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All Payer All Claims Data Requests



 

Data Request Overview

The All Payer All Claims (APAC) data request process varies depending on what type of data you are requesting. Review the APAC Data Request Fact Sheet for more information about the data request process. To learn more about the Data Review Committee, view the Data Review Committee page.

APAC Data Releases

APAC collects claims data on a rolling schedule to ensure that data are as complete and reliable as possible. In a rolling schedule, claims data within a set period are collected multiple times a year. This schedule accommodates claims lag, as well as potential claims adjustments.

It takes 15 months from the first submission deadline for a full calendar year of claims data to be complete and reliable. See the table to the right for upcoming calendar year (CY) data releases. See the APAC Data Request Fact Sheet for more detail on our submission and release schedule.

Data
 Release Date
CY 2021 claims
January 2023
CY 2022 claims
January 2024
CY 2023 claims
January 2025

APAC Vendor Transition

The APAC Program recently completed the transition to Human Services Research Institute (HSRI). What does this mean for data users? For more information, please consult these documents:



​What Data is in APAC:

  • 2011-2022 Claims Data
    • Medical, Pharmacy, and Dental claims data
    • Claim status (paid, denied, etc.)
    • Payments from insurers, Medicaid, and Medicare Advantage
  • Member payment data
    • Member copayments and payments
  • Clinical Coding
    • Diagnosis and procedure codes
    • Bill type, place of service, revenue codes
  • Business and Eligibility Information
    • Line of business data (Medicare Advantage, commercial, etc.)
    • Monthly member eligibility data
  • Member Demographics
    • Gender, age, race, ethnicity, rarest race ethnicity, and primary language
      • More info on the demographic data available in APAC can be found here
      • More info on Oregon's Equity and Inclusion Division's (E&I) efforts to standardize demographic data collection to meet Race, Ethnicity, and Language, Disability (REALD) and Sexual Orientation, Gender Identity (SOGI) standards can be found here.
  • Provider Information
    • Provider data (NPI, names, locations)
  • Payment Methodologies
    • Alternative payment methodologies
    • Medicare Advantage data from insurers

 What Data is Not in APAC:

  • Clinical or electronic health record (EHR) data
  • Prescribed pharmaceuticals (only dispensed)
  • Pharmaceutical rebates
  • Data from commercial insurers or TPAs with <5,000 lives
  • Federal Programs (VA, Indian Health Services, etc.)
  • ERISA-based or self-insured employers exempt from APAC
  • Uninsured and self-pay claims

 APAC Data Not Available for Request:

  • CMS- reported Medicare claims data (except for Oregon State agencies)
  • Names of commercial payers and identifiers in combination with amount paid, allowed, or billed
  • Billed premium data
  • Medicaid-only data (request directly from OHA.HealthAnalyticsRequest@state.or.us)

APAC Data That May Be Available With Restrictions:

  • Identified data requests (e.g., DOB, zip code, names, addresses): Justification is required; subject to scrutiny
  • Data with identified Protected Health Information (PHI): HIPAA permits the release of identified PHI solely for Public Health Surveillance purposes, not for research or publication.
  • Substance Use Disorder (SUD) data: This data requires justification and a data use agreement. It can only be requested for research, audit, and evaluation purposes.

This list is not exhaustive. If you have questions, we encourage you to download the APAC Data User Guide or schedule a consultation meeting with our team. To schedule a consultation meeting, email the APAC admin inbox at APAC.Admin@odhsoha.oregon.gov. ​


Requests for APAC data are subject to the standards and regulations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and OAR 409-025-0160. Requesters must complete an application and review process to determine:

  • Appropriate use of the data
  • Only minimum necessary data
  • Data use and storage complies with HIPAA and ensures data privacy and security

Consultation with the APAC team prior to request is highly recommended. To request a meeting, please email us at APAC.Admin@odhsoha.oregon.gov 

For more information about review process, estimated timeframes, and costs for data requests, see APAC Data Request Fact Sheet and APAC Data User Guide.

Applications vary by requested data type (see below). Once completed, submit application to APAC.Admin@odhsoha.oregon.gov to begin the review process.

Application Forms

Public Use Data Sets

Public Use data set requesters must submit an APAC-2 form. The APAC-2 is reviewed by staff, a Data Use Agreement is executed and then the request is fulfilled. This process generally takes 2-4 weeks. Information under the Resources for Data Requesters section below may be useful in planning a project and using APAC data.

Public data sets do not include any county, city or any geographic identifier below the state level as required under HIPAA for fully deidentified data sets.


Limited Data Set

Limited data set requesters must submit an APAC-3 form and Data Elements Workbook. The APAC-3 is reviewed by staff, reviewed by the Data Review Committee, a Data Use Agreement is executed, and then the request is fulfilled. This process generally takes 2-4 months.


