Submitter Resources

CO APCD Data Submission

The Colorado All Payer Claims Database (CO APCD) is the state’s most comprehensive source of health care claims information; representing the majority of covered lives in the state, including commercial health insurance plans, Medicare, and Health First Colorado (Colorado’s Medicaid program). With the exception of Medicare Fee-for-Service and ERISA-based self-insured employer plans, the CO APCD statute and rule require payers to submit claims data on a monthly basis. ERISA-based self-insured employers can voluntarily submit claims to the database, and CIVHC receives Medicare Fee-for-Service claims through the state agency request program.

Current Submitter Info

Submitter Resources

Payers submitting data to the CO APCD must adhere to the latest Data Submission Guide (DSG), which is updated annually through a collaborative payer rule change process with the Colorado Department of Health Care Policy and Financing (HCPF). Click here for more information on the annual DSG rule change process.

Payer Claims Data Submission Resources:

    Annual File Submissions:  

    On an annual basis beginning in 2019, payers are required to submit annual files related to drug rebates and Alternative Payment Models (APMs). Payers should populate the fields in the template files below for the Alternative Payment Model, APM Control Total, and Drug Rebate submissions, which included two new file types in the 2022 submission period: Value-Based Pharmacy Contract (VB) and Prescription Drug Affordability Board (PD). Please remember to enter the relevant file name, payer code and performance period dates in the header and footer. In addition, please create a file name using proper naming conventions, as outlined in the Data Submission Guide. Links below will download the selected file in excel.

    Alternative Payment Models (APMs)

    Drug Rebates (DR) 

    Prescription Drug Affordability Board (PDAB) Submission Materials: 

    Value-Based Pharmaceutical Contracting (VBPC) Submission Materials: 

    Capitation File (CF) Submission Materials: 

    2024 Annual File Submission Materials (DSGv15 Archive:

    Data Access and Privacy Information

     

    If you are a submitter to the CO APCD and have questions, please email submissions@civhc.org