Health Care Payments Data Program Submitters

Overview 

AB 80 (Chapter 12, Statutes of 2020) provides  OSHPD the authority to establish the Health Care Payments Data (HPD) Program, often referred to as an All Payer Claims Database or APCD, a large-scale database that systematically collects health care claim and encounter data from multiple payer sources within a state.  The enabling legislation identifies the following entities as mandatory submitters to the HPD:  

  • Health care service plans, including a specialized health care service plan. 
  • Insurers licensed to provide health insurance, as defined in Section 106 of the Insurance Code. 
  • Self-insured plans subject to Section 1349.2, or a state entity, city, county, or other political subdivision of the state, or a public joint labor management trust that offers self-insured or multiemployer-insured plans that pay for or reimburse any part of the cost of health care services. 
  • The State Department of Health Care Services, for those enrolled in Medi-Cal and other insurance affordability programs, whether enrolled in Medi-Cal managed care, fee-for-service Medi-Cal, or any other payment arrangement. 
  • The legislation also specifies additional voluntary submitters, who can opt-in to submit their data to the HPD System.  

Submitter Group  

Pursuant to Section 127672 of the Health and Safety Code, HCAI is authorized to convene stakeholder committees or workgroups as necessary to support effective operation of the system. In addition to the statutorily mandated HPD Advisory Committee, HCAI is convening a submitter group to provide a forum for HPD Data Submitters to receive up to date information on submission requirements, troubleshoot data submissions, and address any other technical issues as related to data submission.  

These meetings are intended for entities that will be required to submit or are supporting the submission of data to the HPD System. If you are interested in learning more about joining the submitter group meetings, please email hpd@hcai.ca.gov describing your interest in attending.  

Upcoming Meetings

October 14, 2021

Meeting Archive

July 15, 2021

Submitter FAQ’s 

1. Who will be required to submit data to HPD?

Commercial plans licensed with the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI), who have greater than the threshold of covered lives defined in the HPD Regulations.

Public self-insured entities who have greater than the threshold of covered lives defined in the HPD Regulations.

2. Can anyone else submit data to HPD?

Yes, private self-insured entities, and any other submitter with less than the threshold of covered lives, may apply to voluntarily submit data to HPD.

3. Is it required that we report all claims for services provided in CA or all claims for Californians, even if they were provided out of state?

HPD requires data for CA residents, regardless of where the services were provided.

4. What type of data does HPD require?

Initially, submitters are required to send medical claims and encounters, pharmacy claims, eligibility, and provider data.

The HPD Program anticipates collecting healthcare data for 30 to 34 million Californians, sourced from: the Department of Health Care Services (DHCS) for Medi-Cal members; the Centers for Medicare & Medicaid Services (CMS) for Medicare fee-for-service members; and health plans and insurers for those with employer-based, individual, or Medicare Advantage coverage.

5. Is Medicare Advantage data being collected?

Medicare Advantage data is within the scope of the HPD data collection. This data will be coming directly from commercial health plans. Medicare FFS data will come directly from CMS.

6. How often will submitters need to provide data?

During implementation, each submitter will provide historical data (2019, 2020 and 2021). Ongoing submission is expected to be on a monthly basis. 

7. What data formats will be used?

For the four initial files, HCAI will use the All Payer Claims Database -Common Data Layout (APCD-CDL™) version 2.1, developed by the National Association of Health Data Organizations (NAHDO) and the APCD Council. Copies of the APCD-CDL™ can be obtained at the following location: https://www.apcdcouncil.org/common-data-layout

8. How can data submitters provide input on future updates to the APCD-CDLTM?

The APCD-CDLTM has been developed by the NAHDO and the APCD Council. This national effort has prioritized, and continues to incorporate, input from various stakeholders, including health plans. You can find out more information about the data maintenance request process on the APCD Council website: https://www.apcdcouncil.org/common-data-layout. HCAI will solicit feedback from California health plans about the APCD CDLTM and can facilitate sharing consolidated feedback to the APCD Council to represent the state’s unique and diverse healthcare landscape. Email hpd@hcai.ca.gov for more information.

9. When are test and production submissions scheduled to occur?

  • Testing for historical data submission is planned to start in Q2 2022.
  • Testing for monthly data submission is planned to start in Q3 2022.
  • Monthly production submissions are expected to begin no later than January 2023.

10. Other than the statute, what other documentation is available for potential submitters to review?

  • The HPD Regulations that will enact the statute must be put in place by December 31st, 2021. The HPD Regulations will describe how HCAI is implementing the statute and will be published on our website.
  • The Intake Specifications will describe the requirements of the datasets. A draft version is available for potential submitters to review. The Intake Specifications will be incorporated in the HPD Regulations.
  • A Reporting Manual is being developed and will be available for review in its draft form.

11. Will a submitter be able to apply for a temporary data variance, if they are unable to comply with the Intake Specifications?

Yes. The process for requesting a temporary data variance will be included in the HPD Regulations. A data variance is intended to allow a submitter relief from specific requirements for a limited time while they enhance their data collection processes. Information on how to request a data variance will be included in the HPD Regulations and in the Reporting Manual.

12. What type of edits will HPD apply to submitted files, and what happens if there are errors in the submission?

The HPD System will initially compare submitted data files to the data element definitions in the APCD-CDL™ with regard to data element position, field length, and defined data format. The system will then validate that any required or situational data elements have been populated as defined in the Intake Specifications. Further edits that will be applied include: coding standards, file format and naming conventions, timeliness of submission, duplicated data, and others.

A submitted file will either be accepted or rejected. Rejection is at the file level not the record level. If a file is rejected, the submitter will have a specified time period to resubmit an acceptable file.

13. Where can submitters find out more about how to register for data submission to HPD?

This information will be included in the HPD Regulations, and in the Reporting Manual.

14. Where can I go if I have a question?

Please contact HPD@OSHPD.CA.GOV and HPD staff will be happy to assist.

Submitter Resources 

Contact

Contact HPD at hpd@hcai.ca.gov  for additional HPD questions or inquiries.   

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