Agency Application (Internal Use Only)

This application is only for government official use requests. Processing time will vary depending on request type (public or limited use) and is estimated to take at least three months.

Other Data Request Forms

Cost Waiver Request
This application is for waiving some or all costs associated with filling an APAC request.

Amendment Application
This application is for changes to an approved APAC data request including additional data, change in data use, or change in research protocol. No change in data use or research protocol is authorized until an amendment is approved.

Staff Amendment Application
This application is only for staff changes on an approved APAC data request.

Renewal Application
This application is for extending the Data Use Agreement (DUA), or submitting updated IRB approval, for an approved APAC data request. A reminder that no project activity can occur and APAC data should be destroyed if the DUA or IRB approval (if required) has expired. If you are renewing the DUA and your IRB approval expires within sixty (60) days, please submit an updated IRB approval with this form.

We strongly recommend talking with the APAC Team prior to submitting a data request. To request a meeting, please email us at APAC.Admin@odhsoha.oregon.gov​

OHA recommends data requesters review the following documents to fully understand what data are available in APAC, potential data uses and limitations, and the data request process.

APAC Data User Guide
Release notes, data limitations, business rules and other tips for interpreting APAC data correctly.

APAC Overview
Provides an overview of the APAC database, including what data are collected and released.

APAC Frequently Asked Questions
Answers questions about data collection, management, access and use.

APAC Use Cases 
Showcases previous projects for which APAC data have been approved and used.

Lookup Tables (Excel)
Provides the valid values for certain data elements.

Claim Exclusions version 2018.0.1 (Excel)
Information related to the receipt of substance abuse treatment will not be disclosed without written authorization, unless disclosure is otherwise permitted under 42 CFR part 2. This document contains all diagnosis, procedure and revenue codes that will result in claims line exclusions.​

​OHA supports the use of data for research and healthcare operations. However, APAC requires data requesters to pay the actual costs for data used to inform private activities.

APAC does not use a per year or per file type method for cost. Nevertheless, data requesters are encouraged to request the minimum data necessary for the research questions as required under HIPAA. Multi-year requests will only be approved if the project includes longitudinal analysis or if the condition studied is rare (resulting in a small number of claims in a single year). 

We determine the cost of an APAC data file through the research and administrative activities involved in fulfilling a request. Additionally, the vendor fee of $890 is required to build, validate, and securely transfer the data. APAC will provide an invoice detailing the file type, years approved, cost per hour, and number of hours will be provided after approval of the project. Payment is required before files are created and transferred. Generally, invoices are less than $2,000, including the vendor fee if no special processing is required.​

Special processing, such as matching to an external file or running RAND's Bayesian Improved Surname Geocoding (BISG), is charged at the cost from the vendor. APAC does not release names or street addresses for matching the data requestor's organization. A 'finder file' is required for matching by name and must be provided by the requestor. 

If the cost associated with standard fees is prohibitive, please review APAC's Cost Waiver Request​.


​Requests for Limited Data Sets must be evaluated by OHA's Data Review Committee to make sure your proposed project scope is allowed under OHA policies and state/federal laws.  Learn more on the Data Review Committee webpage.

​The Center for Health Statistics and the All Payer All Claims (APAC) program have linked birth and death records to APAC claims. Making the linked records available will aid research by:

  • allowing researchers to more thoroughly analyze diagnoses and services reported on vital records; and
  • removing the need for researchers to request identified data (such as name and date of birth) to use for linking. This simplifies APAC's review of the data requests and the data requester's obligation to link, remove and sequester any identified data from project teams.

The link available varies by record type. Death certificates are linked by decedents only. Birth records are linked by 'mother/first parent', 'father/second parent' and child.

Each program (APAC and the Center for Health Statistics) applies their own laws and procedures to data requests. To request APAC data with a linked vital records file:

1.   Complete an APAC-3 application for a limited data set and the Data Elements Workbook.

  • Indicate in the APAC-3 project description (1.1) and Linkage (5.2) that you are requesting linked vital records data.
  • Identify in the APAC Data Elements workbook any demographic data elements requested in the vital records data, such as date of birth, addresses, county and zip code.
    • APAC will not transfer data elements in a vital records file that would increase the risk of reidentifying APAC data unless those data elements have been requested and approved through the APAC approval process.
  • For research requests (3.1), indicate on the Institutional Review Board application that linked vital records-APAC data will be used.

2.   After receiving notice of approval for APAC data, apply to the Center for Health Statistics for vital records (birth or death) data. Include the notice of approval from APAC with your signature documentation and specify that you are requesting linked certificate-APAC data. After review by the Center for Health Statistics, APAC will be notified of approval to release the linked data set.

3.   APAC staff will create the linked files which will be sent to the data requester. Any non-linked APAC files approved for use will be transferred by Secure File Transfer Protocol (SFTP) by the APAC Data Vendor. The linked vital records file will be sent separately by SFTP by Health Analytics staff.​

 

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