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www.ahrq.gov/topics/all-payer-claims.html
All-Payer Claims
AHRQ activities focus on developing an effective, feasible approach … for using all-payer claims databases to improve healthcare affordability, efficiency, and cost transparency … Databases: Data Evaluation of All-Payer Claims Databases
This report provides background on APCDs … Expanding and Enhancing All Payer Claims Database System Capacity in States
This report summarizes … the Fifth All Payer Claims Database Conference, Expanding and Enhancing All Payer Claims Database System
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www.ahrq.gov/data/apcd/index.html
February 01, 2018 - All-Payer Claims Databases
The Agency for Healthcare Research and Quality is undertaking activities … to develop an effective and feasible approach for using all-payer claims databases to advance the goal … Overview of All-Payer Claims Databases
All-payer claims databases (APCDs) are large State databases … that include medical claims, pharmacy claims, dental claims, and eligibility and provider files collected … i Go to The Basics of All-Payer Claims Databases: A Primer for States .
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www.ahrq.gov/learning-health-systems/frailty-ehr.html
September 01, 2022 - Developing and Assessing the Validity of Claims-based Indicators of Frailty & Functional Disabilities … Multiple claims-based frailty indexes (CFIs) have been developed and validated over the past few years … ; however, healthcare providers often do not have access to the insurance claims records of their entire … This project focused on validating an established CFI using linked claims-EHR databases of multiple large … Developing and Assessing the Validity of Claims-based Indicators of Frailty & Functional Disabilities
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www.ahrq.gov/sites/default/files/wysiwyg/data/SyH-DR-Claims-Level-Variables-2024.pdf
January 01, 2024 - SyH-DR Data Dictionary: Claims-Level Variables
SyH-DR Data Dictionary: Claims-Level Variables
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www.ahrq.gov/data/apcd/backgroundrpt/index.html
April 01, 2017 - Inventory and Prioritization of Measures To Support the Growing Effort in Transparency Using All-Payer Claims … Inventory and Prioritization of Measures To Support the Growing Effort in Transparency Using All-Payer Claims … Databases
Introduction
Reviewing the Landscape of All-Payer Claims Databases
Measure Inventory … One way to use measures this way is through all-payer claims databases (APCDs). … Contents
Introduction
Overview of All-Payer Claims Databases
Uses of All-Payer Claims Databases
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www.ahrq.gov/sites/default/files/wysiwyg/data/SyH-DR-Data-Dictionary-Claims-Level-Variables-2024mar.csv
April 01, 2024 - Variable Label Variable Name Medicare Files Medicaid Files Commercial Files Variable Type Variable Length Variable Format Synthesized Masked Suppressed (DID) Note / Rule
Admission Type ADMSN_TYPE X X X CHAR 1 CHAR(1) Fully No Yes Records with value equal to 4 were deleted. Inpatient only.
Attending Provider Special…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/apcd/apcdmeasinvrpt.pdf
January 01, 2020 - APCDs are large-scale databases that systematically collect medical claims, facility claims,
pharmacy … claims, dental claims (typically, but not always), and eligibility and provider files from
private … The basics of all-payer claims databases: a primer for states. … The value of all-payer claims databases to states. … All-payer claims databases: an overview for policymakers.
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www.ahrq.gov/data/apcd/confrpt.html
February 01, 2018 - Expanding and Enhancing All Payer Claims Database System Capacity in States
The National Association … The purpose of the Fifth All Payer Claims Database Conference, “Expanding and Enhancing All Payer Claims … The purpose of the Fifth All Payer Claims Database Conference, "Expanding and Enhancing All Payer Claims … Keywords
All payer claims databases. … and Institutional claims that accommodate State reporting needs.
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www.ahrq.gov/pqmp/implementation-qi/toolkit/tcd/about.html
July 01, 2021 - It also required the development of a valid claims-based case definition. … This definition ensured the feasibility of using only administrative claims for this measure. … A lag in claims availability at the state level may create a delay in use of Medicaid claims. … The detailed measure specification may be used on administrative claims in any context. … The lag in claims availability at the state level creates a delay in use of Medicaid claims.
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www.ahrq.gov/data/innovations/syh-dr.html
October 01, 2024 - The Synthetic Healthcare Database for Research (SyH-DR) is an all-payer, nationally representative claims … The database consists of a sample of inpatient, outpatient, and prescription drug claims, including utilization … SyH-DR is a synthetic database that replicates the structure and statistical properties of the original claims … of SyH-DR The Agency for Healthcare Research and Quality (AHRQ) created SyH-DR from eligibility and claims … Claims Files Commercial Inpatient File. Commercial Outpatient File. Commercial Person-Level File.
