BCDA_v3: Item-Level Section Missing in EOB Resource for Few Claims

[Ashvani goyal]

Hi BCDA Team,

We have observed an issue in BCDA_v3 where the item-level section is not available for a few claims in the EOB resource.

Could you please confirm whether this is expected behavior in BCDA_v3? If yes, could you clarify the scenarios in which the item-level section may not be present?

Thanks,
Ashvani Goyal

[Beneficiary Claims Data API (BCDA) Community]

Hi Ashvani,

Thanks for the question about EOBs without item-level details. There are some known cases where claims may not have claim line details:

1. Hospice elections - EOBs with clm_type_cd 1900 or 2900 represent hospice elections and do not contain item-level details.
2. Partially adjudicated - Some claims early in the the adjudication process may be missing details as they undergo processing and payment by CMS. This can be expected of some EOB resources where ExplanationOfBenefit.outcome=partial.

Please let us know if claim line (item-level) details are absent from any EOB resources which are not covered by the two cases above.

Thanks,

The BCDA Team