APCD Data Request Form

Are you an employee of the Virginia Department of Health (VDH), the Department of Medical Assistance Services (DMAS), or the Virginia Bureau of Insurance (BOI)? *

Yes No
Select your organization: *

Virginia Department of Health (VDH) Department of Medical Assistance Services (DMAS) Virginia Bureau of Insurance (BOI)
If you have any questions while filing out this form, please contact Nicole Sidrak, VHI's Business Analyst, at nicole@vhi.org.

Are you requesting access to MedInsight? *

Yes No
Click here to download the APCD New User Form.

Please fill in the required information and submit your completed form to the provided point of contact below.
Suresh Soundararajan
Jacob Wieties
Eric Lowe
If you are interested in receiving a dataset or custom report, please contact Nicole Sidrak, VHI's Business Analyst, at nicole@vhi.org.
If you have any questions while filing out this form, please contact Nicole Sidrak, VHI's Business Analyst, at nicole@vhi.org.

APCD Data Request Form
Please read the information below prior to completing this form.

The Virginia All-Payer Claims Database (APCD) exists under the authority of the Virginia Department of Health (VDH) through legislation passed by the Virginia General Assembly.

Persons or organizations interested in using data from the All-Payer Claims Database must complete the following steps in order to be considered:

1. Complete this online form.

2. Attach a completed Data Specifications File to this form.

3. If requesting a dataset, a signed Data Subscriber Agreement must also be attached to this form.

All completed forms will be reviewed by the APCD Data Release Committee.

The data release committee shall ensure that

i. all data approvals are consistent with the purposes of the All-Payer Claims Database as provided in subsection A;

ii. all data approvals comply with applicable state and federal privacy laws and state and federal laws regarding the exchange of price and cost information to protect the confidentiality of the data and encourage a competitive marketplace for health care services; and
iii. the level of detail, as provided in subsection H, is appropriate for each request and is accompanied by a standardized data use agreement.”

Meetings of this committee are open to the public and held monthly. Applicants are encouraged to participate in the meeting during which their form will be reviewed.

Project Information
What is the purpose of your project? Please check all that apply: *

Population Health Provider/Health Plan Comparison Utilization of Healthcare Services Cost Trends
Provide an overview of your intended use of the data. *
Describe how the data will be beneficial to your project. *
How will the data be stored and secured? *
Do you plan to publish or disseminate the data? *

Yes No
Describe your plans to publish or disseminate the data. *
Provide the name, title, and organization of all individuals that will have access to the data.
If you have any questions while filing out this form, please contact Nicole Sidrak, VHI's Business Analyst, at nicole@vhi.org.

Data Destruction
How long will you need access to the data for? *

One year Two years Three years
If you have any questions while filing out this form, please contact Nicole Sidrak, VHI's Business Analyst, at nicole@vhi.org.

Terms of Use
Subscriber acknowledges and agrees that it has no right, title, or interest in the APCD or de-identified data contained in the report. Subscriber agrees only to use or disclose the report in accordance with Sections II and III in this Application. If Subscriber wishes to use or disclose the report for any purpose not listed in this Application or disclose the report to third parties not listed in Section III, Subscriber will seek VHI’s permission, and may only further use or disclose the report with VHI’s approval. If Subscriber releases the report to any third party, it must only disclose the report in a format that cannot be manipulated, for example, in PDF format. The report and any third parties shall be subject to the same reverse engineering, re-identifying, re-selling restrictions set forth below. If applicable, Subscriber shall not remove any intellectual property, trade dress, identification, proprietary rights notices, or use restriction notices from any report.

Further, Subscriber agrees not to attempt to: (i) reverse engineer or otherwise manipulate the data contained in the report to determine actual reimbursement amounts, (ii) manipulate the data contained in the report to re-identify individuals, (iii) reverse engineer or otherwise manipulate the data contained in the report to identify any of the individual providers or payers; (iv) combine the data in the report with any other public or private data to perform any of the prohibited acts described in subparagraphs (i)-(iii) in this paragraph; or (v) re-sell any of the data within the requested report. Subscriber agrees not to create any derivative works or modify, enhance or otherwise change the data contained in the report, except to reformat in accordance with the requirements below. Subscriber shall only use the report in accordance with local, state and federal laws and regulations. Subscriber shall be responsible for the actions of its employees, agents, contractors, and third parties who access the report.

