Data Submission Program

All health carriers operating in Washington state must submit claims to the WA-APCD, as well as state Medicaid plans, public-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. Submitters are organized into two reporting groups, Group 1 and Group 2.

Group 1 data submitters

Group 1 submitters include commercial health insurers, Medicaid managed care organizations (MCOs), Medicare Advantage plans, and Medicare Part D drug plans for Medicare Advantage enrollees. Data will also be supplied for persons covered under the Health Care Authority Public Employees Benefits Board (PEBB) and Medicaid fee-for-service programs.

Milestones with due dates

Waiver Documents Publicly Available
1/6/17

Data Submission Guide Comments Due from Data Submitters
1/9/17

Final Data Submission Guide Release
1/16/17

Waiver Requests Due
3/15/17

WA-APCD Ready to Accept Data
3/15/17

Historical Data Intake (2013-6)
3/15/17-5/15/17

First Quarterly Data Intake (1QTR 2017 and 2QTR 2017)
7/31/17

Group 2 data submitters

Group 2 submitters include stand-alone dental insurers, the Washington State Labor and Industries program (workers’ compensation), voluntary submitters (self-funded and others), and commercial insurers not included in Group 1.

Milestones with due dates

Group 2 Initial Data Supplier Registration
5/22/17-6/21/17

WA-APCD Ready to Accept Group 2 Data
11/15/17

Data Exemption (Exception) Applications Due
11/30/17

Intake of Historical Data
11/15/17-1/14/18

Data Exemption (Waiver) Applications for First Quarterly Submissions Due
3/1/18

Data Exemption (Extension) Applications for First Quarterly Submissions Due
3/31/18

First Quarterly Data Intake (1QTR-4QTR 2017 and 1QTR 2018)
4/30/18

Additional data submission information

Data suppliers can log into the Onpoint Claims Data Manager  to access submission documentation and details.

Waiver/Exception/Extension Process