Question Regarding Claim IDs

[Jason Turan]

Earlier this week, I spent some time looking through a relative's claims data on the CMS portal under the "Check my claims" feature, then compared that slimmed down dataset to the raw FHIR data for that same individual. The good news: all the service dates, services rendered, and payment amounts lined up. The confusing news: the "Claim Number" in the CMS portal doesn't match the "Claim ID" or "Claim Group" in the FHIR data for the same claim.

Can you offer any insight on this discrepancy? Are the Claim Numbers in the CMS portal simply not stored in the FHIR data? And are the existing "Claim ID" and "Claim Group" values just surrogate keys that link back to internal database records?

Thanks,

Jason

[Kirsten Hansen]

Hi Jason,

We got your message and are looking into your questions. Should have a response for you soon.

Kirsten Hansen

Product Manager

The Blue Button 2.0 API Team

[Kirsten Hansen]

Hi Jason,

Apologies for the confusion. This discrepancy exists due to the upstream data sources for each set of claims data. The ‘Claim Number’ you see in the portal is different from the ‘Claim ID’ and ‘Claim Group’ values due to different data sources. The Claim ID (CLM_ID)  and Claim Group (claim_group_id) values are specific to our upstream database used by the Beneficiary FHIR Database team. The data in the portal comes from a source managed by a different team at CMS, and uses different identifiers. 

More information on Claim ID (CLM_ID) can be found here as well: https://resdac.org/cms-data/variables/claim-id

We welcome your feedback and use cases you have for matching these claim IDs across the available resources for Medicare claims. 

Thank you, 

Kirsten Hansen

Product Manager

The Blue Button 2.0 API Team

[Jason Turan]

I'm revising this conversation I started back in September because I intended to follow up, but never did. Kirsten, to you point about use cases, having a matching Claim ID between the CMS Portal and FHIR data would be extremely valuable in an instance where a patient had a question about a claim he/she directly accessed on the portal, and then contacted a third-party vendor he/she shared data with to discuss that question. Without that unique identifier, the vendor would need to look up provider and service date combinations, which could get messy. If there's room on your roadmap to to add the portal Claim ID as another value to the identifier section of a FHIR resource, then I would be in full support of it!

Jason

[Jillian Theil]

Hi Jason - Thank you for the additional information and feedback, we will take this back to our team to explore the feasibility of adding the portal Claim ID as an additional identifier. 

Best, Jillian Theil
-The Blue Button 2.0 API Team

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