This is the second in a series of blogs about what exactly is in the Colorado All Payer Claims Database (CO APCD). Today we’re looking at one of the most fundamental claims we receive – the professional claim. Professional claims include basic information about why you saw a provider, who you visited, and what happened while you were there – all information which forms the basis for the facility (hospital or provider group) part of the cost of the visit.
Sometimes really cool things are made up of really boring parts; take the Internet for example. When we log on to Facebook, we’re seeing a finished page that has pictures and text and lots of exciting ways to interact with the content. But, on the backside, Facebook is nothing more than a bunch of computer code:
The CO APCD is pretty similar. To file a claim, providers fill out a form that has a bunch of tiny boxes and submit it to the insurance company. After processing by the payer, they send the claim information to the CO APCD, and it becomes even more complicated to look at than the form:
However, in the same way that each line of computer code gibberish translates to something cool, each of the lines on an insurance claim contains information that can be used to do something pretty awesome.
Now, different types of facilities and providers fill out different versions of these forms so rather than explore a bunch of really boring forms, we’re going to use a general example to show what kind of information is provided in a typical professional claim. Additionally, we’re only focusing on what is collected by the CO APCD and not delving into any privacy or security concerns – all that stuff is coming, don’t worry, we want to take this step by step and not drop too much info on y’all all at once.
Professional Claim Dissection Table_2020