Multiple CCW identifiers for a beneficiary

[Leo Meira]

Hi BCDA Team,

We recently encountered BCDA data for a beneficiary that included two different CCW Beneficiary IDs for the same individual. According to CCW’s documentation, each beneficiary should have a unique identification number that does not change over their lifetime and is never reused.

Could you help us better understand this scenario? Specifically:

• Why might two different CCW identifiers be associated with the same beneficiary?
• How does BCDA handle situations like this?
• How frequently should we expect this to occur?
• Which identifier should we use as the reliable, unique identifier for a beneficiary?

With appreciation,

Leo Meira

--
Leo Meira

​​​​


Manager, Software Engineering
leo....@pearlhealth.com
220 5th Avenue, 17th Floor, NY, NY 10001
www.pearlhealth.com





This email address should not be used to communicate private, confidential or sensitive information, including, but not limited to, personal health information protected by the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, as amended and its implementing privacy, security and breach notification regulations ("Protected Information"). If you need to send a communication to the sender of this email or any Pearl Health personnel containing Protected Information, please send an email to he...@pearlhealth.com indicating your need, but not containing the Protected Information, so that you can be provided instructions respecting use of a secure channel.

[Leo Meira]

Hi BCDA Team,

I’m following up on the email sent earlier this week regarding a beneficiary record that contained two different CCW Beneficiary IDs. We’re hoping to better understand this scenario so that we can handle it correctly in our data pipelines.

Would you be able to provide any guidance on the questions below, or let us know if additional context would be helpful?

• Why might two different CCW identifiers be associated with the same beneficiary?
• How does BCDA handle situations like this?
• How frequently should we expect this to occur?

• Which identifier should we treat as the reliable, unique identifier for a beneficiary?

With appreciation,
Leo Meira

Leo Meira ​​​​ Manager, Software Engineering

(508) 816‑2938 |  leo....@pearlhealth.com

This email address should not be used to communicate private, confidential or sensitive information, including, but not limited to, personal health information protected by the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, as amended and its implementing privacy, security and breach notification regulations ("Protected Information"). If you need to send a communication to the sender of this email or any Pearl Health personnel containing Protected Information, please send an email to he...@pearlhealth.com indicating your need, but not containing the Protected Information, so that you can be provided instructions respecting use of a secure channel.

[Beneficiary Claims Data API (BCDA) Community]

Hi Leo,

Thanks for reaching out about this anomaly. In short, our recommendation is to continue to use BENE_ID as the unique identifier though this type of conflict is far from the intended behavior.

• Why might two different CCW identifiers be associated with the same beneficiary?

• • One possible reason for this situation to arise is if two entries for a Medicare enrollee are created within a short period. It may take some time before those duplicate records are consolidated within CCW. 

• How does BCDA handle situations like this?

• • BCDA's upstream data provider, the Beneficiary FHIR Data Server (BFD) will not return the data associated with an MBI if the MBI is assigned to 2+ different BENE_IDs. Scenarios like these are infrequent, only happening for about 2 in every 10,000 unique BENE_IDs in CCW.

• How frequently should we expect this to occur?

• • Although CCW does have some instances where a unique Medicare enrollee has 2 different BENE_IDs, the approach outlined earlier should suppress the effected enrollee's data in those instances. We'll need to gather a bit more info to understand why data for this enrollee with multiple BENE_IDs was included in your latest data pull.

• Which identifier should we use as the reliable, unique identifier for a beneficiary?

• • Our recommendation is to continue to use BENE_ID as the unique identifier in V1 and V2 of BCDA.

We'd like to collect some more information to understand how the data for this Medicare enrollee was returned across two different BENE_IDs, and to try to recommend the BENE_ID to use for this enrollee if possible. We'll reach out directly via email to securely gather those BENE_IDs and additional info to support the investigation.

Thanks,

The BCDA Team

[Samuel Wang]

Hi BCDA Team,

Thanks for the response! Just to follow up on the question about which identifier should we use, I would like to also get some guidance on which of the two BENE_IDs should we use so that it's consistent with the result of the consolidation within CCW when it happens?

Thanks,

Samuel

Samuel Wang ​​​​ Software Engineer II (647) 994‑5133 |  samue...@pearlhealth.com

This email address should not be used to communicate private, confidential or sensitive information, including, but not limited to, personal health information protected by the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, as amended and its implementing privacy, security and breach notification regulations ("Protected Information"). If you need to send a communication to the sender of this email or any Pearl Health personnel containing Protected Information, please send an email to he...@pearlhealth.com indicating your need, but not containing the Protected Information, so that you can be provided instructions respecting use of a secure channel.

