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  • Requestors may click here to download a preview of the questions contained within this form. 

    For employees of the Virginia Department of Health (VDH), Virginia Department of Medical Assistance Services (DMAS) or the Bureau of Insurance (BOI), please contact APCDsupport@vhi.org for access.

  • Virginia All-Payer Claims Database (APCD)

    Data Request Form

  • By completing this form, I confirm that I am authorized to act on behalf of my team and acknowledge the following responsibilities:


    Review and Approval
    I understand that this request will be reviewed by the Virginia APCD Data Release Committee to ensure alignment with legislative intent and compliance with Virginia Code section § 32.1-276.7:1.

    Appropriate Use
    I understand that Virginia APCD data must be used for an approved purpose that supports data-driven, evidence-based improvements in health care access, quality or cost, promotes or improves public health, or otherwise contributes to a better understanding of health care expenditures or health system performance. I understand that the data may not be used for commercial purposes, sold, redistributed or provided to unauthorized third parties.

    Data Subscriber Agreement
    If approved, I understand that a Data Subscriber Agreement must be fully executed before any data is released.

    Publication and Dissemination Review
    I understand that all publications, presentations, or other public disclosures resulting from Virginia APCD data must be submitted to Virginia Health Information (APCDSupport@vhi.org) and any named entities referenced in the work for a 60-day review period prior to release.

    Data Destructionw
    I understand that my team is required to destroy all Virginia APCD data within 30 days of completing the approved research, unless we obtain explicit permission from VHI to retain it for future use.

    Use Limited to Approved Scope
    I understand that Virginia APCD data may only be used for the specific project outlined in this request and approved by the Data Release Committee. I understand that any additional use will require a new request form submission and approval.

    Linkage and Re-Identification
    I acknowledge that intended linkage to any outside data sources must be included in this request form and approved by the Data Release Committee. I understand that re-identification of individuals or entities within the Virginia APCD is strictly prohibited and would constitute a violation of the law.

     

  • Data Applicant Information

  • Organization Type*

  • Have you worked with claims data in the past?:*

  • If you have any questions while completing this form, please email APCDsupport@vhi.org.

  • Project Information

  • What year(s) of data are you interested in? Please check all that apply.*

  • What type of file(s) are you interested in? Please check all that apply.*
  • Which of the following medical claims are you interested in? Please check all that apply.*
  • What payer data are you interested in? Please check all that apply.*
  • Are you requesting health plan identifiers (i.e., payer name)?*
  • Will your research require you to identify specific facilities (i.e., NPI, facility name)?*
  • Will your research require you to identify providers (i.e., NPI, provider name)?*
  • Is there approval for your project from an Institutional Review Board (IRB)?*

  • If you have any questions while completing this form, please email APCDsupport@vhi.org.

  • Data Filters and Cohort Criteria

  • Will VHI need to use diagnosis, procedure, drug or other code lists to identify your requested population or claims?
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  • Data Security

  • Server Type*

  • Provide the name, title and organization of all individuals who will be authorized to access the data. Please notify VHI at APCDSupport@vhi.org of any changes to this list throughout the duration of the project.
  • Has your organization experienced a data breach in the past?*
  • Does your organization have an information security certificate (e.g., SOC 2, HITRUST)?*

  • If you have any questions while completing this form, please email APCDsupport@vhi.org.

  • Data Destruction

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

  • If you have any questions while completing this form, please email APCDsupport@vhi.org.

  • Additional Information Required

  • To complete your application, please fill out the Data Dictionary form with your requested field selections to the best of your ability and upload it below.

    Completion of this form is required in order for your request to be presented to the Virginia APCD Data Release Committee for approval. Blank Data Dictionary forms will not be accepted, and your request cannot move forward in the data release process until the form is completed.

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  • Please upload any supplemental files (e.g., abstract, IRB approval letter, security plan) below.

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  • If you have any questions while completing this form, please email APCDsupport@vhi.org.

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