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Understanding the Data
Resources for Working with BCDA Data

CCLF v. BCDA Data

The goal of the Beneficiary Claims Data API (BCDA) is to provide Accountable Care Organizations with the same claims data as they receive via Claim and Claim Line Feed files (CCLFs). The data delivered to you via BCDA should be the same information as the CCLFs, however this data is now delivered in a new format.

BCDA follows the bulk FHIR specification, and provides the same data as the CCLFs using three FHIR resources: Explanation of Benefit (EOB), Patient, and Coverage. This means that your claims data will be delivered through three resource types rather than 12 CCLF files.

  • The Explanation of Benefit resource type provides the same information you’ve previously received in CCLF files 1-7. The EOB files contain the lines within an episode of care, including where and when the service was performed, the diagnosis codes, the provider who performed the service, and the cost of care.
  • The Patient resource type can be thought of as your CCLF files 8 and 9: this is where you get your information about who your beneficiaries are, their demographic information, and updates to their patient identifiers.
  • The Coverage resource type provides information about the beneficiaries’ insurance coverage, including information about dual coverage.

BCDA Data Security and Quality

CMS provides Accountable Care Organizations (ACOs) with beneficiary identifiable claims data for preliminarily prospectively and prospectively assigned beneficiaries and other beneficiaries who receive primary care services from an ACO. CMS reminds ACOs that there are limitations to using claims data–whether through CCLF or BCDA–to replicate or validate your ACO’s assigned beneficiaries and expenditure/utilization calculations. CMS provides ACOs with beneficiary-identifiable claims data for the purposes of:

  • Redesigning care processes and coordination of care for ACOs beneficiary populations
  • Enabling practitioners in an ACO to better coordinate and target care strategies toward individual beneficiaries
  • Evaluating the performance of its ACO participants or its ACO providers/suppliers
  • Conducting quality assessment and improvement activities
  • Conducting population-based activities relating to improved health

For the appropriate beneficiaries, the data provided to the ACO through BCDA includes claims for all services covered by Part A (Hospital Insurance) and Part B (Supplemental Medical Insurance) that were provided and processed during the prior month. Claims data also include prescriptions covered by a Part D Prescription Drug Program in which the beneficiary is enrolled. ACOs will be able to retrieve both the CCLF and BCDA claims data concurrently for the foreseeable future; we encourage our users to use both the CCLF and BCDA data sources to compare and contrast the data that is being delivered to your ACO. BCDA Engineers have designed the API to deliver the same claims data as is contained in the CCLFs.

Substance Abuse Codes Not Included

BCDA excludes all claims with substance abuse codes (as required by the Confidentiality of Alcohol and Drug Abuse Patient Records Regulations, 42 CFR Part 2).

BCDA Data Dictionary

The CCLF to BCDA Data Dictionary is provided to BCDA users to facilitate their data mapping process.

The Data Dictionary was last updated in February 2021.

Because BCDA delivers data in the FHIR format, data field names will be different from previous data fields delivered through CCLFs. In this spreadsheet, BCDA has provided a crosswalk between all CCLF data fields and their new locations within BCDA Claims files. The Data Dictionary also provides supplementary context for each of the CCLF/BCDA data fields, including:

  • Claim Field Names and Descriptions
  • Data Type
  • Format
  • PII/PHI

Some data fields have not yet been mapped from CCLFs to BCDA.

The Beneficiary FHIR Data Server (BFD) API team is working hard to map all of the CCLF fields in the near future. The fields that have not been mapped yet are shaded in grey. Other fields will also not be mapped to BCDA. Additional information for unmapped fields can be found in the notes column of the BCDA Data Dictionary.

Sample BCDA Files

In order to aid in users' understanding of BCDA file data and structure, we provide sample Explanation of Benefit, Patient, and Coverage files for download. These files contain synthetic data, but the structure of the files is similar to the actual files you will be pulling and downloading from BCDA.

  1. Explanation of Benefit
  2. Patient
  3. Coverage