However, although APCD data files can be quite large (millions of records), the files are not transmitted daily, but monthly, quarterly, and, in some cases annually. This is important when receiving vast numbers of claims daily from different payers offering a large variety of policy configurations, coupled with various remittance arrangements resulting from diffuse contracted payment provisions. While clear benefits exist to using an EDI format in the claims transaction world due to the large number of variations that can exist within the health care claims system, an EDI format provides the flexibility and space savings that are not achievable using a flat file configuration. The PACDR guides infer that the medical and dental claims files be submitted in an Electronic Data Interchange (EDI) format, using the applicable X12N Transaction Set structure (segments, data elements, levels, loops) found in the PACDR guides. Historically, APCD files (with one exception) have been formatted and submitted as standard ASCII, comma delimited, text files. Neither ASC X12 standards or Type 3 Technical Reports define transport requirements.вЂќ Given this ambiguity, considerable discussion has taken place between data submitters and administrators over the past six months regarding the most efficient and cost-effective mode of data transmission. The second paragraph of the Preface to the PACDR guides states that: вЂњTrading partners define their specific transport requirements separately. While there is no question that the adoption of the PACDR guides will provide more clarity to data submitters and APCD administrators, resulting in more accurate and timely data, significant confusion still exists regarding the method of transmission of the data files from the payers to the state agencies. The approval of the PACDR guides has finally resulted in national industry adopted standards that define the sources of data used to populate the APCD medical and dental claims files submitted to state regulatory agency trading partners administering APCDвЂ™s who are defined as public health authorities under HIPAA. Although expected in coming months, an ANSI X12N reporting guide for an APCD eligibility file has not yet been approved by the ASC. These guides define the transaction sets used to exchange post adjudicated claims data for institutional, professional, and dental claims. After deliberating with impacted parties over a twelve month period, the Accredited Standards Committee (ASC) X12 approved the ANSI X12N 5010 837 Post Adjudicated Claims Data Reporting (PACDR) guides in August of 2012.

Asc x12 5010 standard guide