An earlier Query detailed the submission and intake stages for data sent each month to the Colorado All Payer Claims Database (CO APCD). During these stages, each batch of data moves through several cycles of testing to determine the accuracy and validity of the information in relation to previously submitted data and exterior data sets, when available. Many of these cycles operate with a pass/fail criteria, and should a file fail, the payer must resubmit it with the necessary corrections. Once successfully submitted, the claims are incorporated into the data warehouse, where they undergo regular quality evaluations and additional processing before being available for release.
Additional Data Processing
There are three types of additional processing steps that data manager, Human Services Research Institute (HSRI), performs to improve the everyday utility and functionality of the CO APCD. Each processing component also has its own data quality checks to ensure continued credibility of CO APCD output.
- Custom coding and logic that allows quick analysis of specific types of information from the claims like allowed amounts (total, and individual patient and plan paid), or flags for things like emergency department visits, dental, pharmacy or medical claims.
- Application of third-party tools such as data groupers or drug reference files.
- Lists of common classification information that is frequently linked to the data during analyses like ICD 10 codes or the Colorado Division of Insurance regions.
Quarterly Quality Evaluations
Since at this stage the data has already cleared multiple accuracy and alignment assessments, the quality checks inside the data warehouse focus more on the completeness of the entire database, rather than a specific batch of submissions. To this end, CIVHC analyzes the CO APCD quarterly to determine the completeness of two important indices:
- Master Patient Index – an internal, encrypted (de-identified) list of people with coverage in Colorado.
- Master Provider Directory – a list of providers in Colorado with unique identifiers.
The Master Patient Index and the Master Provider Directory function as “control lists” within the CO APCD, allowing CIVHC to match people and providers previously in the database to the current version of the data warehouse. The quarterly quality checks help CIVHC identify and gaps in the CO APCD which might require re-submissions by a payer or multiple payers.
The in-warehouse quality checks and processing procedures are reviewed regularly and updated as needed. On occasion, it is some of these updates that are performed during a bi-monthly refresh, resulting in a more accurate and complete data set.