Development of a Uniform Medical Claims Payer Reporting Standard

FALLS CHURCH, Va.--(BUSINESS WIRE)-- The Accredited Standards Committee X12 (ASC X12) and APCD Council announce a new initiative to develop a Uniform Medical Claims Payer Reporting Standard. In order to offer standardized reporting requirements for the states that collect this data, and to ease the burden for the payers that are required to submit the data, ASC X12N (Insurance) has been engaged with the APCD Council to consider the various business models in place today, determine the most efficient business model, and develop the resulting work products (e.g. Implementation Guide).

Currently, 14 states have enacted legislation to collect health insurance claim and/or remittance information from both private and public payers to support the development of state-based All-Payer Claims Databases (APCDs) – states are collecting medical, dental, and pharmacy claims in addition to eligibility and provider files. In addition to state reporting requirements, Medicare and Medicaid have defined business needs for similar claim/remittance data. The information included in this business process is very similar to the information reported by plans to Medicare and state Medicaid programs for paid encounter reporting. There is a very real opportunity to align these processes.

To meet state and federal reporting requirements to date, business models for reporting medical claims data require the use of different variations of the claim, remittance, and coordination of benefits ASC X12 transactions. More information about state reporting requirements can be found at

In response to industry business needs, the APCD Council and workgroups of ASC X12N met on July 12, 2011 to discuss the need for a uniform state reporting Implementation Guide. The purpose of that call was to consider the various business models and discuss the need to identify a single, standardized "best practices" model to meet the various business needs for the reporting requirements. This initial discussion will be followed by collaborative work, coordinated through ASC X12N, with a kick-off meeting scheduled to occur during the October 2011 ASC X12 meeting.

ASC X12N welcomes participation in this collaborative work and invites interested parties to the October 2011 meeting. Participation from members who have an understanding of the reporting needs will be critical to the success of this initiative.

Margaret Weiker, Chair of the Insurance Subcommittee, thanked the APCD Council for bringing this opportunity to X12. “I believe this will result in a positive outcome, increase the quality of the data and reduce the implementation cost for the industry.”

“The APCD Council is thrilled to be working with X12N on this standardization effort, which will result in lowered administrative costs for payers, enable states to more easily share data between them, provide predictability for vendors, states, and payers on data layouts, and provide a public forum for the addition of new data elements as APCDs evolve nationally to meet state transparency and national health reform needs,” said Patrick Miller, co-chair of APCD Council.

About ASC X12

ASC X12, chartered by the American National Standards Institute more than 30 years ago, develops and maintains EDI and CICA standards along with XML schemas which drive business processes globally. The diverse membership of ASC X12 includes technologists and business process experts, encompassing health care, insurance, transportation, finance, government, supply chain and other industries. For additional information, visit E-mail: [email protected]

About APCD Council

The APCD Council is a federation of government, private, non-profit, and academic organizations focused on improving the development and deployment of state-based all payer claims databases (APCDs). The APCD Council is convened and coordinated by the Institute for Health Policy and Practice (IHPP) at the University of New Hampshire (UNH) and the National Association of Health Data Organizations (NAHDO). For additional information, visit E-mail: [email protected]


The National Association of Health Data Organizations (NAHDO) is a national membership and educational association dedicated to improving health care data collection and use. Standardizing how and what data are collected has been an ongoing priority of NAHDO for the past 25 years. The mutual understanding of the importance of data standards for state reporting systems made for a natural relationship between NAHDO and ANSI X12N. For the past 15 years NAHDO has been an active member of ANSI X12. With full cooperation of both organizations, an ANSI X12 approved implementation guide was developed and continues to be maintained. This standard provides the data content and messaging standards that many states have written into their data collection rules and regulations. Because of the relationship with ANSI X12N, these standards are also consistent with the standards used in other parts of the health care industry. The most notable is the consistency of the state reporting systems with the HIPAA mandated transactions. For more information, visit Email: [email protected]


Patrice Scheyer, 703-970-4480
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APCD Council
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