Frequently Asked Questions (FAQ)

​​​​​​No, healthcare claim data will only be submitted by healthcare payers / insurance companies.

An All-Payer Claims Database is a repository of healthcare, pharmacy, and dental claims data from both private and public payer sources across the state. An APCD also includes eligibility and other publicly available data to create a comprehensive, longitudinal multi-payer dataset in order to provide the greatest opportunities for improving the health care delivery system.

An APCD will allow public and private health care purchasers and consumers to identify and compare: health plans, health insurers, health care facilities, and health care practitioners which provide safe, value-based, cost-effective, high quality healthcare services. Georgia’s APCD will promote cost and quality transparency, assess geographic variations in price and utilization, track healthcare spending drivers and trends, and promote public health.

As of June 2021, there are 26 states with active, in progress or voluntary APCDs of some kind.  A good source of information about national APCD efforts is https://www.apcdcouncil.org/state/map.

Georgia is aligned with and following the standards established by the APCD Council, which is convened and coordinated by the Institute for Health Policy and Practice (IHPP) at the University of New Hampshire (UNH) and the National Association of Health Data Organizations (NAHDO).

Many different entities may submit data to the APCD, either voluntarily or through a statutory requirement. Insurance companies, medical services plans, hospital plans, hospital medical service corporations, health maintenance organizations, and fraternal benefit societies with at least 1,000 covered lives in the previous calendar year will submit data. The Department of Community Health and Medicaid Care Management Organizations, the State Health Benefit Plan, and numerous other agencies are required to submit data. While certain entities, such as ERISA plans, are not required to submit data, they may choose to do so voluntarily.

​​​​​​Submitting entities do not include an entity that provides health insurance or a health benefit plan that is accident-only, specified disease, hospital indemnity, long-term care, disability income, or other supplemental benefit coverage.

 

ERISA-based self-insured employers can voluntarily submit claims to the APCD.

​​​​​​“Claims data” means information included in an institutional, professional, dental, or pharmacy claim or equivalent information transaction for a covered individual, including the amount paid to a provider of health care services plus any amount owed by the covered individual. Claims data may also include related information about a patient, provider, or health plan which is utilized by the payer to process the claim.

The APCD does not store patient identifiers such as social security number, name, or address. All patients are de-identified before being loaded into the state’s analytic environment. In addition, any attempt to re-identify patients from APCD data is strictly prohibited.

Data in the APCD is protected physically, technically, and administratively. Access controls to the data are strictly limited to minimally necessary staff with appropriate training and clearance. Analysts are prevented from intentionally or unintentionally removing detailed information from the storage environment. State of the art software and hardware solutions are in place to further protect the data.

​​​​​​By statute, the APCD is a collaborative effort between the Georgia Office of Health Strategy and Coordination (OHSC) and the Georgia Tech Research Institute – Center for Health Analytics and Informatics (GTRI-CHAI).

​​​​​​Each quarter, the APCD will publish Public Use Files containing aggregated data which can be used for many types of analysis. These files will be offered free of charge.

Requests for specific customized datasets will involve submission of a formal data request, review of that request by a committee, and execution of a data use agreement. A fee will be charged for fulfilling these custom requests.

​​​​​​​We expect to receive requests for data from agencies, research organizations, universities, corporations, and the public. We are forming a data review committee which will evaluate each request. The committee will assess the purpose of the request and the requestor’s controls in place to protect the data. They will also ensure that the request meets our requirement that no attempt will be made to re-identify the individuals, and that the data meets a “window threshold” which is an indicator that there is enough data such that individuals will not be identified.