This is the fourth in a series of blogs about what exactly is in the Colorado All Payer Claims Database (CO APCD). Today we’re looking at one of the most fundamental claims we receive – the pharmacy claim. Pharmacy claims include basic information about what drug(s) you received, the type of drug, dosage, etc, how much was paid for it by you and your insurance company, whether your prescription is new or a refill, and more.
Sometimes really cool things are made up of really boring parts; take the Internet for example. When we log on to Facebook, we’re seeing a finished page that has pictures and text and lots of exciting ways to interact with the content. But, on the backside, Facebook is nothing more than a bunch of computer code:
The CO APCD is pretty similar. To file a claim, providers fill out a form that has a bunch of tiny boxes and submit it to the insurance company. After processing by the payer, they send the claim information to the CO APCD, and it becomes even more complicated to look at than the form:
However, in the same way that each line of computer code gibberish translates to something cool, each of the lines on an insurance claim contains information that can be used to do something pretty awesome.
Now, different types of facilities and providers fill out different versions of these forms so rather than explore a bunch of really boring forms, we’re going to use a general example to show what kind of information is provided in a typical pharmacy claim. Additionally, we’re only focusing on what is collected by the CO APCD and not delving into how we protect personal health information, but we have a lot of that information in other blogs for you to explore.