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1. All-Payer Claims Databases | Agency for Healthcare Research and Quality
   www.monahrq.ahrq.gov/data/apcd/index.html
   February 01, 2018 - Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … 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 … in States All-Payer Claims Databases Measurement of Care: Systematic Review and Environmental Scan … Databases Measure Inventory for Use With All-Payer Claims Databases (Final Contract Report)  (PDF,

2. All-Payer Claims | Agency for Healthcare Research and Quality
   www.monahrq.ahrq.gov/topics/all-payer-claims.html
   Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … Home Topics A All-Payer Claims … 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

3. Reviewing the Landscape of All-Payer Claims Databases | Agency for Healthcare Research and Quality
   www.monahrq.ahrq.gov/data/apcd/backgroundrpt/review.html
   July 01, 2022 - Databases Introduction Reviewing the Landscape of All-Payer Claims Databases Measure Inventory … A weakness of APCDs is the lag between claims and what is currently happening in the market. … databases, or other claims databases (Medicare or Medicaid). … They create twice-yearly cost reports based on claims from four major insurers. … Lastly, several organizations contribute discrete groups of claims-based measures.

4. Inventory and Prioritization of Measures To Support the Growing Effort in Transparency Using All-Payer Claims Databases | Agency for Healthcare Research and Quality
   www.monahrq.ahrq.gov/data/apcd/backgroundrpt/index.html
   April 01, 2017 - 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 …      Purpose of Project Reviewing the Landscape of All-Payer Claims Databases      Technical Expert … Panel      Environmental Scan Measure Inventory Data Evaluation of All-Payer Claims Databases     

5. Expanding and Enhancing All Payer Claims Database System Capacity in States | Agency for Healthcare Research and Quality
   www.monahrq.ahrq.gov/data/apcd/confrpt.html
   February 01, 2018 - 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. … Since the first APCD system was established in 2003, the number of States collecting claims and other … and Institutional claims that accommodate State reporting needs.

6. Data Evaluation of All-Payer Claims Databases | Agency for Healthcare Research and Quality
   www.monahrq.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 100% Key variable

7. 3P-Rd-Data-Dictionary-Geographic-Level (xls file)
   www.monahrq.ahrq.gov/sites/default/files/wysiwyg/data/3P-RD-Data-Dictionary-Geographic-Level.xlsx
   February 02, 2023 - State APCD/CMS Claims ZIP_CD X X X X X X X X X X X X X X X STATE 2-Digit alpha state code Char $2. … physicians Char 2 XXXXX: Minimum Patient Age APCD/CMS Claims XXXXX_MIN_AGE X X B, F, G A, G A, G … per Month APCD/CMS Claims XXXXX_MIN_CLMS_PERMONTH X X B, F, G A, G A, G B, C, D, E, F, G A, G A, G … per month across all 3P-RD physicians Num 8 XXXXX: Average Number of Claims per Month APCD/CMS Claims … per month across all 3P-RD physicians Num 8 XXXXX: Maximum Number of Claims per Month APCD/CMS Claims

8. About the Measure | Agency for Healthcare Research and Quality
   www.monahrq.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.

9. 3P_RD_AHRQ_PUF_Data_Dictionary (xls file)
   www.monahrq.ahrq.gov/sites/default/files/wysiwyg/data/3P-RD-Data-Dictionary.xlsx
   March 16, 2023 - SECTION IV: Source Claims Files Indicates data element names and availability in claims files for APCD … Organizational NPI APCD/ CMS Claims X X X X X X ORG_NPI Organizational NPI CHAR 10 $10. … Number of 3P-RD physicians associated with the physician practice site X APCD/ CMS Claims X X X X X … X 3P-RD Physician APCD/ CMS Claims X X X X X X SING_SPEC_TYPE If Single Specialty, Which? … State X APCD/ CMS Claims X X X X X X STATE State CHAR 7 $2.

10. References | Agency for Healthcare Research and Quality
    www.monahrq.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.

11. Synthetic Healthcare Database for Research (SyH-DR) | Agency for Healthcare Research and Quality
    www.monahrq.ahrq.gov/data/innovations/syh-dr.html
    January 01, 2024 - Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … Determinants of Health Synthetic Healthcare Database for Research (SyH-DR) All-Payer Claims … The Synthetic Healthcare Database for Research (SyH-DR) is an all-payer, nationally representative claims … 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.

