Get Flawless High Data Quality in APCD Submissions: Automated Data Validation Solution 

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The Importance of Data Quality in APCD Payer Submissions

Data Quality and accuracy are vital for APCD payer submissions. Why is that? Each state has state-specific dataset rules, thresholds, and precise compliance requirements. Payers and insurance companies must comply with crucial checks to ensure data consistency and avoid hefty penalties. Many payers and insurance providers need help to keep up with the stringent rules and checks while they submit the client’s claim submission.   

Additionally, if they choose to create these datasets with manual validation, it is tedious and very time-consuming. These numerous hurdles can impede their capacity to submit accurate and high-quality data.  

Datagaps has been a trusted partner for renowned insurance providers, offering support for payer submissions for over 35 years. With 9+ years of product deployment and support, they have deployed 150+ rules per state and pre-built rulesets for 20+ specific APCDs.  

In this blog, we’ll discuss various checks and best practices for ensuring data quality and why an automated data validation solution from datagaps is ideal for insurance providers and payers.  

Essential Data Validation Checks for APCD Compliance

Ensuring Accuracy and Consistency of Data Value, Type, Length, and Threshold Compliance Checks

Effective data validation involves multiple dimensions of checks to ensure every data point is accurate and consistent.   

  • Data Value Check: Verifying that the data values fall within the expected range.  
  • Data Type Check: Data Type Check: Ensuring data types are correct, such as quantities, numeric values, or timelines dates.  
  • Data Length Check: Confirm that data entries meet the required length specifications.  
  • Threshold Compliance Check: Ensure data adheres to pre-defined thresholds set by state regulations.  

Member ID Consistency Checks

One of the most critical validation checks for APCD submissions is ensuring member ID consistency. Inconsistent member IDs can lead to data discrepancies that compromise the integrity of the entire dataset. Implementing rigorous checks for member ID consistency helps in maintaining the reliability of the data submitted

Best Practices for APCD Data Quality: Strategies for Success

1. Implementing Standardized Data Testing Procedures

Standardized, best-practice data testing frameworks are essential for maintaining data quality. These frameworks provide a structured approach to data validation, ensuring all necessary checks are consistently applied across all submissions.

2. Utilizing Automated Data Testing Tools

Manual data validation processes are not only time-consuming but also prone to errors. Automated data testing tools streamline the validation process, saving time and reducing the likelihood of errors. These tools can efficiently handle high volumes of data, ensuring thorough and accurate validation. 

3. Maintaining Clear Documentation and Data Lineage

Clear documentation and transparent data lineage are crucial for tracking data sources and transformations. This transparency helps promptly identify and rectify data issues, thereby maintaining data quality. 

4. Impact of Non-Compliance: The High Stakes of Data Validation

Failing to comply with APCD submission requirements can have severe consequences. Financial penalties for non-compliance are hefty, with fines reaching up to $25,000 per incident. Additionally, operational setbacks due to rejected submissions can damage a healthcare payer’s reputation and lead to costly delays.

APCD Data Submission Requirements

Some of the Data Quality checks that Healthcare Payers are required to perform before submitting these datasets to APCDs are listed below: 

  • Domain Checks   
  • Consistency Checks   
  • Unicity Checks   
  • Completeness Thresholds   

Why do Solutions Like Datagaps Add Value to APCD Compliance?

Ensuring data quality and compliance in All-Payer Claims Database submissions is paramount in this healthcare landscape. The challenges are significant, and the stakes are high. It encourages states to establish an APCD to collect pharmacy claims, medical claims, provider data, and member eligibility data. Each healthcare payer is responsible for submitting this data to the state APCD following the stringent Data Quality guidelines and thresholds set forth by the state’s APCD Councils. This is where solutions like Datagaps come into play, offering unparalleled value to healthcare payers. Below, we delve into the key reasons why partnering with Datagaps can transform your APCD submission process and significantly enhance your operational efficiency.  

Datagaps Solution Key Features

What Makes Datagaps' APCD Solution Indispensable?

  • Automated Rule Application: Implements over 150 rules per file to maintain stringent data quality.   
  • State-Specific Templates: Ensures each submission adheres to state standards.   
  • End-to-End Encryption and Data Handling: Safeguards sensitive information in transit and at rest.   
  • Alerts and Reporting: Monitors submissions and flags issues as they arise, with automated alerts and notifications for quick resolution.  

