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Keep up with the BCDA community

This is the home-base for BCDA updates and announcements. For more history, please view our public GitHub repo. To join conversation, sign up for the BCDA Google Group where we share ideas, answer questions, and engage in community troubleshooting efforts.

Version 1 of the BCDA Partially Adjudicated Claims Enhancement live for use on May 16!
May 16, 2023

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the initial production release of 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 the 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 fully adjudicated claims data. As ‘partially adjudicated’ claims, these claims have entered the Medicare processing system, however, they 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 helps 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 and the Data Dictionary can be found here.

Additionally, please check out the BCDA Google Group announcement that also contains additional details about the PACA launch.

Reminder to not share PII, PHI, and sensitive information
November 3, 2022

Please do not share Personally Identifiable Information (PII) as defined in the Privacy Act of 1974 or Protected Health Information (PHI) when posting to the BCDA Google Group under any circumstances.

While the BCDA Google Group is a place to share general information, it is still a public forum where PII, PHI, and sensitive information cannot be shared. A good rule of thumb is, “when in doubt, leave it out”.

Examples of PII, PHI, and other sensitive information include:

  • Medicare Beneficiary Identifier (MBI)
  • Taxpayer Identification Number (TIN)
  • National Provider Identifier (NPI)
  • Social Security Number (SSN)
  • API keys or access credentials (e.g., Client ID, Client Secret)

Personal information commonly appears in API requests or payloads referenced in:

  • Google Group posts or emails
  • Files and attachments

Please redact PII, PHI, and other sensitive information in the following ways:

  • For emails and editable documents, replace sensitive information with the word "REDACTED."*
  • For screenshots and non-editable documents (e.g., PDFs) use any editing tool to completely cover or erase sensitive information. This can be done by adding a shape over the information. Make sure the shape is set to 100% opaque and save the final image in a format that supports layers (e.g., PDF).
*EXAMPLE OF A REDACTED RESPONSE 
      
        {
        
        "entityType": "individual",
        
        "taxpayerIdentificationNumber": "REDACTED",
        
        "nationalProviderIdentifier": "REDACTED",
        
        "performanceYear": 2017,
        
        "measurementSets": [
        
        {
        
        "measurements": [
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Google Group announcement archive 2023-2020
(Click here to navigate to the Google Group announcement archive within the Google Group itself.)
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