Adjustments

[Levi Hesley]

Hey BCDA Community,

How should we go about adjusting payment amount values in the data?

 In the CCLF files, we would generally change the claim payment amount to negative where there is an adjustment type of 1(cancellation). 

The BCDA data has an active or cancelled status as well as an adjustment type showing interim bill, final bill and debit adjustment. Should I just filter the cancelled claims from analytical tables and reverse the payment sign for debit adjustments or what is the correct way to account for this?

Thank you,

Levi

 

[Beneficiary Claims Data API (BCDA) Community]

Hi Levi,

Thank you for reaching out. BCDA represents claim adjustments a bit differently than CCLF, so a direct translation of the same approach doesn’t quite apply. In CCLF, cancellations are treated as explicit negative transactions, which is why reversing the payment amount works there. In BCDA, cancellations indicate that a particular version of a claim has been nullified, rather than representing a financial reversal of that amount.

A comparable approach in BCDA is to focus on claims with an active status to represent the base payment values, and incorporate debit adjustments as reductions to those amounts. In this context, cancelled claims can be understood as indicators that a claim version should be excluded, rather than treated as negative values.

Thanks,
The BCDA Team

[Levi Hesley]

That makes sense. 

Thanks for the clarification!

Levi,

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