BCDA Data
Beneficiary Claims Data API (BCDA) uses Bulk Fast Healthcare Interoperability Resources (FHIR) to share claims data.
Data Dictionary
The Data Dictionary maps the different data fields and locations between BCDA and Claim and Claim Line Feed (CCLF) files. Explore all the differences between the data sources.
Download the BCDA Data Dictionary to learn about:
- claim field names and descriptions
- new data field locations
- data types and format
Partially adjudicated claims data
REACH ACOs can access claims that aren’t fully processed or approved yet. This reduces the time to access Parts A and B claims data to 2-4 days after submission.
Sample files
Download sample data files, which share similar content and structure to production data. Try the sandbox environment to access test data from the API.
- ExplanationOfBenefit.ndjson
- Patient.ndjson
- Coverage.ndjson
- Claim.ndjson (partially adjudicated claims data)
- ClaimResponse.ndjson (partially adjudicated claims data)
Data overview
Beneficiary Claims Data API (BCDA) updates partially adjudicated claims data daily and adjudicated claims data weekly. Data includes:
Data type | Definition |
---|---|
Medicare Part A claims data | Inpatient hospital stays, care in skilled nursing facilities, and hospice care |
Medicare Part B claims data | Doctors' services, outpatient care, preventive services, and durable medical equipment (DME) |
Medicare Part D claims data | Prescription drugs prescribed by healthcare providers |
Resource types
Claims data is organized by resource types, which are requested at the /Patient and /Group endpoints. Version 2 has minor changes in resource types from v1.
- ExplanationOfBenefit (EOB)
-
Similar to CCLF files 1-7, ExplanationOfBenefit stores details for episodes of care, including where and when the service was performed, diagnosis codes, provider, and cost of care. Updated weekly.
- Patient
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Similar to CCLF files 8 and 9, Patient stores enrollees' demographic details and updates to their patient identifiers. Updated weekly.
- Coverage
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Coverage stores enrollees' insurance coverage details, including dual coverage. Updated weekly.
- Claim
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Available for partially adjudicated claims only, Claim stores financial and clinical details on professional and institutional claims. This is typically used for treatment payment planning and reimbursement. Updated daily.
- ClaimResponse
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Available for partially adjudicated claims only, ClaimResponse stores details about the adjudication status and processing results for a claim, predetermination, or preauthorization. Updated daily.