Reg: Claim adjustment/cancellation handling

[Arjun subramaniyan]

Does the BCDA API share the most recent EOB with a status active and the previous linked EOB's with a status cancelled, whenever there is a cancellation?

1. What about adjustments? how will the status differ in that case?

2. Would you link the new EOB to the old EOB with a prior valueSet https://build.fhir.org/ig/HL7/carin-bb/ValueSet-C4BBRelatedClaimRelationshipCodes.html

3. If there are multiple adjustments for the same claim, should we expect multiple EOBs that are related?

[Beneficiary Claims Data API (BCDA) Community]

Hello!

Thanks for your questions about how adjustments and cancellations to claims are reflected in BCDA's EOB resources. We're reviewing the information you shared and will get back to you early next week.

Thank you,
The BCDA Team

[Beneficiary Claims Data API (BCDA) Community]

Hello & sorry for the delay in getting an update out to you.

Typically, new versions of a claim from adjustments or cancellations would be added as a separate EOB record with a new claim identifier. When a new EOB is issued for an adjustment or cancellation it will share the claim-group identifier rather than using the prior valueSet you shared. Each adjustment will create a new, related EOB resource.

Hope this helps! Let us know if you have any further questions.

The BCDA Team

[Arjun subramaniyan]

What would be the Claim group identifier in this case?

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[Beneficiary Claims Data API (BCDA) Community]

Hello,

The Claim Group ID is an eob.identifier[N] value where system='https://bluebutton.cms.gov/resources/identifier/claim-group'. Here's an example json value:

[
  {
    "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
    "type": {
      "coding": [
        {
          "code": "uc",
          "display": "Unique Claim ID",
          "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType"
        }
      ]
    },
    "value": "12345"
  }
]

Thanks,

The BCDA Team