This page provides technical guidance on data intake and acquisition for APD data submitters. Scroll down to review APD submitter technical information and documentation. More information is available in Section III of the APD Guidance Manual.

Entities that submit data to the APD ("data submitters") will do so primarily using the Original Source Data Submitter (OSDS) system. Once operational, the OSDS system will accept data submissions in the following formats:

  • X12 834 Plan Membership Reporting
  • X12 837 Post-Adjudicated Claims Data Reporting (PACDR)
  • National Council for Prescription Drug Programs (NCPDP) Post-Adjudication Standard

DOH requires that data submitters submit plan membership data for all Commercial off-exchange members. After enrollment, member data is submitted using the X12 834 X318 standard transaction. The OSDS 834 X318 Companion Guide defines NYS-specific requirements for processing member data.

DOH also requires that data submitters submit post-adjudicated claims data for all members and for all health care related claims that have been adjudicated (‘encounter data’). After adjudication, claims data is submitted using X12 PACDR and the NCPDP Post-Adjudication Standard transactions. X12 PACDR is used for institutional, professional, and dental claims. The NCPDP Post-Adjudication Standard is used for pharmacy claims. The OSDS PACDR and NCPDP Companion Guides define NYS-specific requirements to be used for processing encounter data.

It is important to note that the OSDS Companion Guides supplement and do not contradict any requirements in the X12 Implementation Guides, Version 5010, and the NCPDP Post-Adjudication Standard Version 4.2 Implementation Guide, or related documents.

OSDS STANDARD COMPANION GUIDE – DATA SUBMITTER INFORMATION: Instructions Related to the Exchange of Electronic Data Interchange (EDI) with the OSDS system. Based on X12 Implementation Guides, Version 5010 and the NCPDP Implementation Guide, Version 4.2. The OSDS Data Submitter Information Companion Guide is intended to provide information needed by data submitters to exchange (EDI) data with the (OSDS) system. It includes information about registration, testing, support, and other information.

OSDS STANDARD COMPANION GUIDE - X12 837 Post-Adjudicated Claim Data Reporting (PACDR): Instructions related to Transactions Based on X12 837 X298, X299, X300 Implementation Guides, Version 5010, and related documents.

OSDS STANDARD COMPANION GUIDE - X12 834 Plan Member Reporting: Instructions related to Transactions Based on the X12 834 X318 Implementation Guide, Version 5010, and related documents.

OSDS STANDARD COMPANION GUIDE - NCPDP Post-Adjudication Standard: Instructions related Transactions Based on NCPDP Post-Adjudication Standard Implementation Guide, Version 4.2, and related documents.

TIER 2 EDIT DISPOSITION SPREADSHEET: If a submission file passes Tier 1 editing (standard level syntax and structure editing), the OSDS system will perform Tier 2 editing on each record. The OSDS system process will check to ensure functional edits are met (external code sets and logical validation). Edit descriptions and logic for each OSDS edit are found on the Tier 2 edit document.