If Subscriber reformats the data distributions of this report it must be accompanied by the following statement:

“Virginia Health Information (VHI) has provided the aggregated information from the APCD used in this report which was compiled in accordance with Virginia law. VHI has no ability to independently verify this data. By accepting this report the requester agrees to assume all risks that may be associated with or arise from the use of inaccurately submitted data. VHI edits data received and is responsible for the accuracy of assembling this information, but does not represent that the subsequent use of this data was appropriate or endorse or support any conclusions or inferences that may be drawn from the use of this data.”

Subscriber acknowledges that in consideration for VHI’s services and the report generated by VHI, VHI may charge a fee for the report as determined by VHI. VHI will invoice Subscriber at the time VHI delivers the report, which is due and payable within 30 days after receipt of the report and invoice. Any collection costs, attorney’s fees or other expenses reasonably incurred by VHI in collecting amounts due are Subscriber’s responsibility. Subscriber also agrees to pay any federal, state or local taxes, duties or excises which VHI is required to pay or collect upon generation of the report. If Subscriber claims no such taxes are due, it shall provide VHI with copies of such documentation as may be required by the taxing authority.

EXCEPT FOR THE EXPRESS WARRANTIES CONTAINED IN THESE TERMS OF USE, VHI MAKES NO OTHER WARRANTIES, EXPRESS OR IMPLIED, IN FACT OR IN LAW AS TO ANY MATTER WITH RESPECT TO THE APCD, THE DOCUMENTATION OR ANY SERVICES PROVIDED BY VHI UNDER THIS AGREEMENT. EXCEPT FOR THE EXPRESS WARRANTIES HEREIN, THERE IS NO WARRANTY THAT THE APCD IS TRUE, COMPLETE, CORRECT, OR ERROR FREE. EXCEPT AS SET FORTH HEREIN, VHI SPECIFICALLY DISCLAIMS ANY AND ALL WARRANTIES, WHETHER EXPRESS OR IMPLIED, INCLUDING WITHOUT LIMITATION ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE, FREEDOM FROM INFRINGEMENT AND ANY IMPLIED WARRANTIES ALLEGEDLY ARISING FROM TRADE USAGE OR COURSE OF DEALING. VHI DOES NOT WARRANT AND WILL NOT BE LIABLE FOR THE INTERPRETATION OF ANY OF THE APCD DATA BY SUBSCRIBER. ANY SUCH INTERPRETATIONS OR DECISIONS RESULTING FROM THE APCD DATA ARE AT THE SOLE RISK OF SUBSCRIBER.

VHI SHALL NOT BE LIABLE UNDER ANY CIRCUMSTANCES FOR ANY INCIDENTAL, SPECIAL, OR CONSEQUENTIAL DAMAGES OR ECONOMIC LOSS ARISING OUT OF OR IN CONNECTION WITH THE DELIVERY, USE OR PERFORMANCE OF THE APCD OR THE APCD DATA BASED UPON BREACH OF WARRANTY, BREACH OF CONTRACT, NEGLIGENCE, STRICT LIABILITY IN TORT, OR ANY OTHER LEGAL THEORY, EVEN IF VHI HAS BEEN ADVISED OF THE POSSIBLITY OF SUCH DAMAGES.

All notices to Subscriber will be made to the address set forth above. VHI shall not be liable for its failure to timely generate a report or perform any other obligations under these Terms of Use during any period in which performance is delayed by acts of God, fire, war, terrorism, earthquake, embargo, riots, strikes, governmental acts, interruption in phone or internet service, or any other cause outside the reasonable control of VHI.
Signature *

Clear
Date
If you have any questions while filing out this form, please contact Nicole Sidrak, VHI's Business Analyst, at nicole@vhi.org.

Additional Information Required
In order to complete your application, please fill out the Data Dictionary form to the best of your ability and upload below.
Data Dictionary *
If you have any questions while filing out this form, please contact Nicole Sidrak, VHI's Business Analyst, at nicole@vhi.org.
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APCD Data Request Form

Data Applicant Information

Project Information

Data Destruction

Terms of Use

Additional Information Required