Identifying SNF Admission Claims Data

[R Templin]

Does anyone have recommendations or solutions for identifying claims that indicate an admission to a Skilled Nursing Facility? 

We’re looking for patient information, admission dates, high-level diagnosis details, and SNF location, with data refreshed daily. Even if the information is lagged by a week, it would greatly support our care management team in identifying ACO patients in a SNF, managing their stay, and planning for a safe transition home.

[Beneficiary Claims Data API (BCDA) Community]

Hello,

You can identify claims at Skilled Nursing Facilities by looking at one of two values, the Location of Bill Code or the Place of Service Code.

For institutional claims, BCDA returns the Location of Bill code in the facility.extension[N].valueCoding.code element both in fully adjudicated claims (Explanation Of Benefit resources) and partially adjudicated claims (Claim resources).

For professional claims, BCDA returns the Place of Service code in the item[N].locationCodeableConcept.coding[N].code element in fully adjudicated claims only (EOB resources). Place of Service codes are not available on partially adjudicated claims (Claim resources) at this time.

For more details on these fields and values mapping to SNF claims, you can review the information in BCDA's data dictionary and the data dictionary for partially adjudicated claims.

Thanks,
The BCDA Team

[Jacob Dumbauld]

Good Afternoon!

I'm working this with the original poster. Thank you so much for your help - this was exactly what I needed. I do have a follow up question, but first some additional context. I am pulling the claim dataset from the /group endpoint in an effort to track SNF admissions in partially adjudicated claims as described above. My question is: Is it possible to identify the location that these claims so that we can see what SNF location is associated with the record?

We initially identified tax ID, provider type, and provider spec in some initial research, but I was unable to find any of these values in our dataset. Any advice on why this may be, or where else I should look to answer where this question?

Best,

Jake

[Beneficiary Claims Data API (BCDA) Community]

Hi Jake,

Thanks for the follow-up question. You can use the National Provider Identifier (NPI) provided in partially adjudicated claims data to lookup more information about the facilities using the NPPES NPI Registry search tool. If you need programmatic access to the information, you might consider using the NPPES API.

Only BCDA's fully adjudicated claims data include the fields you mentioned. The available data fields for partially adjudicated claims data (Claim and Claim Response resources) are listed in the data dictionary for partially adjudicated claims.

Hope this helps!
The BCDA Team