August 20, 2016
BCBSRI supports the All-Payer Claims Database
The State of Rhode Island has implemented the All-Payer Claims Database (APCD), which calls for health insurers and third party administrators to submit claims information for the purposes of studying and comparing healthcare data, identifying opportunities to improve healthcare quality and health outcomes, and reduce healthcare costs. The State has implemented safeguards to protect members’ information and identities.
BCBSRI had recently suspended submission of claims to the APCD based on a U.S. Supreme Court case involving a similar program in Vermont. That decision was that a state cannot require submission of data by groups subject to the Employee Retirement Income Security Act (ERISA), but that an ERISA group health plan may voluntarily submit data for a program such as an APCD. BCBSRI now supports the implementation of the APCD in Rhode Island as follows:
For self-funded/ASC ERISA group plans, BCBSRI does not submit claims unless a group directs us to do so, and a communication about this election has already gone out.
For fully insured groups and non-ERISA group plans, BCBSRI will continue to submit claims data to the APCD.
More information about the APCD is available from the Department of Health at www.health.ri.gov/data under the link for “HealthFacts RI.”