisions that holistically improve the mechanics of healthcare in the Commonwealth.

Who benefits from the APCD?

How is the APCD administered in Virginia?

The Virginia APCD exists under the authority of the Virginia Department of Health (VDH) through legislation passed by the Virginia General Assembly in 2012. VDH contracts with Virginia Health Information (VHI) to administer the APCD to be consistent with the law.

The APCD is a voluntary program with participation committed by Virginia’s major health insurance companies. Funding for the database includes 40% from participating health insurance companies, 40% from the Virginia Hospital and Healthcare Association (VHHA), and 20% from VHI.

How do I access APCD data?

Depending on the nature of the request, data from the APCD may currently be accessed via any of the following formats:

  • MedInsight Analytics
  • De-identified Data Extracts
  • Custom Reports

Pricing is dependent on which of these formats is most suitable, as well as the amount of data needed to fulfill the request. All requests for access to data from the APCD require adherence to an application process, outlined below.

What is the application process for accessing APCD data?

Any request for an aggregate report that meets the following criteria may only require a shortened DSA/application:

  • Observation counts greater than 10
  • Payer and Provider identifiers are removed

All other requests require a more extensive application and DSA that must be submitted. A copy of the full DSA can be provided upon request.

Please submit any questions or completed applications here, and VHI will follow up on your request.

How can self-insured employers help?

As the APCD becomes increasingly comprehensive, it provides more insight and ability to all users. Therefore, self-insured employers have an important role to play by having their Third-Party Administrators (TPA) contribute data to the APCD.

Resources: a coalition of statewide APCDS and interested parties, Virginia Articles on APCDs, August 5, 2013 Richmond Times Dispatch

Link to APCD users form for the Virginia Department of Health