Pre-Adj Availability for MSSP

[David Roberts]

Hi there,

I'm curious what is blocking availability of pre-adj data for MSSP. Will the ETL simplification (IDR only) of v3 API potentially affect that blocker?

Thank you,

David

[Beneficiary Claims Data API (BCDA) Community]

Hi David,

In BCDA v2, partially adjudicated claims data is available to REACH ACOs only. The decision to allow access to partially adjudicated claims data is made separately for each model by the CMS team supporting that model.

In BCDA v3, partially adjudicated claims data will be available to organizations participating in the Medicare Shared Savings Program, ACO REACH, and Increasing Organ Transplant Access (IOTA) Model. KCEs in the Kidney Care Choices (KCC) model are not expected to have access to partially adjudicated claims data.

Thanks,
The BCDA Team