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 Encounter Intake System (EIS). Currently, the APD’s EIS accepts data submissions in the following formats:

• X12 Post Adjudicated Claims Data Reporting (PACDR)
• National Council for Prescription Drug Programs (NCPDP) Post Adjudication Standard

DOH requires that data submitters submit post-adjudicated claims data for all members and for all health care related claims that have been adjudicated. 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 EIS Companion Guides define specific NYS DOH requirements to be used for processing encounter data. It is important to note that the below three EIS Companion Guides supplement and do not contradict any requirements in the X12 Implementation Guides (Version 5010), the NCPDP Post Adjudication Standard Version 4.2 Implementation Guide, or related documents.

EIS STANDARD COMPANION GUIDE - TRADING PARTNER INFORMATION: Instructions Related to the Exchange of Electronic Data Interchange (EDI) with the EIS. Based on X12 Implementation Guides, Version 5010 and the NCPDP Implementation Guide, Version 4.2. The EIS Trading Partner Information Companion Guide is intended to provide information needed by trading partners to exchange Electronic Data Interchange (EDI) data with the Encounter Intake System (EIS). It includes information about registration, testing, support, and other information.

EIS STANDARD COMPANION GUIDE - X12: Instructions related to Transactions Based on X12 Implementation Guides, Version 5010, and related documents. To acquire copies of the X12 Implementation Guides, Version 5010, and related documents, please visit http://store.x12.org/store/healthcare-5010-original-guides.

EIS STANDARD COMPANION GUIDE - NCPDP: Instructions related Transactions Based on NCPDP Post Adjudication Standard Implementation Guide, Version 4.2, and related documents. To acquire a copy of the NCPDP Implementation Guide, Version 4.2, visit http://www.ncpdp.org

TIER 2 EDIT DISPOSITION SPREADSHEET: If a submission file passes Tier 1 editing (standard level syntax and structure editing), the EIS will perform Tier 2 editing on each claim. The EIS process will check to ensure functional edits are met (external code sets and logical validation). This involves testing for valid Implementation Guide specific code set values and other code sets adopted as HIPAA standards, as well as DOH required edits. Edit descriptions and logic for each EIS edit are found on the Tier 2 edit document.