BCDA Notice: Temporary changes in the transition from 2022 to 2023

[Beneficiary Claims Data API (BCDA) Community]

Hello BCDA community!

BCDA is posting this guidance about temporary changes to the production API that will affect your use of BCDA between December 2022 and January 2023. 

• Between December and January, continuing model entities go through an update in Medicare enrollee assignments as part of the transition between performance years. New model entities are also introduced for the new performance year. CMS must ensure that BCDA returns appropriate claims data despite an expected delay in receiving the updated Performance Year (PY) 2023 Medicare enrollee lists in January.
• To receive claims for assigned Medicare enrollees from PY 2022, BCDA offers the use of an identifier in the /Group endpoint, called `runout`, which will only return claims with a service date before December 31, 2022. After BCDA receives PY 2023 enrollee lists, this same `runout` identifier will continue to be available for model entities to receive runout claims from PY 2022. 

In January 2023 (before BCDA receives the PY 2023 Medicare enrollee lists):

• To request any claims, model entities will need to use the runout identifier with the /Group endpoint. When using the runout identifier, data returned by the API will be restricted to claims with a service date of 12/31/2022 or earlier.
• Requests to the /Group and /Patient endpoints without the runout identifier will result in an error message for the error type "400 Bad Request."
  • The error message: "This resource is disabled until January 2023 attribution data is available. We expect this endpoint to be re-enabled no later than the end of January 2023. In the meantime, please use /Group/runout/$export which caps the claims data at 2022-12-31."

Between January and April 2023 (after BCDA receives the PY 2023 Medicare enrollee lists):

• Requests to the /Group and /Patient endpoints can again use the all identifier, as normal, and will return claims with a service date in 2023 for PY 2023 Medicare enrollees.
• To request runouts data, model entities can also make a call using the runout identifier with the /Group endpoint for PY 2022 Medicare enrollees. When using the runout identifier, data returned by the API will be restricted to claims with a service date of 12/31/2022 or earlier.

Frequently Asked Questions from previous years: 

1. How do I request all patient and coverage data?
   • All participants in the Medicare Shared Savings Program, Global and Professional Direct Contracting (to be the ACO REACH Model in 2023), and Kidney Care Choices models will be able to resume normal operations when making requests to the /Patient and /Group endpoints using the `all` identifier to retrieve claims, patient, and coverage data. This is dependent on the availability of the  Medicare enrollee lists from the PY 2023 Claim and Claim Line Feed (CCLF) files.
   • In order to request data for PY 2023, please use 'all' identifiers if this is your initial data request with BCDA, as this data will not have any service date restrictions. More guidance on requesting all resources types can be found on our website here: https://bcda.cms.gov/build.html#requesting-all-three. After your initial data request, you may use the '_since' parameter in order to filter data to updates since your last request. More guidance on how to filter data can be found on our website here: https://bcda.cms.gov/build.html#requesting-filtered-data. 
   • In order to request "runout" data from PY 2022, you must separately use the 'runout' parameter with the /Group endpoint, which returns data for Medicare enrollees who were attributed to your organization in PY 2022 but not PY 2023. These claims will have a service date no later than December 31, 2022. You may use the '_since' and 'runout' parameters in conjunction in order to limit runout data to updates since your last runout request.
2. When will these changes end?
   • We expect these changes to be in effect until BCDA retrieves the January 2023 attribution file from CMS. This should be no later than January 31, 2023. After this time, requests to /Patient and /Group using `all` will return to their normal state of operation. In addition, you can continue to use /Group with `runout` to retrieve your PY 2022 runouts data. BCDA will update the Google Group when you can begin using `all` again.
3. Will we be notified once the January 2023 attribution is completed?
   • Our team will update this BCDA Google Group when the typical functionality of the /Group and /Patient endpoints are available again. Until then, your requests to /Patient or /Group without the runout identifier will fail and they will return an unavailable (400 Bad Request) message.
4. What are some example requests and outcomes from using BCDA in January 2023? 
   • Caller makes request for Patient or Group all endpoint
   1. 1. GET /api/v2/Patient/$export
      2. GET /api/v2/Group/all/$export
   • Caller receives 400 Bad Request response.
     1. An operational outcome is returned to redirect users to use /api/v2/Group/runout/$export endpoint
   • Caller makes request to Group runout endpoint.
     1. GET /api/v2/Group/runout/$export
   • Caller receives 202 Accepted response.
     1. Content-Location header sent with the job location.
     2. Content-Location: /api/v2/jobs/2
   • Caller polls job endpoint waiting for job to complete.
     1. GET /api/v2/jobs/2
   • Caller downloads job data
   1. 1. GET /data/2/output.json
      2. All claims data will be capped to 2022-12-31.