12. Asthma 1 Measure Calculation Steps (pdf file)
    www.monahrq.ahrq.gov/sites/default/files/wysiwyg/pqmp/toolkits/flow-diagrams.pdf
    March 11, 2021 - Asthma 1 Measure Calculation Steps Medicaid/APCD claims data Eligibility Table (summary of continuous … (all medical claims during time frame) Pharmacy Claims Data HEDIS ASM-C/MMA-A NDC Lists2 … Import into SAS data format Medical Claims Data (long format medical claims during time frame with … Data Medical Claims Data (long format medical claims during time frame) Asthma_Meds: Evaluation … DEC_IDENT_CE 10 4 Comorbidity Claims (all medical claims during time frame) PMCA v3 Algorithm

13. Appendix B: Prioritization of Conditions for Measure Inventory | Agency for Healthcare Research and Quality
    www.monahrq.ahrq.gov/data/apcd/backgroundrpt/app-b.html
    November 01, 2020 - Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … Us Español FAQs Home Data & Analytics All-Payer Claims … Data Infographics Data Visualizations Data Tools Data Innovations 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

14. United States Health Information Knowledgebase | Agency for Healthcare Research and Quality
    www.monahrq.ahrq.gov/data/ushik.html
    July 01, 2022 - Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … The All-Payer Claims Databases portal contained APCD File Submission Specifications from 14 states. … APCDs are large-scale databases that systematically collect healthcare claims data from a variety of … , pharmacy claims, eligibility files, provider (physician and facility) files, and dental claims from … leveraging data from within the insurance claims and reimbursement system.

15. Tables 1-7 (pdf file)
    www.monahrq.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-195-tables%201-7.pdf
    December 18, 2019 - Contingency Table for Presence of Seizure in Administrative Claims and Charts Seizure in Claims … Contingency Table for Presence of Indicators of Increased Intracranial Pressure in Administrative Claims … and Charts Indicators of Increased Intracranial Pressure in Claims Based on ICD-9-CM Codes … Sensitivity Analysis with Variation in Claims-Based Exclusion Criteria among Children with Neuroimaging … Overuse Percentage within the Chart Review Sample using Claims or Chart Review Criteria Chart Review

16. Overuse of Computed Tomography Scans for the Evaluation of Children with a First Generalized Afebrile, Atraumatic Seizure: Tables 14-17 (pdf file)
    www.monahrq.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-0198-tables14-17.pdf
    October 16, 2019 - 522)** 0.5 (1.4) 5.5 (8.8) 8.5 (13.2) 0.1 (0.5) 78.2 (17.8) 2.8 (2.0) 4.3 (6.6) Subset following claims … (7.0) 7.9 (12.1) 0.1 (0.3) 80.6 (15.7) 2.6 (1.5) 4.0 (5.8) Subset following claims … missing or unmatched ZIP code, yielding n=522 (98.1%). *** Among the subset of children following claims … missing or unmatched ZIP code, yielding n=293 (99.0%). **** Among the subset of children following claims … denominator exclusions (n=293)*** 10.5 (14.5) Subset following claims numerator exclusions (n=243)*

17. CHIPRA 194: Section 7, Tables 15-18 (pdf file)
    www.monahrq.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-194-section-7-tables-15-18.pdf
    April 17, 2019 - (8.1) 7.6 (12.2) 0.1 (0.2) 80.6 (16.7) 2.5 (1.4) 3.7 (6.0) Subset following claims … (8.0) 7.7 (12.1) 0.1 (0.2) 81.1 (16.4) 2.5 (1.4) 3.4 (5.6) Subset following claims … missing or unmatched ZIP code, yielding n=4,312 (98.2%). *** Among the subset of children following claims … missing or unmatched ZIP code, yielding n=2,626 (98.2%). **** Among the subset of children following claims … denominator exclusions (n=2,626)*** 9.1 (12.7) Subset following claims numerator exclusions (n=2,156

18. Tables 11-14 (pdf file)
    www.monahrq.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-196-section-7.pdf
    December 18, 2019 - 1,585)*** 0.4 (0.7) 5.7 (8.6) 6.9 (10.5) 0.1 (0.2) 80.4 (16.0) 2.6 (1.4) 3.9 (6.1) Subset following claims … (7.2) 8.4 (13.1) 0.1 (0.2) 81.5 (16.6) 2.4 (1.4) 3.0 (4.9) Subset following claims … missing or unmatched ZIP code, yielding n=1,585 (98.3%). **** Among the subset of children following claims … a CT scan (n=2,977)** 9.4 (13.3) Subset who had an MRI (n=1,585)*** 10.2 (13.2) Subset following claims … CT exclusions (n=1,781)**** 8.2 (11.8) Subset following claims MRI exclusions (n=1,363)***** 10.0 (

19. Discussion | Agency for Healthcare Research and Quality
    www.monahrq.ahrq.gov/data/apcd/backgroundrpt/discuss.html
    April 01, 2017 - Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … Databases Introduction Reviewing the Landscape of All-Payer Claims Databases Measure Inventory … Although claims data have been tagged a source of health care price transparency, when cost data are … Although APCDs do include a large number of health care claims, some populations are omitted. 2 , 8 , … The meeting had the following priorities: Engage stakeholders on key issues related to claims-based

20. Conclusion and Future Directions | Agency for Healthcare Research and Quality
    www.monahrq.ahrq.gov/data/apcd/backgroundrpt/conclusion.html
    April 01, 2017 - Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … Us Español FAQs Home Data & Analytics All-Payer Claims … Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims … Databases Introduction Reviewing the Landscape of All-Payer Claims Databases Measure Inventory … This will require building a dataset by removing potential duplicates or claims that have been replaced