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All Payer All Claims Data Submissions


Overview

The All Payer All Claims Reporting Program (APAC) has been integral to Oregon’s health system transformation since it was established in 2009. It contains administrative health care data such as insurance coverage, health service cost and utilization for Oregon’s insured populations. APAC provides access to timely and reliable data essential to assess the cost of health care, improve quality, reduce costs and promote transparency.

The purposes of APAC are described in statute (ORS 442.373) and include:
  • Allowing health care policymakers to make informed choices
  • Improving the quality and affordability of health care and health care coverage
  • Comparing the costs and effectiveness of treatment settings and approaches
  • Providing information to consumers and purchasers of health care
Dental data submissions are due with the July 31, 2020 data submissions and include data from January 1, 2019 – June 30, 2020. A separate complete set of files is required; please refer to the tables below for further details (Quarterly submission of claims data; annual submission of payment arrangement file). OHA is requesting the submission of the same data for January 1, 2017 through December 31, 2018. The submission of the earlier data will help OHA build stronger data files more quickly to assess the cost, utilization and trends for dental care.

For APAC program inquiries please contact: apac.admin@state.or.us.
For technical APAC submission inquiries please contact: APAChelp@hsri.org.

High-Level Vendor Transition Schedule

(last updated 1/20/2021)

Activity
SubactivityStatus/Date
System Design 

Complete
System Security 
Complete
Data Submission 

 
 Design Plan
Complete

Communications from HSRI begin
Complete
 Development
Complete
 Introductory training in test system for data submitters (video recording)
Complete (Oct. 15, 2020)


APAC Help Desk opens
Complete (Nov. 4, 2020)

Testing instructions distributed to all registered data submitters
Complete
 Medical and Pharmacy test files submitted by all data submittersComplete
 Dental test files submitted by all dental data submittersComplete
 Launch (production) training for data submitters to review additional features and changes since testing (video recording)
Complete (Jan. 5, 2021)
 Production portal available for file submission

Complete (Jan. 6, 2021)

Deadline for files to be passing in the new system
Jan. 31, 2021

Data Access/Use  
 Data Dictionary available
End of Jan. 2021
 Data Elements Workbook for Limited data sets (APAC-3) forms available
Mid-Feb. 2021
 Data Migration completed; 2020 Q4 data (submitted January 31, 2021) available in production analytic viewsMid-Mar. 2021

Mandatory Reporters

The Oregon Health Authority identifies mandatory reporters based on the type of the organization, the number of lives it covers in Oregon and the lines of business it operates: 

Types of organizations and number of covered lives

  • Insurance carriers and fraternal benefit societies with more than 5,000 covered lives
  • Third party administrators with more than 5,000 covered lives
  • All pharmacy benefits managers
  • All coordinated care organizations
  • All insurers providing Medicare Part A, B, or D benefits
  • All insurers providing benefits for dual eligibles
  • All insurers offering a plan in Oregon’s health insurance exchange and
  • All insurers providing group health insurance to PEBB or OEBB

Reportable lines of business

  • Medicare Advantage Part C and Medicare Part D
  • Medicaid
  • Individual health insurance
  • Small employer health insurance
  • Large group health insurance
  • Health insurance provided through associations and trusts
  • PEBB and OEBB group health insurance plans
  • Self-insured plans not subject to ERISA and
  • Dental insurance

Quarterly submission of claims data

reporting requirements table. Can also be found in APAC Submission memo 

Annual submission of payment arrangement file

reporting requirements table. Can also be found in APAC Submission memo

Information and documents for quarterly claims and annual payment arrangement files

Primary Care Alternative Payment Methods – Contract Reporting

These data are not collected as part of the APAC program. Please refer to the Primary Care Payments page for more information.

Additional Resources for Data Submitters

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