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, CO APCD statute and rule (legislation) 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.
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:
Alternative Payment Model (APM) and Drug Rebate 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. 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.
- APM Data Submission Manual
- APM Blank File
- APM Control Total Blank File
- Drug Rebate Data Submission Manual
- Drug Rebate Blank File