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CIVHC Shop for Care: FAQs

17

How are prices set for health services?
How much of the price should I expect to pay? Should I expect to pay the whole price?
I want to make sure I get the best care. Should I choose the place with the highest price?
Will Shop for Care tell me how much I have to pay for a health service? Should I expect to pay the average price?
How should I use Shop for Care if I have health insurance or other coverage, like Medicare or Medicaid (Health First Colorado)?
How should I use Shop for Care if I have no health insurance?
What do the prices include? Does the price reflect all bills I may receive?
How did you decide which services to include?
I noticed that the tool includes a five-digit code after the name of service. What is that?
I don’t see the service I’m looking for. Do you plan to add prices for more services?
Where does the price data in the tool come from?
What year is the price data for?
How are the “average price” and “price range” calculated?
Where do the quality ratings come from?
I don’t see quality data for all facilities. Why is it missing for some?
I wish the tool gave more information about quality. Can I get more information?
Why doesn’t the tool show all facilities for all procedure?

CIVHC Shop for Care: Preguntas frecuentes

17

¿Cómo se fijan los precios de los servicios médicos?
¿Qué parte del precio debo pagar? ¿Debo pagar el precio total?
Quiero asegurarme de recibir la mejor atención. ¿Debo elegir el lugar con el precio más alto
¿Me dirá Shop for Care cuánto tengo que pagar por un servicio médico? ¿Debo esperar pagar el precio promedio?
¿Cómo debo utilizar Shop for Care si tengo seguro médico u otro tipo de cobertura, como Medicare o Medicaid (Health First Colorado)?
¿Cómo debo utilizar Shop for Care si no tengo seguro médico?
¿Cómo decidió qué servicios incluir?
He observado que la herramienta incluye un código de cinco dígitos después del nombre del servicio. ¿De qué se trata?
¿Por qué la herramienta no muestra todas las instalaciones para todos los procedimientos?
No veo el servicio que busco. ¿Tienen previsto añadir precios para más servicios?
¿De dónde proceden los datos de precios de la herramienta?
¿De qué año son los datos de precios?
¿Cómo se calculan el “precio medio” y el ” rango de precios”?
¿Qué incluyen los precios? ¿Refleja el precio todas de las facturas que pueda recibir?
¿De dónde proceden los índices de calidad?
No veo datos de calidad para todas las instalaciones. ¿Por qué faltan para algunos?
Me gustaría que la herramienta diera más información sobre la calidad. ¿Puedo obtener más información?

CO APCD Administration

6

Why was CIVHC selected as CO APCD Administrator, and what does that mean?
Shouldn’t the CO APCD be run by a public entity that is subject to accountability standards like sunshine laws, the Open Records Act, or the scrutiny of state auditors since they are in charge of very sensitive health care data?
How does HCPF hold CIVHC accountable?
How is the CO APCD paid for and how much does it cost?
What power does CIVHC have to compel health plans to comply with the CO APCD reporting requirements?
Were consumers included in developing the CO APCD?

Data Release

19

I’ve seen the data available on this site, how can my organization get more detailed reports from the CO APCD?
Who decides who can get information from the CO APCD? What rules do they use?
Could a company get a report from the CO APCD identifying all the people in a given zip code who have a certain diagnosis or have been prescribed a certain drug?
What kind of information can organizations get from the CO APCD?
Are there limitations on the data that organizations can get from the CO APCD?
What information is required in order to submit a data request?
What kind of organizations can get information from the CO APCD?
What can CO APCD data be used for? Are there any restrictions on the purposes for which it may be used?
Can an organization charge others for information it gets from the CO APCD?
Is there any circumstance in which a private company or individual could get personal, identifiable health information out of the CO APCD?
What happens if an entity misuses CO APCD data or uses it for a purpose other than that for which the entity applied?
Why is there a fee associated with CO APCD data?
What is a data access fee and what is included in a non-public release?
Do the fees associated with a data request differ by the type of requesting organization?
Do you offer discounts or waivers?
Is the data access fee the same for subsequent data pulls?
Will I need to sign a contract?
How do I pay for the data?
What type of payment is accepted?

Evaluation

4

Formative Evaluation: What Will We Do, Why Will We Do It, and How?
Process Monitoring and Evaluation: Did We Do What We Said We Would Do? What Worked Well? What Can Be Improved?
Outcome Monitoring and Evaluation: Did Our Activities Have The Expected Effects?
Impact Evaluation: What Was The Long-Term Impact of Our Program?

General

11

What does the CO APCD do?
Why do we need an APCD in Colorado?
What can be done with claims data?
How is this information useful to patients?
Do other states have APCDs and how is Colorado’s different?
Will this information go into some sort of national database?
Will the CO APCD bring about competition that lowers costs?
What if providing transparent prices actually encourages hospitals and physicians with lower costs than their peers to raise their rates?
If Colorado does indeed move toward more integrated, Kaiser-like health systems—which don’t process “claims” in the same fashion as other health plans—won’t that make the CO APCD obsolete?
How do hospitals and providers feel about having their prices publicized?
Will the detailed health history and family health questionnaire that I filled out for my doctor or insurance company be stored in the CO APCD?

