Data submission program
About data submissions
The WA-APCD is a state-mandated APCD, established under state law to collect healthcare claims data. All health carriers operating in Washington State must submit claims to the WA-APCD. This includes state Medicaid plans, public-employee benefits plans, school-employee benefits plans, third-party administrators paying claims on behalf of health plans, and the Washington State Labor and Industries program (RCW 43.371.030). Self-funded employer-sponsored plans and Taft-Hartley trust health plans may submit claims data on a voluntary basis.
Required data includes member eligibility and demographics, provider details, and claims for medical, pharmacy, and dental services. Data covers charges, payments, diagnoses, and procedures.
Data submissions follow a standardized guide with secure electronic formats. Submitters provide data quarterly by specific deadlines (April 30, July 31, October 31, and January 31) for the prior three month’s claims.
Data submitters
Submitters include:
- commercial health insurers,
- Medicaid managed care organizations (MCOs),
- Medicare Advantage plans, and Medicare Part D drug plans for Medicare Advantage enrollees,
- stand-alone dental insurers,
- the Washington State Labor and Industries program (workers’ compensation), and
voluntary submitters (self-funded and others).
Data is also supplied for persons covered under the Health Care Authority Public-Employees Benefits Board (PEBB), School-Employees Benefits (SEBB), and Medicaid fee-for-service programs.
Access the data supplier portal
If you are a data submitter, log in to access the Onpoint Health data’s data-supplier portal Link: http://www.onpointcdm.org/
Data supplier support
Log into the Onpoint Claims Data Manger to access submission documentation and details.
Download the WA-APCD submission guide.
Suppliers should email Onpoint at wasupport@onpointhealthdata.org with any questions about the portal or log-in credentials. Email apcd@hca.wa.gov for questions related to eligibility, registration, submission exemptions and other data submitter related policy questions.
Contact Onpoint:
wa-support@onpointhealthdata.org
207-623-2555
Onpoint Health Data
55 Washington Ave,
Portland, ME 04101
Exemption request process
As described in WAC 182.70.060 and 182.70.080, the Health Care Authority (HCA) may grant data suppliers exemptions to a reporting requirement.
Submitters may apply for three kinds of exemptions:
- Waiver: data supplier is exempted from complying with a reporting requirement for a defined period not to exceed one reporting year
- Extension: data supplier receives additional time (not to exceed one reporting quarter) to submit a quarterly data submission or data resubmission requirement
- Exception: data supplier is approved to file historical data for a period less than the period specified in rule
The exemption procedure and application form are available below; data suppliers also can obtain these materials via the Onpoint Claims Data Manager portal. See the exemption procedure for detailed instructions and submission deadlines.
- Complete applications will be reviewed by HCA and a written response provided to applicants within 30 days of receipt for waivers and exceptions and 15 days for extensions. Submitters may request administrative review of denied applications within 30 days of receiving HCA's decision. Denials at administrative review may be appealed to an administrative law judge through the Office of Administrative Hearings.
Data security
How is WA-APCD data protected?
The WA-APCD adheres to industry-leading data privacy and security standards to protect the confidentiality of personal information and business data. The data center is in full compliance with HIPAA and HITECH and Onpoint Health Data has earned Certified status by the Health Information Trust (HITRUST) Alliance.
How does Washington HealthCareCompare make sure that its data is reliable?
Data quality processes are in place for the WA-APCD including completeness and validity checks. Washington submissions include 482 data elements across four file types with more than 200 reference table look-ups to verify data quality and accuracy.
Building on the completeness and validity stage, data next undergo a battery of validations that assess the interrelationships of individual data elements and evaluate rates against parameter-driven thresholds to spot anomalies and errors. Additional trending and cross-file and cross-payer validation and quality checks are conducted.
Each data submitter providing data to the WA-APCD is asked to validate the submissions to attest that the results provided to them have been accurate. HCA and Onpoint Health Data use experts in health data assessment who follow a standard process to check that the data is valid and reliable. This process includes performing data quality checks with providers and practices allowing them the opportunity to verify performance and cost measures and patient and provider attribution, and thorough testing of reliability scores to the data.