BCDA V3 – Clarification on Changes in Claim Line Items and HCPCS Code

[Ashvani goyal]

Hi BCDA Team,

We identified a discrepancy in the claim data received through BCDA V3 and would like to clarify the expected behavior.

For a few claims, when comparing the initial and subsequent datasets, we observed the following:

• In the initial dataset, the same claim contained 9 line items.
• In the subsequent dataset, the same claim contained only 3 line items.
• For one of the line items that was present in both datasets, the HCPCS code was different in the subsequent dataset.
• We are fine with the claim outcome being reported as Complete. Our concern is specifically regarding the changes in the number of line items and line-level data between the datasets.

Could you please confirm whether this type of change is expected in BCDA V3 as a claim progresses through processing/adjudication?

If this is expected, we would appreciate your guidance on how we should handle such claims in our downstream process:

1. Should we replace the entire existing claim, including all line items, with the latest version received?
2. Or should we update only the line items that are present or have changed in the latest dataset?
3. If line items that were present in the earlier dataset are not included in the subsequent dataset, should we remove those line items or retain them from the earlier version?
4. When line-level information such as the HCPCS code changes, should the latest dataset be considered the authoritative version?

We can provide sample claims with the corresponding data from both datasets for your review.

Please let us know if you would like us to share the samples through the appropriate channel.

Thanks,
Ashvani

[Beneficiary Claims Data API (BCDA) Community]

Hi Ashvani,

Sorry for our delayed follow-up regarding the discrepancies you've seen in Claim Line Items and HCPCS codes. We've reached out via email to collect more information about these claims. Please let us know if you don't receive an email from bc...@cms.hhs.gov

Thank you!

The BCDA Team

[Ashvani goyal]

Hi BCDA team,

Thank you for your response.

We have uploaded requested claim information on secure box folder.

Please let us know if you need any additional information .

Thanks,
Ashvani Goyal