MOST Form

5

Are old MOST forms (completed prior to 2015 revision) still valid, or do we have to redo MOST forms for all our patients/clients/residents?
Is there a Spanish version of the MOST?
Does a MOST replace or revoke advance directives?
What if MOST orders conflict with the patient’s other advance directives?
What if a patient brings in a MOST/POLST/POST/MOLST form from another state that doesn’t exactly comply with Colorado requirements for the MOST?

Non-Public Data Releases

6

What format will I receive the data in?
What is the typical file size for a standard data set?
How is the data delivered?
How do I access the data once it’s delivered?
What support can I expect after delivery?
How long does it take?

Privacy and Security

16

Why should the government, or a private entity like CIVHC, be able to collect information about the health care services I’m using?
How does the CO APCD keep information private and safe?
Will my medical information be at risk to data breaches I’ve read about?
How can you guarantee us that no one will hack into the CO APCD?
As a patient, can I opt out of having my information included in the CO APCD?
Insurance claims show diagnosis codes, not just treatment codes, so could someone get into the CO APCD and see that I have cancer, or AIDS?
How can you adequately protect the health information of people living in rural areas where the population is so low that it wouldn’t be difficult to determine who a person of a certain age with a certain diagnosis is?
If you take out the zip codes from sparsely-populated areas, won’t it be difficult to be able to see health care utilization from, say, the eastern plains?
I’ve heard that 87 percent of the population can be accurately identified with just 3 pieces of information: zip code, birthday and gender, so can’t someone get into the CO APCD and get enough information to steal my identity?
What do you mean by “date of birth will be changed to age or age range”?
What would a hacker see if he got into the database?
How does the CO APCD Data Manager ensure their employees with access to the database don’t hack in remotely or that a disgruntled former employee doesn’t hack in?
Could an employer or law enforcement agency requisition information about an individual from the CO APCD?
Could the federal government request information about an individual from the CO APCD?
Will you ever release identified information?
Is CIVHC going to sell my health information to make the CO APCD sustainable?

Self-Insured

7

What is a Self-Insured Health Plan?
Why Do Self-Insured Claims Need to be Included in the CO APCD?
I’m a self-insured, employer-funded health plan regulated by ERISA (“ERISA plan”). Am I required to submit health claims data to the CO APCD?
As an ERISA plan, what happens to the data my ASO/TPA submitted on my behalf prior to the Supreme Court’s March 1, 2016 decision? Will the data be used in public and non-public data releases moving forward?
If I’m another category of payer, not an ERISA plan, can I stop submitting data to the CO APCD?
I’m an ERISA plan. I have not yet submitted any data to the CO APCD and have not submitted an opt-out form. Do I still need to submit an opt-out form and will there be any penalties for my failure to timely submit an opt-out form?
Is there a cost to submit?

Shop for Care FAQs and Methodology

25

Why does CIVHC release health care price information?
Where does the data come from?
How can I use the Shop for Care information?
What if I don’t have insurance or I have Medicaid (Health First Colorado) or Medicare?
Why should I care about the total price if I have insurance?
Does the price listed reflect all of the bills I might receive?
How did you decide which services to display?
What year and payer type do these reports represent?
What year and payer type do these reports represent?
What does the 5-digit “CPT” number after the imaging procedure represent?
What does the 5-digit “CPT” number after the imaging procedure represent?
How are the “average price” and “price range” calculated?
How are the “average price” and “price range” calculated?
What does it mean if the “average price” is the same as the “price range”?
Why aren’t all facilities shown for all procedures?
Why Isn’t There Patient Experience and Hospital Quality Information for All Facilities?
Where Do the Patient Experience and Overall Hospital Quality Star Ratings Come From?
Why don’t you have additional quality information available?
Will CIVHC be releasing price information for more services?
How are the imaging prices calculated?
How are the “Other Procedures” prices calculated?
What is PROMETHEUS?
Should I Expect to Pay the Entire “Average Price”?
Why Don’t You Show Prices for Medicare and Medicaid?
What Does the “Percent Procedure Price” Reflect in “Other Procedures”?

Submissions

19

How should partially denied claims (paid claims containing denied lines) be submitted?
Will gender codes be standardized across all three files?
Does CIVHC expect that the data fields to be submitted in field number order, or, in the logical order given in the Submission Guide?
What is the threshold guidance for column MC107?
What value should appear in the Payer Code columns?
Do Version Numbers ( MC005A) need to be consecutive?
Should only paid and discharged claims be included?
What is the guidance for MC055 (Procedure Code) for institutional claims?
What is the guidance for columns MC065 (Co-pay Amount) and MC066 (Coinsurance Amount)?
What is the guidance for columns marked as O (Optional)?
Should all detail lined be supplied for a paid claim?
What column names should be supplied in the first row?
What are the definitions for MP003 (Provider Entity)?
Values for column MC054 (Revenue Code), a required column, are not available for professional claims. Should we apply for a variance for this deficiency?
What is the guidance for column MC055 (Procedure Code) where payments are made based on Revenue Code?
What is the guidance for MC058 ( ICD-9-CM Procedure Code)?
What is the column delimiter?
Do Colorado license numbers need to be prefixed with the state code?
What is the proper coding for dependents over age 18?

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Do you offer discounts or waivers?

Do you offer discounts or waivers?

< 1 min read

No, we do not offer discounts or waivers.

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Updated on August 11, 2017

Who decides who can get information from the CO APCD? What rules do they use?

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