[Beneficiary Claims Data API (BCDA) Community]

Hi Samuel,

Once our team completes the investigation, we'll follow up in our email conversation with Leo on the right BENE_ID to use in this specific instance. If there's more general guidance we can provide after the investigation, we'll share that information here in the Google Group.

Thanks,
The BCDA Team

[HDAI Development]

One more ask for the BCDA team as you work toward resolution/clarification of this issue...

The instances of this issue that my team has found tend to follow a pattern where we receive one MBI and BENE_ID for a beneficiary, then in subsequent data pulls, we receive a different MBI and BENE_ID for the same beneficiary, with no reference to the former MBI or BENE_ID. Given that MBIs in the Patient resource already contain a currency indicator, we ask that as part of resolving this issue, BCDA includes both new and old MBIs, with the appropriate currency indicator on each one (rather than only including the new MBI).

We can provide patient examples if it would be helpful, feel free to reach out.

Thanks,
HDAI Development team

[Leo Meira]

Hi BCDA Team,

Following up on the previous thread. In the scenario where we receive two different CCW identifiers for the same beneficiary, 

• which one should we use and consider as the active CCW identifier (the old CCW identifier or the new CCW identifier)?
• what is the impact of using just one CCW identifier for a beneficiary? Are we going to exclude some claim data because those claims are associated with only one CCW identifier?

Did the BCDA team perform any reconciliation/correction on BCDA's end to resolve this issue of a beneficiary having multiple CCW identifiers?

With appreciation,

Leo

Leo Meira​​​
Manager, Software Engineering

[Beneficiary Claims Data API (BCDA) Community]

Hi Leo & HDAI Development Team,

We've reached out to each of you over email to collect some additional information. Please let us know if you have not received an email from bc...@cms.hhs.gov.

Thanks,
The BCDA Team

[HDAI Development]

Hi BCDA team,

I had followed up a while ago in the private email thread about this but never heard back. Any updates on this issue?

Thanks!

--
You received this message because you are subscribed to a topic in the Google Groups "Beneficiary Claims Data API (BCDA) Community" group.
To unsubscribe from this topic, visit https://groups.google.com/d/topic/bc-api/B-SFHeV-1vs/unsubscribe.
To unsubscribe from this group and all its topics, send an email to bc-api+un...@googlegroups.com.
To view this discussion visit https://groups.google.com/d/msgid/bc-api/87438d0c-06c0-45e9-a0b8-e9a5f478b32cn%40googlegroups.com.

[Leo Meira]

Hi BCDA team,

Similar to HDAI Development, we followed up a while ago in the private email thread about this but never heard back.

With appreciation,

Leo

Leo Meira ​​​​ Manager, Software Engineering

(508) 816‑2938 |  leo....@pearlhealth.com

This email address should not be used to communicate private, confidential or sensitive information, including, but not limited to, personal health information protected by the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, as amended and its implementing privacy, security and breach notification regulations ("Protected Information"). If you need to send a communication to the sender of this email or any Pearl Health personnel containing Protected Information, please send an email to he...@pearlhealth.com indicating your need, but not containing the Protected Information, so that you can be provided instructions respecting use of a secure channel.

You received this message because you are subscribed to the Google Groups "Beneficiary Claims Data API (BCDA) Community" group.
To unsubscribe from this group and stop receiving emails from it, send an email to bc-api+un...@googlegroups.com.
To view this discussion visit https://groups.google.com/d/msgid/bc-api/CANUfSJS8X1T6SraEySNueHq2McOjaUmdeF9h4SRNq-ucjxvHng%40mail.gmail.com.

--

Leo Meira

Engineering Manager

508.816.2938 | leo....@pearlhealth.com | https://www.linkedin.com/in/leonardo-b-meira/

[Beneficiary Claims Data API (BCDA) Community]

Hi all,

Sorry for the delayed response, our team appreciates your patience and continued use of BCDA.

In general, we recommend using the "active" identifier - whichever ID is receiving claims. BCDA performs no reconciliation of BENE_IDs (though BCDA does suppress data when there is more than one BENE_ID for a given MBI). If you've seen any changes to the BENE_ID for a given claim in subsequent requests, those would have been made by an upstream data provider. Until the upstream data providers reconcile the IDs of a beneficiary, there could be claims tied to both IDs.

In BCDA v3, beneficiary identifiers will have an obsolete date that can tell you which one is active, but there's no such indicator available in BCDA v1 or v2.

Thank you,
The BCDA Team