New Data Fields Added to BCDA payloads

[Jimmy McConnell]

The Beneficiary Claims Data API (BCDA) is excited to announce that we will be achieving data parity* with Claim and Claim Line Feed (CCLF) files that you are used to receiving from CMS. Until now, we have been unable to offer about 15 fields that were available in CCLF files, but our upstream data source, the Beneficiary FHIR Data Server (BFD) has successfully mapped these missing fields to BCDA’s payloads. In addition to the information on these newly added fields below, the BCDA Data Dictionary will also be updated in the coming week with the new FHIR mapping information. Please reference the BCDA Data Dictionary for more information. 

*Note: IDR Load Date Field will not be mapped. This field is generated from a different upstream data warehouse than the one where BCDA sources its claims data. 

Data Updates

BCDA is adding support for 16 new data elements. As part of this change, 1 data element will also be removed as it has become out of sync with the source of our address-related data. 

Removed Data Element 

We will no longer be mapping or sending the Beneficiary County Code field. Please ensure your applications are updated accordingly.

• Beneficiary County Code: 
  • CCW Field Name: BENE_COUNTY_CD

• FHIR element location: Patient.address.district

New Data Elements Available

• Claim Health Insurance Prospective Payment System Uncompensated Care Amount: 
  • CCW Field Name: CLM_UNCOMPD_CARE_PMT_AMT
  • FHIR element location: ExplanationOfBenefit.extension
  • Description: This field identifies the payment for disproportionate share hospitals (DSH). It represents the uncompensated care amount of the payment.
    Comments: This field applies only to inpatient claims.
• Previous Identifier Effective Date: 
  • CCW Field Name: EFCTV_BGN_DT
  • FHIR element Name: ExplanationOfBenefit..period.start
  • Description: Previous Identifier Effective Date
• Previous Identifier Obsolete Date: 
  • CCW Field Name: EFCTV_END_DT 
  • FHIR element Name: ExplanationOfBenefit.period.end
  • Description: Previous Identifier Obsolete Date
• Part B Carrier Claim Control Number: 
  • CCW Field Name: CARR_CLM_CNTL_NUM
  • FHIR element Name: ExplanationOfBenefit.extension
  • Description: The claim control number is an identifier assigned by the processing system (i.e., the Encounter Data System Contractor) to a claim.
    This is the field that, in combination with the original claim control number, identifies a unique version of a service record.

• FI Document Claim Control Number: 

• CCW Field Name: FI_DOC_CLM_CNTL_NUM
• FHIR element Name: ExplanationOfBenefit.extension
• Description: The historical final action algorithm used the original document control number (FI_ORIG_CLM_CNTL_NUM); the
  updated algorithm uses the current document control number (FI_DOC_CLM_CNTL_NUM) – and employs all 23
  characters of the value rather than just the first 15 characters. The updated algorithm also considers the claim
  accretion date (CWF_CLM_ACRTN_DT) when determining the sequence in which claims were processed.

• FI Original Claim Control Number: 
  • CCW Field Name: FI_ORIG_CLM_CNTL_NUM
  • FHIR element Name: ExplanationOfBenefit.extension
  • Description: The historical final action algorithm used the original document control number (FI_ORIG_CLM_CNTL_NUM); the
    updated algorithm uses the current document control number (FI_DOC_CLM_CNTL_NUM) – and employs all 23
    characters of the value rather than just the first 15 characters. The updated algorithm also considers the claim
    accretion date (CWF_CLM_ACRTN_DT) when determining the sequence in which claims were processed.

• Beneficiary Death Date: 
  • CCW Field Name: BENE_DEATH_DT
  • FHIR element Name: Patient.deceased[N]
  • Description: Indicates the date of death of the beneficiary.
• Claim Effective Date: 
  • CCW Field Name: NCH_WKLY_PROC_DT
  • FHIR element Name: ExplanationOfBenefit.supportinginfo.timingDate   
  • Slice: claimrecvddate
  • Description: The date the weekly NCH database load process cycle begins, during which the claim records are loaded into the Nearline file. This date 
    will always be a Friday, although the claims will actually be appended to the database subsequent to the date.

• Claim Line Institutional Revenue Center Date: 
  • CCW Field Name: REV_CNTR_DT
  • FHIR element Name: ExplanationOfBenefit.item.servicedate
  • Description: This is the date of service for the revenue center record. However, it is populated only for home health claims, hospice claims, and Part B 
    institutional (HOP) claims. For home health claims, which are paid based on episodes that can last up to 60 days, this variable indicates 
    the dates for the individual visits.

