Weekly pulls

[Lightbeam Development]

Hello,

We are setup to pull BCDA data every week.  Each time, we use the last time we ran as the _since parameter.  From your website, it says " The API will then produce claims data from the bulk data endpoints that have been loaded since the entered date."  Is there a chance of missing data with this approach?  Do we need to add a lookback from the since date to ensure we don't miss any data?  I hope I am explaining this well enough.

Thank you,

LB Dev

[Lightbeam Development]

To follow up on this, if a claim changes, does the since parameter work off of some internal modify timestamp?  We are trying to avoid pulling more data from the api than we need, but using the since parameter seems to be missing data for us.  Any guidance would be appreciated!

[Jack Shoemaker]

Dear LB Dev,

It is disturbing to read that the SINCE parameter does not result in mutually exclusive and non-overlapping sets of data that when combined result in a comprehensive data set - no missing data. We run the BCDA daily for the Claim and ClaimResponse data types. Our assumption is that we don't miss any claims. The report in this email makes me wonder. We await response from the ACO REACH team.

• Jack

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Jack N Shoemaker / (336) 202-2165

 

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From: bc-...@googlegroups.com <bc-...@googlegroups.com> on behalf of Lightbeam Development <lightbeamd...@gmail.com>
Sent: Thursday, June 26, 2025 09:44
To: Beneficiary Claims Data API (BCDA) Community <bc-...@googlegroups.com>
Subject: [BCDA] Re: Weekly pulls

 

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[Beneficiary Claims Data API (BCDA) Community]

Hi LB Dev,

Sorry to hear of the trouble using the _since parameter. Please share a bit more information to help us investigate:

1. What type of data do you suspect may be missing from BCDA's responses?
2. Are your job requests made with the /Group/all or /Patient endpoint?

In general, we recommend supplying the transactionTime of your last job request as the value for the _since parameter. The _since parameter follows the Bulk Data Access IG, and BCDA will filter resources based on their lastUpdated date and the date supplied to _since.

We've noted this in the Requesting Filtered Data section of the BCDA website, but please let us know if you have further questions or suggestions on how we can improve the documentation.

Thank you,
The BCDA Team

[Lightbeam Development]

Our working theory now is that we may be missing data because BCDA only provides claims data for members that were aligned to your ACO at the time of the data pull.  So if I do a new backload pull today for all data, it would not include claims for inactive members.  Is this assumption correct?

Thanks!

On Thursday, June 26, 2025 at 10:56:37 AM UTC-4 jshoemaker wrote:

[Beneficiary Claims Data API (BCDA) Community]

Hi LB Dev,

That's correct - when making requests using the /Group/all or /Patient endpoints, BCDA will return claims data for only the Medicare enrollees currently attributed to your model entity. You may also request runouts data for the enrollees attributed to your organization in the previous performance year using the /Group/runout endpoint. These claims will have a service date no later than December 31, 2024.

You can learn more about requesting runouts data from the BCDA website. Please don't hesitate to reach out with any questions.

Thank you,
The BCDA Team

[Lightbeam Development]

Is there a way to continue this via email?  We are missing data for some patients, and I can't figure out why.  I have a few questions about how the api works and the differences in data between Group and Patient, for example.

Thanks again!

[Lightbeam Development]

From what I have learned so far, the Patient json that is returned (by either Patient or Group endpoint) includes only the currently active members of your ACO.  Since you need this patient file to link to the corresponding EOB json (BENE_MBI_ID to FHIR), there is no way to get older claims for a patient who leaves the ACO?  For example, if I do monthly pulls and a patient has a claim this month but then drops out of the ACO, depending on when I pull, I may miss this months claim and won't ever be able to query that data again.  Am I misunderstanding a large workflow miss here?  From what I have tracked down with our missing patients, 3 out of 4 of them are no longer in this ACO.  We are seeing claims for them from cms claims files, but I cannot pull these via the bcda api.  Is there anyone else out there having similar issues?  Is there another flag I am missing here?

Thanks for any help,

LB