BCDA v3 – Missing Claim Type for Member Compared to BCDA v2

[Ashvani goyal]

Hi BCDA Team,

We have identified a discrepancy in the claim types received for certain members when comparing BCDA v3 with BCDA v2.

For example, for a particular member:

• BCDA v2: We received both INST (Institutional) and PROF (Professional) claims.
• BCDA v3: We received only PROF (Professional) claims for the same member, while the INST claims are missing.

Could you please help us understand why the INST claims are not being returned in BCDA v3 for these members?

Specifically, could you confirm:

1. Is there any change in the claim-type inclusion/filtering logic between BCDA v2 and v3 that could result in INST claims being excluded?
2. Are there any known limitations or differences in the upstream data source that could explain why a member may have PROF claims but no INST claims in v3?
3. If the INST claims are expected to be available in v3, could you please investigate whether these claims are missing from the BCDA v3 response/data generation process?

We can provide specific member/claim details and the corresponding v2/v3 results for investigation if needed.

Thanks,
Ashvani Goyal