The BCDA Team

[Beneficiary Claims Data API (BCDA) Community]

Hello BCDA Community,  

We are sharing a reminder about the temporary changes to BCDA that will affect your usage between December 2022 and January 2023.

Starting on January 1, 2023, please follow this guidance for accessing data through BCDA: 

• To request any claims, model entities will need to use the runout identifier with the /Group endpoint. When using the runout identifier, data returned by the API will be restricted to claims with a service date of 12/31/2022 or earlier. 
• Requests to the /Group and /Patient endpoints without the runout identifier will result in an error message for the error type "400 Bad Request".
  • The error message: "This resource is disabled until January 2023 attribution data is available. We expect this endpoint to be re-enabled no later than the end of January 2023. In the meantime, please use /Group/runout/$export which caps the claims data at 2022-12-31." 

Our upstream data partner’s last updated data load will be processed this weekend (12/31/22-1/1/23) and will be available to users on Tuesday, January 2, 2023. After this date, BCDA will be available to users, but the API will not receive updated or new data from its upstream data source for approximately 2-4 weeks.

The BCDA API aims to receive Performance Year (PY) 2023 Medicare enrollee lists by January 19, 2023. Once these PY 2023 enrollments are processed, BCDA functionality will resume according to the following guidance: 

• Requests to the /Group and /Patient endpoints can again use the "all" identifier and will return claims with a service date up to 2023 for PY 2023 Medicare enrollees.
• To request runout data, model entities can also make a call using the runout identifier with the /Group endpoint for PY 2022 Medicare enrollees. When using the runout identifier, data returned by the API will be restricted to claims with a service date of 12/31/2022 or earlier. 
• Once our upstream data partner has processed the enrollments and data updates are available again, we will share more information on new and enhanced data fields available in 2023. The updates will be related to the following: 
  • Data element additions:
    • Claim Query Code to HHA and HOSPICE Claim Types 
    • Carrier Claim Billing NPI Number 
    • Coverage Start/End Dates for Parts A, B and D 
  • Data updates: 
    • Diagnostic Related Group (DRG) Code will expand from 3 characters to 4 characters 

Please read the full guidance in our initial post on December 15, 2022, titled "BCDA Notice: Temporary changes in the transition from 2022 to 2023." Feel free to email us or post a message in our BCDA Google Group with any questions or concerns. 

We wish you a happy new year!

The BCDA Team

bc...@cms.hhs.gov 

[Raghavprasanna Rajagopalan]

Hi team,

Wanted to confirm two things here:

- we currently use `/api/v2/Patient/$export` in our pipelines. Are we able to swap out the URL to `/api/v2/Group/runout/$export` with no other changes to how we poll job status and pull NDJSON data?

- at the end of January, when the usual endpoint becomes available, will the initial request (without _since parameter) return data starting from 01/01/23 or do we have to set the _since to 01/01/23? (the recommendation "please use 'all' identifiers if this is your initial data request with BCDA, as this data will not have any service date restrictions." seems to me to indicate that the Patient/$export will return only data beginning from 01/01/23, but wanted to confirm this, as we've already pulled all PY 2022 data and don't want to reimport that.)

Thank you!

Best,

Raghav

Secured by Paubox - HITRUST CSF certified

[Beneficiary Claims Data API (BCDA) Community]

Hi Raghav,

Thank you for reaching out and sharing this question with the community.

BCDA pulls the job status and NDJSON data in the same way, regardless of these temporary changes.

In addition, when use of the /Group and /Patient endpoints restarts, the _since parameter will need to be used to pull data starting from January 1, 2023.

Please feel free to reach out with any additional or more specific questions, if not already addressed.

Regards,

The BCDA Team

[Ron Gross]

Hi,

Do you have any new estimation for the restart of /group and /patient endpoints for 2023 data?

Thank you

[momin.shiraj440]

Hello BCDA Team,

Do you have any new estimation for the restart of /group and /patient endpoints for 2023 data?

{

    "resourceType": "OperationOutcome",

    "issue": [

        {

            "severity": "error",

            "code": "exception",

            "details": {

                "coding": [

                    {

                        "system": "http://hl7.org/fhir/ValueSet/operation-outcome",

                        "code": "Request Error",

                        "display": "This resource is disabled until January 2023 attribution data is available.  We expect this endpoint to be re-enabled no later than the end of January 2023. In the meantime, please use /Group/runout/$export which caps the claims data at 2022-12-31."