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www.ahrq.gov/sites/default/files/2025-02/platt-report.pdf
January 01, 2025 - using all-payer claims databases. … for claims data for all patients. … Using claims codes as indicators of potential SSI, we calculated an unadjusted claims-based
SSI risk … We
compared rankings based on all-payer claims data to those based upon Medicare claims alone. … claims.
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www.ahrq.gov/data/apcd/backgroundrpt/references.html
April 01, 2017 - The basics of all-payer claims databases: a primer for states . … All-payer claims databases: an overview for policymakers . … Validity of electronic prescription claims records: a comparison of commercial insurance claims with … Making use of all-payer claims databases for health care reform evaluation . … All payer claims databases: unlocking the potential . NEHI Issue Brief.
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www.ahrq.gov/data/apcd/backgroundrpt/data.html
April 01, 2017 - Further, the issue of duplicate claims likely far outweighs the claims lost.
Table 3. … (typically, 30% of claims are not inpatient). … claims contain fewer diagnosis codes. … file
Deductible amount
100%
In claims file
Amount prepaid
100%
In claims file … Amount paid
100%
In claims file
Coinsurance
100%
In claims file
Allowed amount
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www.ahrq.gov/data/apcd/measureinventory.html
October 01, 2017 - All-Payer Claims Database Measure Inventory
The Agency for Healthcare Research and … Quality is undertaking activities to develop an effective and feasible approach for using all-payer claims
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www.ahrq.gov/data/apcd/envscan/index.html
June 01, 2017 - All-Payer Claims Databases Measurement of Care: Systematic Review and Environmental Scan of Current Practices … and Evidence
Next Page
Table of Contents
All-Payer Claims Databases Measurement of … Included
State-and national-level momentum is building to create and maintain all-payer claims … large-scale databases that systematically collect professional, facility, pharmacy, laboratory, and dental claims … Suggested citation: All-Payer Claims Databases Measurement of Care: Systematic Review and Environmental
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www.ahrq.gov/sites/default/files/wysiwyg/learning-health-systems/frailty-ehr.pdf
September 01, 2022 - EHRs versus Claims
EHRs are inherently different from insurance claims. … , (2) in EHR only, (3) in claims only, and (4) in neither
EHR nor claims. … Then, the ratio of claims vs. … o Data Notes: OLDW claims data included only Medicare Advantage (MA) and
commercial claims. … of Claims vs.
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www.ahrq.gov/data/apcd/envscan/references.html
November 01, 2020 - The basics of all-payer claims databases: a primer for states. … The value of all-payer claims databases to states. N C Med J 2014;75(3):211-3. … All-payer claims databases: an overview for policymakers. … Making use of all-payer claims databases for health care reform evaluation. … Overview of the Massachusetts all payer claims database.
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www.ahrq.gov/patient-safety/settings/hospital/candor/demo-program/grants/findings.html
August 01, 2022 - Malpractice claims. 7 The grantee aimed to establish a baseline level of legal claims and other malpractice … Overall, the number of claims, lawsuits, and paid claims in the UT System decreased after Texas enacted … Capturing meaningful claims data, in particular, may require several years due to the malpractice “claims … Shoulder dystocia-related claims. … “Incurred” amounts (loss payments on closed claims and reserves set aside to pay pending claims) were
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www.ahrq.gov/sites/default/files/publications/files/prioritization-report_0.pdf
January 01, 2020 - Further, the issue of duplicate claims likely far outweighs the
claims lost.
16 All-Payer Claims … claims contain
fewer diagnosis codes. … file
Deductible amount 100% In claims file
Amount prepaid 100% In claims file
Amount paid 100% In … claims file
20 All-Payer Claims Databases Report
Variable Type
Nonmissing Range
in Quarter … Validity of electronic prescription claims records: a comparison of commercial
insurance claims with
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www.ahrq.gov/data/apcd/envscan/summary.html
June 01, 2017 - All-Payer Claims Databases Measurement of Care: Systematic Review and Environmental Scan of Current Practices … Evidence
Executive Summary
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Table of Contents
All-Payer Claims … These key characteristics of APCD data enable measurement not possible with hospital discharge claims … databases (MPCDs), or other claims databases (Medicare or Medicaid). … They create twice-yearly cost reports based on claims from four major insurers.