Ohio and All Payer Claims Databases

updated 6.15.2015

About All Pay Claims Databases

More than 11 states have formed all-payer claims databases (APCD) that contain data derived from medical claims, pharmacy claims, eligibility files, provider (physician and facility) files, and dental claims from both private and public payers. The data usually includes patient and provider demographics as well as clinical, financial, and utilization information.  Although typically created by state mandate, a few states have successfully adopted voluntary reporting of APCD data.

Benefits of an APCD

  • Allows for data-driven policymaking and legislative efforts
  • Encourages consumer engagement and informed decision-making
  • Drives quality improvement efforts by allowing for performance assessments across systems and payers
  • Supports data-driven management of health care cost and utilization
  • Improves population health by illuminating disease and vaccination patterns
  • Informs private and public sector contracting decisions (e.g. allows exchanges to use performance data to determine if an insurer should be allowed to participate)
  • Assists with state regulation of insurers (e.g. allows states to determine if proposed rate increases are reasonable as required by the ACA)

 

All Payer Claims Database Resources

APCD Council (http://www.apcdcouncil.org/)

Helpful fact sheets:

APCD Showcase (http://www.apcdshowcase.org/)

Examples from state all-payer claims databases (APCDs) have been organized in order to provide stakeholders with tangible examples of APCD reports and websites. The examples have been organized by intended audience, and are also searchable by additional criteria.

Other Resources