• Claim Operational Indirect Medical Education Amount: 
  • CCW Field Name: IME_OP_CLM_VAL_AMT
  • FHIR element Name:  ExplanationOfBenefit.extension
  • Description: This is one component of the total amount that is payable on PPS claims, and reflects the IME (indirect medical education) payments for
    operating expenses (such as labor) for the claim. There are two types of IME amounts that may be payable for many PPS claims; the other type of IME payment is for the IME capital amount (variable called CLM_PPS_CPTL_IME_AMT). Both operating and capital IME 
    payments are components of the PPS, as well as numerous other factors.

• Claim Operational Disproportionate Amount: 
  • CCW Field Name: DSH_OP_CLM_VAL_AMT
  • FHIR element Name:  ExplanationOfBenefit.extension
  • Description: This is one component of the total amount that is payable on PPS claims, and reflects the DSH (disproportionate share hospital) payments for operating expenses (such as labor) for the claim. There are two types of DSH amounts that may be payable for many PPS claims; the 
    other type of DSH payment is for the DSH capital amount (variable called CLM_PPS_CPTL_DSPRPRTNT_SHR_AMT). Both operating and capital DSH payments are components of the PPS, as well as numerous other factors.

• Date Beneficiary Enrolled in Hospice: 
  • CCW Field Name: CLM_HOSPC_START_DT_ID 
  • FHIR Element: ExplanationOfBenefit.supportinginfo.timing.period  
  • Slice: admissionperiod
  • Description: For Home Health prospective payment system (PPS) claims, the 'from' date and the 'thru' date on the RAP (Request for Anticipated
    Payment) initial claim must always match. The "from" date on the claim may not always represent the first date of services, particularly for Home Health or Hospice care. To obtain the date corresponding with the onset of services (or admission date) use the admission date from the claim (variable called CLM_ADMSN_DT for IP, SNF and HH - and variable called CLM_HOSPC_START_DT_ID for HOS claims).

• Date Beneficiary Ended Hospice: 
  • CCW Field Name: NCH_BENE_DSCHRG_DT
  • FHIR element Name: ExplanationOfBenefit.supportinginfo.timing.period  
  • Slice: admissionperiod
  • Description: The last day on the billing statement covering services rendered to the beneficiary (a.k.a 'Statement Covers Thru Date').
• Beneficiary Derived Mailing Address Fields: 
  • CCW Field Name: DRVD_LINE_[N]_ADR
  • FHIR element Name: Patient.address[N]  
  • Description: Beneficiary’s street address.

• Claim Provider Tax Number: 
  • CCW Field Name: TAX_NUM
  • FHIR element Location: ExplanationOfBenefit.CareTeam.provider  
  • Description: The SSN or Employee Identification Number (EIN) of the provider of the indicated service. This number identifies who receives payment for the indicated service. 

As always, we welcome your feedback in response to this change. You can share your experience by posting a message in our Google Group.

[Stephanie Sydorko]

Hi BCDA Team,

We are looking for hospice begin and end dates in our data based on the mappings above, but have not been able to find any in our EOBs. We have patients in our April CCLF 8 files with bene_rng_bgn_dt and bene_rng_end_dt set, so there are recent hospice patients for the ACO. Could someone verify the mapping ExplanationOfBenefit.supportinginfo.timing.period? We haven't seen any instances of supportinginfo, supportingInfo or supporting_info in our EOBs. 

Thank you for your help!

Stephanie

[adam.s...@ltcaco.com]

Is there any updated on this?  We are experiencing the same.

Thanks,

Adam

[adam.s...@ltcaco.com]

Is there any updated on this?  We are experiencing the same.

Thanks,

Adam

On Wednesday, May 12, 2021 at 6:35:39 PM UTC-4 Stephanie Sydorko wrote:

[Beneficiary Claims Data API (BCDA) Community]

Hello,

The previous version of the data dictionary (DD) was incorrect. The correct mapping for BENE_RNG_BGN_DT and _END_DT is "ExplanationOfBenefit.information.timing.period.start" and ".period.end", respectively. This has been corrected in the latest version of the DD, which can be found here.  

Best,
The BCDA Team

[Jake Halpert]

Dear BCDA Team -

Is the CLM_UNCOMPD_CARE_PMT_AMT variable still supposed to be in BCDA production data for INPATIENT EOBs ? I'm fairly certain it's not being delivered, so maybe there's been a regression on the BFD side if it was executing properly previously. It is not appearing within the extensions any INPATIENT EOB Resources we've retrieved via BCDA this year.

Thanks as always,

Jake

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[jacob.b...@gmail.com]

I think I found the discrepancy. This field appears to be returned only by v1 (STU3) of the API, but not v2. Is this what you are finding as well — and if so, are you able to fix in near term by adding to v2 (R4)?