1. High Data Quality with Automated Data Validation

One of the most substantial benefits of Datagaps is its comprehensive data validation capabilities. It encourages states to establish an All-Payer Claims Database (APCD) to collect pharmacy claims, medical claims, provider data, and member eligibility data. Each healthcare payer is responsible for submitting this data to the state APCD following the stringent Data Quality guidelines and thresholds set forth by the state’s APCD Councils. Each dataset must adhere to stringent state-specific rules and thresholds. Datagaps automates this complex validation process, applying over 150+ rules per state to ensure every data point is accurate and compliant. This automation reduces the manual effort required and significantly minimizes the risk of errors.  

2. State-Specific Pre-built Rulesets

Navigating the myriad of state-specific APCD requirements can be overwhelming. Each state has its unique set of regulations, which can change frequently. Datagaps simplify this complexity with pre-built rulesets tailored to each state’s requirements. These pre-built templates ensure that all data submissions are aligned with the latest state regulations, reducing the burden on your compliance team and ensuring seamless submissions.  

3. Low-Code Solution

Integrating new tools into existing data pipelines can often be a disruptive and resource-intensive process. Datagaps offers a low-code solution that seamlessly integrates with your current systems. This plug-and-play functionality means you can enhance your data validation processes without significant downtime or disruption to your operations. The low-code environment is also user-friendly, allowing your team to manage and easily modify validation rules as needed.  

4. Alerts and Reporting

Timely identification and resolution of data issues are crucial for maintaining Data Quality. Datagaps provides instant alerts and comprehensive data validation reporting features. Our solution monitors your reports and flags any anomalies or issues as they arise. Automated alerts ensure your team can address problems immediately, reducing the risk of non-compliance and rejected submissions. Detailed reports offer insights into the validation process, helping you understand and improve your data quality over time.  

5. Scalability and Flexibility

As your organization’s data volume grows, so do the capacity and efficiency to handle the volume and complexity of your data. Datagaps solution is designed to scale with your needs, handling increasing data volumes and adapting to new regulatory requirements. This scalability ensures that your data validation processes remain robust and effective, even as your operational demands evolve, while maintaining high data quality consistent across all reports.

6. Cost and Time Efficiency

Manual data validation is not only error-prone but also resource-intensive. Datagaps automates this process, freeing up your team’s productivity to focus on more strategic tasks by reducing the time and effort required for data validation. Datagaps help you achieve significant cost savings. Moreover, the efficiency gains mean faster submission turnaround times, reducing the risk of delays and associated financial or legal penalties.  

7. Proven Track Record

With over 9+ years of product deployment and support, Datagaps has a proven track record of success. The platform supports 35+ payer submissions and has deployed state-specific rulesets in 18+ states. This extensive experience and expertise make Datagaps a reliable partner for healthcare payers looking to enhance their APCD submission processes.  

Reasons to Partner with Datagaps

  • Data Validation: Ensures data accuracy across multiple dimensions with automated, state-specific rules.  
  • Seamless Integration: Low-code, plug-and-play integration with existing data pipelines minimizes disruption.  
  • Notification & Alerts: Provide automated alerts and detailed reporting for immediate resolution of issues.  
  • Scalability: Adapts to increasing data volumes, complexity, and evolving regulatory requirements.  
  • Cost Efficiency: Reduces manual effort, significantly saving costs and time.  
  • Proven Success: Supported by a strong track record and extensive industry experience.  

Embrace Automated Data Validation Processes for High-Quality APCD Submission

Implementing robust data validation processes is not just about avoiding penalties—it’s about ensuring the integrity and reliability of healthcare data. Solutions like Datagaps provide automated, state-specific validation tools that streamline the entire submission process, ensuring compliance and enhancing data quality. 

Explore Datagaps Solutions

Don’t let Data Quality issues hold you back. Discover how Datagaps can help you achieve flawless APCD submissions. Schedule a demo today. 

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Established in the year 2010 with the mission of building trust in enterprise data & reports. Datagaps provides software for ETL Data Automation, Data Synchronization, Data Quality, Data Transformation, Test Data Generation, & BI Test Automation. An innovative company focused on providing the highest customer satisfaction. We are passionate about data-driven test automation. Our flagship solutions, ETL ValidatorDataFlow, and BI Validator are designed to help customers automate the testing of ETL, BI, Database, Data Lake, Flat File, & XML Data Sources. Our tools support Snowflake, Tableau, Amazon Redshift, Oracle Analytics, Salesforce, Microsoft Power BI, Azure Synapse, SAP BusinessObjects, IBM Cognos, etc., data warehousing projects, and BI platforms.  www.datagaps.com 

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