05/18/2023
CT APCD Public Comment Period Announcement 2023
Notice of Public Comment Period
AGENCY:
Connecticut Office of Health Strategy (OHS).
ACTION:
30 Day Public Comment Period.
SUMMARY:
In accordance with the policies and procedures of the All Payer Claims Database (APCD), its administrator, OHS, is providing a 30 day public comment period on proposed updates to the APCD Data Submission Guide (DSG) also known as the Data Submission Companion Guide, to enable the collection of new data elements: 1) dental claims, 2) fully denied claims, and 3) Race, Ethnicity and Language data in accordance with Conn. Gen. Stat. §19a-754d.
COMMENT PERIOD:
The comment period begins Friday, May 19, 2023, and ends Saturday, June 17, 2023, 11:59 p.m. EST
CONTACT:
All comments should be sent electronically to Amy.Tibor@ct.gov with “APCD DSG comment” in the subject line.
All comments submitted will be published on the OHS website; in addition, all comments will be reviewed and considered prior to finalizing the DSG.
SUPPLEMENTARY INFORMATION:
All Payer Claims Database
Created in 2012 by Public Act 12-166 and now codified as Conn. Gen. Stat. §19a-755a, Connecticut’s APCD receives eligibility, medical claims, pharmacy claims, and provider information from health plans or insurers on services rendered to and paid for residents of the state. Information derived from the APCD, supports OHS’ mission to improve health and outcomes for Connecticut residents and to promote research addressing, safety, quality, cost-effectiveness, transparency, access, and efficiency at all levels of health care delivery.
APCD Data Submission Guide
To ensure the consistency and quality of data supplied to the CT APCD, health insurers report their data according to specifications detailed in the APCD DSG. When the DSG’s specifications need to adapt to keep pace with changes in data collection and coding standards, health insurers’ capabilities, and the State’s needs, the DSG is updated to continue to serve as a reliable resource for health plans providing data to the CT APCD.
APCD Data Submission Guide Modification Process
In consultation with the APCD Advisory Group, a subcommittee of the Health Information Technology Advisory Council, OHS established an APCD DSG workgroup (DSGW) to review the existing DSG and provide recommendations for the collection of dental and denied claims data in alignment with national standards. The final report of the DSGW can be found here: Recommendations to Modify Data Submission Guide for Denied and Dental Claims (ct.gov)
Additionally, Conn. Gen. Stat. §19a-754d requires the collection of Race, Ethnicity, and Language (REL) data, already being collected in the APCD, to align with the new standards.
Consequently, OHS had to update the DSG to provide guidance and enable collection of dental and fully denied claims, and REL information using the new standards.
A final DSG is slated to be published by July 2023.
Modifications
The following modifications approved by the APCD Advisory Group address four primary areas updated in the APCD’s data collection specifications:
- Race, ethnicity, and language (REL) data collection. Conn. Gen. Stat. §19a-754d requires OHS to develop REL data collection standards that align with recommendations from the OHS Community and Clinical Integration Program (CCIP) and with standards from the U.S. Office of Management and Budget (OMB) and the International Organization for Standardization (ISO). In support of this requirement, DSG specifications has been updated to cite a list of codes released in 2022 by OHS (available here: https://portal.ct.gov/-/media/OHS/Health-IT-Advisory-Council/REL/PA-21-35-REL-Data-Collection-Standards.pdf).
Health insurers are asked to use this code set when reporting their data to the APCD. Insurers that are unable to satisfy this requirement can continue to report REL-related data using legacy code values until their capabilities are brought into alignment. This change affects coding for five eligibility fields in the DSG related to race (ME021, ME022), ethnicity (ME025, ME026), and language (ME033).
- Denied claims data collection. Requirements have been updated to standardize the reporting of both partially and fully denied claims using a common set of codes instead of the current array of insurer-specific codes. Denied claims should now be reported to the CT APCD using Claim Adjustment Reason Codes maintained by the Accredited Standards Committee (ASC) X12 (available here: https://x12.org/codes/claim-adjustment-reason-codes).
As with REL data, insurers that are not prepared to update their approach can continue to report carrier-defined codes if those codes and their descriptions are provided to the CT APCD prior to submission. This change impacts the Denial Reason codes reported in the medical claims, pharmacy claims, and dental claims (see below) using fields MC124, PC117, and DC095, respectively.
- Dental claims data collection. Following a 2022 determination by the APCD Advisory Group that dental claims are a high-value data set missing from the CT APCD, the DSG has been expanded to include a new file layout to support dental data collection in alignment with industry and national standards.
- Updating DSG Fields: The date modified column that did not add value to submitters was removed, the Risk Adjustment Covered Plan field was also modified. In addition, the denial reason was updated in the DSG to highlight details for submitters.
The full Data Submission Guide can be viewed on the OHS website here: https://portal.ct.gov/-/media/OHS/Health-IT-Advisory-Council/Publications/APCD-Related-Publications/CT-APCD-Data-Submission-Guide.pdf