APCD data extracts
Priority Health is the first health plan in Michigan to use the all-payer claims database (APCD) format. It's a more consistent, user-friendly, externally accepted format for providing you with member eligibility, paid medical claims and paid prescription claims data extracts.
- APCD data extracts are pipe-delimited CSV files.
- They're available through Filemart on the 15th of every month.
- You'll receive an email notice when new files are ready to download.
- Eligible entities may request them; they're not available to individual providers.
Learn more about all-payer claims databases at the APCD Council website.
Data available through APCD extracts
The types of information you'll find in the extracts include:
- Medical claims: Diagnosis codes, types of care received, admission and discharge information, insurance information, and financial data for identified risk groups.
- Prescription claims: Prescription fill dates, prescribing practitioner, paid amount.
- Eligibility: Insurance product information including deductible, copayment and coinsurance amounts and member demographics.
How to import APCD files into Excel and maintain the formatting
The following information is available on an easy-to-print APCD FAQs document.
- Download the file from Filemart.
- Open up a new Excel workbook.
- Go to the Data tab. Select From Text. A file browsing menu opens.
- Browse to the document you downloaded from Filemart and select Open.
- (Step 1) In the Text Import Wizard, choose the Delimited button. Click Next.
- (Step 2) Unselect the Tab delimiter. Check Other. Type a "pipe" character ( | , do not use a lowercase L ) in the Other field. Click Next.
- (Step 3) In the Data preview field, hold down the shift key and use the scroll bar to highlight everything in the field.
- At the top of the Step 3 window, click the Text radio button. Click Finish. Click OK.
- Name and Save your new APCD data extract file.
Download our Data Dictionary
This PDF lists the fields appearing in each extract with data description, type, size and format. The fields appear in this order:
- APCD data fields (all standard fields, populated if data is available)
- Michigan Data Collaborative (MDC) fields (all standard fields, populated if data is available)
- Priority Health-specific fields
Timeframe of each month's extracts
Eligibility extract: Members shown are those who had active medical coverage on the 15th of the previous month. For example, the Feb. 15 extract includes members covered on Jan. 15.
Medical and prescription extracts: Show claims paid from the first through the last day of the previous month. For example, in the Jan. 2019 file that is generated on Feb. 15, 2019, the paid date for the claims must fall on a date from Jan. 1 to Jan. 31.
PCP, ACN assignments
Eligibility extract: Assignments are based on the 15th of the month. If a member has one PCP through July 14 and changes PCPs on July 15, the member is assigned to the new PCP. The previous PCP and ACN will not receive eligibility data.
Medical and prescription extracts: Assignments are based on the date of service. If a claim is paid in January 2019 but the service date was Dec. 15, 2018, the claim is assigned to the PCP the member had on Dec. 15, and that PCP is assigned to the ACN they were affiliated with as of Dec. 15.
ACNs, PHOs, POs and medical groups can receive our APCD extracts. Only groups who have risk-sharing contracts in place will receive the financial data. Individual providers are not eligible.
How to request APCD extracts
Eligible entities should contact their Provider Performance Specialist.