Claims data

[ajay mistry]

Hello BCDA team,

We are trying to fetch claims data but I am unable to locate the endpoint for that. I see only patient, explanation of benefit and coverage. 

I may be missing something here. Would really appreciate any help you can provide.

Thank you

Ajay 

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Thanks,
Ajay Mistry

[Beneficiary Claims Data API (BCDA) Community]

Hi Ajay,

Thanks for your question regarding BCDA claims data. Those three FHIR resources (Explanation of Benefit, Coverage, and Patient) contain information related to a Medicare enrollee and their fully adjudicated Medicare claims. You can find a high-level overview about the type of data available in each of the resources here, and information on making API requests for them, including sample cURL commands, here. Once requested, the resources will be available for download as .ndjson files.

For REACH ACOs, BCDA also offers data for partially adjudicated claims - claims which have been submit to Medicare but not yet fully processed or paid. You can find more information on BCDA's partially adjudicated claims data here.

Hope this helps! Please let us know if you have any other questions.
The BCDA Team