Submission of Claims; Personal Identification Data Not Public Record

  1. Law
  2. Georgia Code
  3. Health
  4. Office of Health Strategy and Coordination
  5. Georgia All-Payer Claims Database
  6. Submission of Claims; Personal Identification Data Not Public Record

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  1. Beginning in January, 2023, and every month thereafter, all submitting entities shall submit claims data for state residents to the GAPCD in accordance with this article and rules and regulations promulgated pursuant to this article.
  2. Submitting entities shall submit 95 percent of data within 60 days from the day that the adjudicated claims were paid, and 100 percent of data within 180 days from the day adjudicated claims were sent for payment. The administrator shall establish a Data Submission Guide to ensure uniformity of data, which may be based on currently existing data standards, such as the National Council for Prescription Drug Programs (NCPDP) and ASC X12 Post Adjudicated Claims Data Reporting (PACDR).
  3. Self-funded employer sponsored plans may voluntarily submit monthly claims data to the GAPCD when the employer has opted in writing to the submission of the data. The carrier or administrator shall notify the employer of the employer's option to authorize the submission of the data.
  4. Direct personal identifiers contained in claim data submitted pursuant to this article shall not be considered a public record and shall not be subject to Article 4 of Chapter 18 of Title 50, relating to open records.

(Code 1981, §31-53-47, enacted by Ga. L. 2020, p. 743, § 1/SB 482.)


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