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.

Current Submitters

Number of Lives by Payer by Year (October 2018)

Claims Paid Through Dates

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.

Submitter resources:

Self-Insured Employers

On March 1, 2016, the Supreme Court made a decision in the Gobeille vs. Liberty Mutual case prohibiting states from mandating the submission of health care claims from ERISA-based self-insured employers.

However, the Supreme Court decision DOES NOT prohibit voluntary submission of claims information from self-insured ERISA plans, and non-ERISA self-insured employers are still required to submit data according to the current CO APCD rule.

CIVHC and the Colorado Department of Health Care Policy and Financing strongly recommend ERISA-based self-insured employers to submit their data to the CO APCD. By including claims information, employers can identify ways to save costs and improve the health of their employees while enhancing health care transparency for the benefit of all Coloradans.

Resources

Please contact us at ColoradoAPCD@civhc.org with any questions.