BCDA V3 – Alternative for EOB Type Classification

[Ashvani goyal]

Hello BCDA Team,

We are currently evaluating BCDA V3 Sandbox data and have a question regarding claim type identification for ExplanationOfBenefit (EOB) resources.

In BCDA V2, we used the following CodeSystem URL present in ExplanationOfBenefit.type.coding.system to determine the EOB claim type:

https://bluebutton.cms.gov/resources/codesystem/eob-type

Based on the corresponding codes (e.g., PDE, HHA, OUTPATIENT, DME, INPATIENT, etc.), we classified claims into different categories for downstream processing.

However, in the BCDA V3 Sandbox data, we are not seeing this CodeSystem URL in the EOB resources. As a result, we are unable to determine the claim category using our existing logic.

Could you please advise:

1. Has the eob-type CodeSystem been removed or replaced in BCDA V3?

2. Is there an alternative field, CodeSystem, extension, or mapping that should be used to identify claim types such as PDE, HHA, DME, OUTPATIENT, INPATIENT, etc.?

3. Are there any migration guidelines or examples available for customers who previously relied on the eob-type classification in BCDA V2?

Any guidance or documentation references would be greatly appreciated.

Thank you for your assistance.

Best Regards,
Ashvani Goyal
AaNeel Technology Solution Pvt.Ltd.

[Beneficiary Claims Data API (BCDA) Community]

Hi Ashvani,

Thanks for wading into BCDA v3 sandbox data and sharing your findings. We shared the feedback with our upstream data provider and they will add an EOB-type code system for you to achieve the same results.

Once those details have been finalized, we'll share them with you in this thread.

Thanks,
The BCDA Team

[Ashvani goyal]

Could you please let us know if there are any updates? If the work is still in progress, could you also share an estimated timeline for when this information will be available?

This is important for us to correctly classify claim types (such as PDE, HHA, Outpatient, DME, etc.) as part of our BCDA V3 implementation.

Thank you for your continued support. We look forward to your update.

Regards,
Ashvani Goyal

[Somaiya Shakil]

Hi Ashvani,

Have you explored using https://bluebutton.cms.gov/fhir/CodeSystem/CLM-TYPE-CD? The codes line up with the values you would get from using https://bluebutton.cms.gov/resources/codesystem/eob-type/.

Regards,

Somaiya

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Subject: [BCDA] Re: BCDA V3 – Alternative for EOB Type Classification

 

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