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All Payer Claims Database


What is an APCD?

For the past several years a growing number of states have been passing All Payer Claims Database (APCD) mandates. APCDs are large-scale databases created by state mandate that regularly collect medical claims and pharmacy claims data. Some also collect provider, dental claims, and eligibility data. APCD functionality varies from state to state due to state-specific considerations such as, technical capacity, funding, and authority to collect, use, and release data, but all share a similar purpose. State APCD regulations require insurance carriers and third party administrators (TPAs) to submit the data to the APCDs on behalf of the self-funded plans.

 

What is the purpose of an APCD?

APCDs are tools that may be used to increase health care transparency, better understand and address health care cost, quality, and utilization, and support state health system transformation efforts.

 

Is Meritain reporting to any of the states with an APCD?

Provided the required regulatory threshold is met to make APCD requirements applicable, Meritain has been submitting appropriate data in States where APCD reporting requirements exist.

 

To which states does Meritain currently submit data?

Meritain currently submits data to the following states:

 

  • Colorado
  • Minnesota
  • Massachusetts
  • Maine

This content is being provided as an informational tool. It is believed to be accurate at the time of posting and is subject to change. It is recommended that plans consult with their own experts or counsel to review all applicable federal and state legal requirements that may apply to their group health plan. By providing this information, Meritain Health is not exercising discretionary authority or assuming a plan fiduciary role, nor is Meritain Health providing legal advice.