                    }

                ],

                "text": "This resource is disabled until January 2023 attribution data is available.  We expect this endpoint to be re-enabled no later than the end of January 2023. In the meantime, please use /Group/runout/$export which caps the claims data at 2022-12-31."

            }

        }

    ]

}

[Khrisendat Persaud]

Also writing here because I have the same concerns.

[Beneficiary Claims Data API (BCDA) Community]

Hi BCDA Community,

We know you are looking froward to accessing 2023 claims data! By tomorrow, February 15, 2022, we anticipate all participants in the Medicare Shared Savings Program, ACO REACH payment model, and Kidney Care Choices payment model will be able to resume normal operations when making requests to the /Patient and /Group endpoints using the 'all' identifier to retrieve claims, patient, and coverage data with production credentials. This is in conjunction with the availability of Claim and Claim Line Feed (CCLF) files with attribution data for Performance Year (PY) 2023 and receipt from our upstream data partners.

Additional reminders from our Year-end notice:

Current Status

Until tomorrow, February 15, 2022:

• To request any claims, users will need to use the runout identifier with the /Group endpoint.

• Requests to the /Group and /Patient endpoints without the runout identifier will result in an error message for the error type "400 Bad Request."
  • The error message: "This resource is disabled until January 2023 attribution data is available. We expect this endpoint to be re-enabled no later than the end of January 2023. In the meantime, please use /Group/runout/$export which caps the claims data at 2022-12-31."

• When using the runout identifier, data returned by the API will be restricted to claims with a service date of 12/31/2022 or earlier.

Starting tomorrow:

Starting February 15, 2022:

• Requests to the /Group and /Patient endpoints can again use the all identifier, as normal.
• In order to request data for PY 2023, please use 'all' identifiers if this is your initial data request with BCDA, as this data will not have any service date restrictions. More guidance on requesting all resource types can be found on our website in the Request All Three Resource Types section. After your initial data request, you may use the '_since' parameter in order to filter data to updates since your last request. More guidance on how to filter data can be found on our website in the Request Filtered Data section.
• In order to request "runout" data from PY 2022, you must separately use the 'runout' identifier with the /Group endpoint, which returns data for beneficiaries who were attributed to your organization in PY 2022 but not PY 2023. These claims will have a service date of December 31, 2022 or earlier. You may use the '_since' and 'runout' parameters in conjunction in order to limit runout data to updates since your last runout request.
  • The runouts identifier will be updated February, March, and April 2023. There won't be any new data added after April 2023 for beneficiaries who were attributed to your organization in PY 2022 but not PY 2023.

Additional information on new and enhanced data fields:

• Data element additions:
  • Claim Query Code to HHA and HOSPICE Claim Types - The Claim Query Code is defined as a code indicating the type of claim record being processed with respect to payment (debit/credit indicator; interim/final indicator).  This data element currently appears in the Explanation of Benefit (EOB) resource for Inpatient, Outpatient and SNF claim types.  As part of this release, the Claim Query Code will also be supplied in the EOB resource for Hospice and HHA claim types.  This data element appears as an extension in the EOB billablePeriod attribute.
  • Carrier Claim Billing NPI Number - The Carrier Claim Billing NPI Number is defined as the CMS National Provider Identifier (NPI) number assigned to the billing provider.  As part of this release, this data element will appear in the Explanation of Benefit (EOB) resource for Carrier claims.  This data element has been mapped into the EOB provider attribute.
  • Coverage Start and End Dates for Parts A, B, and D - Previously the start date (supplied in the Coverage resource in the period.start attribute) was the earliest start date across all of a Medicare user's coverages (e.g. the earliest start date across their A, B and D coverage).  As part of this release, the attribute now reflects the start date for each individual coverage type A, B and D.  The end date for each coverage type is now also supplied, in the period.end attribute.
• Data updates:
  • Diagnostic Related Group (DRG) Code will expand  from 3 characters to 4 characters - The length of the DRG code field in the source database has been increased from 3 characters to 4 characters.  The DRG code is supplied in Inpatient and SNF claim types, in the eob.diagnosis.packageCode attribute, 

Please read the full guidance in our initial post on December 15, 2022, titled "BCDA Notice: Temporary changes in the transition from 2022 to 2023." Feel free to email us or post a message in our BCDA Google Group with any questions or concerns. 

Best,

BCDA team