Previous queries have detailed the process for the monthly submission and intake of claims data to the Colorado All Payer Claims Database (CO APCD). This query explores the steps the data undergo after being accepted into the warehouse.
Once payer-submitted data has successfully passed the extensive initial validation and quality tests performed by CIVHC and data manager Human Services Research Institute (HSRI) and NORC at the University of Chicago, the data are ready to be ingested into the warehouse.
CO APCD Specific Processing
Once the data makes it into the warehouse, HSRI performs a series of additional processing steps aimed towards maintaining the functionality and utility of the CO APCD. Each step includes its own data quality checks to ensure elimination of errors and the continued high-quality output of CO APCD data.
- Inclusion of “value-add fields to the data, which expand analytic capabilities of the CO APCD by quickly linking claims to types of information that make performing analyses more efficient.
- For example, these fields may be used to flag freestanding emergency departments or claims by type (medical, pharmacy, or dental).
- Addition of classification information commonly linked to data, such as Colorado Division of Insurance (DOI) regions.
- Application of third-party tools such as data groupers or drug reference files
Continued Quality Assessments
At the time of ingestion into the warehouse, the data has already cleared numerous validation checks to ensure the quality of each specific batch of submissions. The third stage of post-ingestion data quality checks, performed primarily by HSRI, focuses on assessing the completeness and the overall health of the database rather than a specific batch of submissions.
HSRI analysts compare the submitted data to historic benchmarks, checking volume of submission by claim type, monthly payments by member, eligibility file volume, and other key measures compare reasonably with expected amounts. Significant gaps or anomalies may indicate an error in data submission or processing that will need to be addressed before final production and release.
As part of this process, HSRI also maintains and updates two important indices for review by CIVHC:
- Master Patient Index – An internal, de-identified list of people with health coverage in Colorado
- Master Provider Dictionary – A complete list of providers in Colorado and their unique identifier
These indices function as a benchmark “control group” of people and providers in the CO APCD, allowing CIVHC to compare the data with the current version of the data warehouse. Through cross-comparison of the database with these master lists, CIVHC analysts can identify where there may be existing gaps that may necessitate resolution or re-submission by a payer or group of payers.
Processes for in-warehouse quality checks and processing steps are regularly reviewed and re-visited by CIVHC and HSRI to ensure the process remains as comprehensive, effective, and efficient as possible.