Updates

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the initial production release of the Beneficiary Claims Data Application Programming Interface (BCDA) Partially Adjudicated Enhancement on May 16th, 2023. This initial release was designed as an expansion of the data available to Medicare providers from BCDA and is available to Accountable Care Organizations (ACOs) participating in the ACO Realizing Equity, Access, and Community Health (ACO REACH) Model. Access to partially adjudicated claims data reduces the time to access Parts A and B fee-for-service claims to 2-4 days after claim submission, while it is typically up to 14 days for adjudicated claims data. As ‘partially adjudicated’ claims, these claims have entered the Medicare processing system, but are not paid or fully processed by CMS and may be subject to changes. The data is delivered through the Claim and ClaimResponse bulk Fast Health Interoperability (FHIR®) specification resource types. Part D (drug coverage) and Durable Medical Equipment (DME) are not included in partially adjudicated claims. This enhancement can be used to increase care coordination, improve healthcare outcomes, and reduce overall healthcare cost for Medicare beneficiaries.

For more information on partially adjudicated claims, the User Guide can be found here.

Version 2 of the Beneficiary Claims Data API (BCDA V2) is now live for production use. BCDA will support all functionality for both V1 and V2 of the API for the foreseeable future. However, because BCDA V2 conforms to the FHIR R4 specification and follows the CARIN Implementation Guide, your organization may want to switch over to ensure you’re aligned with the latest industry standard.

If you wish to transition your implementation to utilize BCDA V2 endpoints instead of V1, simply replace ‘v1’ in API call URLs with ‘v2’. For more information, see the Building Your Application page or explore the CMS V2 API FAQ Documentation. The BCDA Data Dictionary has also been updated with V2 FHIR data mapping information. For more information, please visit the Understand the Data Page.

The BCDA team is excited to announce a release of the newest version of the BCDA data dictionary, which provides a crosswalk between BCDA data and the Claim and Claim Line Feed (CCLF) file. Summary of the updates:

- Corrections from the previous version of the data dictionary.

- Inclusion of new tabs to help with interpretation: "Column Definitions", "Glossary", and "Change Log".

Please visit the Understanding BCDA Data Page to download this new data dictionary and review the updates.

Users may now cancel/delete running jobs by utilizing the DELETE endpoint. The new delete feature will only work on jobs actively running and not in any terminal state (completed, failed, archived, expired, cancelled).

Example Request to the new DELETE endpoint

DELETE /api/v1/jobs/{jobId}

We hope this feature will be useful in cancelling especially long-running jobs. For more details, see the Building Your Application page.

The Beneficiary Claims Data API (BCDA) is excited to announce that we have achieved data parity* with Claim and Claim Line Feed (CCLF) files that you are used to receiving from CMS. Until now, we have been unable to offer about 15 fields that were available in CCLF files, but our upstream data source, the Beneficiary FHIR Data Server (BFD) has successfully mapped these missing fields to BCDA’s payloads.

These fields include: CLM_UNCOMPD_CARE_PMT_AMT, EFCTV_BGN_DT, EFCTV_END_DT, and more. We are also removing one data field: BENE_COUNTY_CD.

*Note: IDR Load Date Field will not be mapped. This field is generated from a different upstream data warehouse than the one where BCDA sources its claims data.

The BCDA Data Dictionary is now updated with all of these mappings. Please see the Data Dictionary or the community announcement in the Google Group for detailed information.

As promised, BCDA has retrieved the January attribution file and the temporary changes implemented during the end of year have been reset. Requests to /Patient and /Group using `all` have returned to their normal state of operation. In addition, you can continue to use /Group with `runout` to retrieve claims runout data for beneficiaries who were attributed to your ACO in 2020 but not in 2021. These claims will have a service date no later than December 31, 2020. Please consult the Building Your Application page for guidance on using the `runout` attribute.

The production API is undergoing a change that will affect your use of BCDA in the remainder of December 2020 and throughout January 2021.

Why the change?

Between December and January, ACOs go through a change in their participant lists and related beneficiary assignment as part of the transition between performance years. BCDA has a delay in receiving the updated beneficiary list in January, so BCDA has been working to ensure that we only return appropriate claims data. Last year, BCDA had to be turned off to address this delay; this year, BCDA is releasing new capabilities to maintain its uptime year-round.

BCDA is introducing a new identifier in the /Group endpoint, called `runout`. Between December 2020 and mid-January 2021, this identifier will only return claims with a service date before December 31, 2020. Until BCDA receives January 2021 attribution information, the only way to retrieve claims is to use the group ID `runout` with the /Group endpoint; requests to /Patient or /Group with other group IDs will fail. After BCDA receives January 2021 attribution information, this same `runout` identifier will also be available for ACOs to receive claims runout information from 2020.

Full details about how to implement these changes are available in the End of Year Requests section on the Building Your API page.

Welcome to BCDA's new website! We have streamlined the documentation to better facilitate quick experimentation in sandbox, detailed onboarding in production, and to showcase and match our sibling APIs. Please explore and do not be afraid to share your feedback with the team as we continue to iterate on these changes. For returning visitors, all of the documentation and resources from the previous site are still here.

For more history and updates on BCDA's journey, please view our public GitHub repo. You are also welcome to join the BCDA Google Group and look back on the questions and community troubleshooting there.