Temporary service disruption to partially adjudicated claims data
Beneficiary Claims Data API (BCDA) Community
Effectively immediately, we are temporarily disabling production access to partially adjudicated claims data in BCDA to perform unplanned maintenance on the API. We are working to restore service to BCDA and will update the Google Group with more information.
This issue is limited to /Group and /Patient requests for the Claim and ClaimResponse resources. There is no impact to requests for the EoB, Patient, or Coverage resources.
We apologize for any disruption this may have caused. Please don't hesitate to reach out to our team here or via email at bc...@cms.hhs.gov if you have any questions.
Thank you,
The BCDA Team
Beneficiary Claims Data API (BCDA) Community
Maintenance is ongoing and the Claim and ClaimResponse resources remain disabled. At this time, we recommend any requests you make for fully adjudicated data use the _type parameter to exclude Claim and ClaimResponse resources as follows:
GET /api/v2/Group/all/$export?_type=ExplanationOfBenefit,Patient,Coverage
As a reminder, this issue is limited to REACH ACOs making /Group and /Patient requests for the Claim and ClaimResponse resources. There is no impact to requests for the EoB, Patient, or Coverage resources or to entities in the Medicare Shared Savings Program or Kidney Care Choices Model. We apologize for any disruption this may have caused. Please don't hesitate to reach out to our team here or via email at bc...@cms.hhs.gov if you have any questions.
Thank you,
The BCDA Team
Beneficiary Claims Data API (BCDA) Community
Maintenance is ongoing and the Claim and ClaimResponse resources remain disabled. To improve error visibility during maintenance, all jobs explicitly requesting the Claim and ClaimResponse resources will now fail with a 400 response code. Job requests made by REACH ACOs that do not include the _type parameter will complete as usual, however the job results will omit the Claim and ClaimResponse resources.
As a reminder, this issue is limited to REACH ACOs making /Group and /Patient requests for the Claim and ClaimResponse resources. There is no impact to requests for the EoB, Patient, or Coverage resources or to entities in the Medicare Shared Savings Program or Kidney Care Choices Model. We apologize for any disruption this may have caused. Please don't hesitate to reach out to our team here or via email at bc...@cms.hhs.gov if you have any questions.
Thank you,
The BCDA Team
Avinash Kumar
Do you know if it's ready to pull for partially adjudicated claims data? Do you have an estimated timeline for services to be online?
Beneficiary Claims Data API (BCDA) Community
Hi Avinash,
Thank you for reaching out. The partially adjudicated claims endpoints are still offline, and we will notify the group both when we have a definitive timeline for the maintenance and when service is fully restored.
We apologize for any disruption this may have caused; we know partially adjudicated claims support time-sensitive care management, and the issue resolution is top priority. Please continue to reach out to our team here or via email at bc...@cms.hhs.gov if you have any questions.
Thank you,
The BCDA Team
Beneficiary Claims Data API (BCDA) Community
Maintenance is ongoing and the Claim and ClaimResponse resources remain disabled. Our teams are working to restore service to these resources. On Monday 9/30, we will provide you all with our teams' next steps and a timeline for when access to the Claim and ClaimResponse resources will restored.
As a reminder, this issue is limited to REACH ACOs making /Group and /Patient requests for the Claim and ClaimResponse resources. There is no impact to requests for the EoB, Patient, or Coverage resources or to entities in the Medicare Shared Savings Program or Kidney Care Choices Model.
Thanks,
The BCDA Team
Beneficiary Claims Data API (BCDA) Community
Hi REACH ACOs,
Our teams are performing some final checks on the fix to restore the Claim and ClaimResponse resources. At this time, we anticipate restoring access to partially adjudicated claims data later this week. We will continue to provide progress updates and notify you when the endpoints are available.
Thank you for your patience. As always, please don't hesitate to reach out to our team here or via email at bc...@cms.hhs.gov if you have any questions.
Thanks,
The BCDA Team
Beneficiary Claims Data API (BCDA) Community
We're glad to inform you that a fix is ready for our team to deploy which will restore access to the Claim and ClaimResponse resources. To ensure we can appropriately monitor the release process, we will roll-out the fix tomorrow morning.
Once access to the Claim and ClaimResponse resources is restored, REACH ACOs will no longer receive 400 Bad Request errors using the _type parameter with these resources and REACH ACOs' requests without the _type parameter will once again include the Claim and ClaimResponse resources.
We expect to have access fully restored tomorrow and will keep you up-to-date with the process. Additionally, we will share more information as to the root cause and impact of this service disruption.
Thanks for your patience!
The BCDA Team
Beneficiary Claims Data API (BCDA) Community
We're happy to inform you that the Claim and ClaimResponse resources are once again available. REACH ACOs should now be able to request Claim and ClaimResponse data as usual. Please reach out if there are any issues.
As you know, BCDA suppresses all substance abuse disorder (SUD)-related diagnosis codes in accordance with SAMHSA privacy guidance. We identified an issue with the way claims including those diagnosis codes were filtered while investigating missing data. During the service outage, our teams updated the filters to ensure all, and only, SUD-related data is suppressed. We are still analyzing the impact of the issue, and will provide a detailed update on the changes you may see in your partially adjudicated data when it is complete.
Thank you,
The BCDA team
Beneficiary Claims Data API (BCDA) Community
Hi BCDA Community,
We have completed our review of the impact of the recent SAMHSA filtering errors. These issues pertained only to REACH ACOs requesting partially adjudicated claims data.
Context: BCDA suppresses all substance abuse disorder (SUD)-related diagnosis codes in accordance with SAMHSA privacy guidance per the list of codes in Appendix A of the CCLF Information Packet. During the service outage earlier this month, our teams updated the filters to ensure all, and only, SUD-related data is suppressed.
To summarize the issues with the way partially adjudicated claims including those diagnosis codes were filtered:
- On 9/19, we identified an issue causing some partially adjudicated data to be incorrectly labeled as SAMHSA-related and thus suppressed. Some of you have reported unusually low numbers of institutional partially adjudicated claims compared to professional, and we believe this to be the cause. The excess filtering applied to any institutional claims with a HCPCS code.
- On 9/23, while addressing the under-share, we identified a separate issue with the SUD filter where certain kinds of SUD diagnosis codes were not being correctly filtered out. Each ACO to whom an impacted enrollee was attributed at any time between May 2023 and September 2024 has been notified. As a reminder, as most claims are adjudicated within a month or two of the care event, BCDA does not recommend storing PAC data long-term.
- The 10/5 claims data upload delay was an unrelated upstream issue which has also been resolved.
Going forward, you are likely to see a higher number of institutional PAC claims. Roughly, under 2 percent of enrollees attributed to REACH ACOs in production had an SUD claim at any point from May 2023-September 2024 and those enrollees' non-SUD claims are not suppressed; this fix is not likely to have a noticeable impact on your overall number of claims.
Thank you for your patience, and please continue to reach out if you have any questions.
The BCDA team