HealthFacts RI Database

Background

The Rhode Island All-Payer Claims Database (RI APCD), known as HealthFacts RI, is a statewide database that brings together healthcare claims and enrollment information from public and private insurers. It helps the State, researchers, and other stakeholders better understand healthcare costs, use of services, and patterns of care.

HealthFacts RI is authorized under Rhode Island law (R.I. Gen. Laws Title 23, Chapter 23-17.17) and is operated by the Rhode Island Department of Health in partnership with the Executive Office of Health and Human Services, the Office of the Health Insurance Commissioner, and HealthSource RI.

The RI APCD includes data from commercial, Medicare, and Medicaid payers who have more than 3,000 covered lives in Rhode Island. Data collection has been ongoing since 2014, and payers are required to regularly submit six types of files to the database via their health insurance payment systems. The data does not have any names, addresses, or other personally identifying information; it is anonymous as it cannot be linked to particular people. Rhode Island residents can opt out of the database at any time.

Data Files Currently Maintained by the RI APCD

File Type	File Description
Eligibility	Includes medical, dental, and pharmacy enrollment information for the members covered by each payer during the reporting period. Files include member demographic information and information regarding an individual’s plan and coverage type.
Medical Claims	Includes information on the medical services rendered to covered individuals during the reporting period. This file contains a wealth of useful cost and utilization data, such as diagnosis and procedure codes, charge amount, paid amount, copay amount, deductible amount, type of setting, and rendering/billing provider information, etc.
Dental Claims	Includes information on the dental services rendered to covered individuals during the reporting period. Among the data elements submitted in this file are procedure code, charge amount, paid amount, copay amount, deductible amount, rendering/billing provider information, dental quadrant, and tooth surface codes, among other data.
Pharmacy Claims	Includes information on pharmacy services rendered to covered individuals during the reporting period. Among the data elements submitted in this file are National Drug Code, national pharmacy ID, prescribing provider information, generic/brand drug indicator, plan paid amount, copay amount, and deductible amount.
Provider	Includes information on the providers associated with the medical, dental and pharmacy services submitted during the reporting period. These files contain data related to healthcare providers themselves, including elements such as National Provider Identifier, provider name, provider specialty, and provider geographic information (e.g., city, ZIP code, etc.)
Alternative Payment Model (APM)	Includes non-fee-for-service (non-claims) payments. APM data supplements claims payment data to provide a full picture of healthcare payments. Types, amounts, and covered services under APMs vary across contracts and payers. Examples of APM (non-claims) payments are care management fees, incentive payments, infrastructure and operations payments, shared savings payments and risk settlements, and population-based payments.
CurrentCare	Includes supplemental Race and Ethnicity data provided by the state’s HIE.

Key Resources

Those interested in better understanding the utility and value of the RI APCD can review the following materials: