NDC and Admission Type Codes coming to Partially Adjudicated Claims

[Beneficiary Claims Data API (BCDA) Community]

Hi BCDA Community!

We're excited to announce the upcoming addition of National Drug Codes (NDC) and Claim Admission Type Codes to BCDA's partially adjudicated claims.

Later this week, these new fields for partially adjudicated claims will be available to REACH ACOs via Claim resources.

National Drug Code

Available for both institutional (FISS) and professional (MCS) claims, this field will identify the NDC assigned to each medication. The NDC will be located at Claim.item[N].detail[N].productOrService.coding[N].code and an example is provided below:

Institutional (FISS) and Professional (MCS)

"item": [
    {
      "detail": [
        {
          "productOrService": {
            "coding": [
              {
                "system": "http://hl7.org/fhir/sid/ndc",
                "code": "00777310502"
              }
            ]
          }
        }
      ]
    }
  ]

Supporting info for National Drug Codes

BCDA will include quantity information associated with each NDC for both institutional (FISS) and professional (MCS) partially adjudicated claims located at Claim.item[N].detail[N].quantity. The unit of measure however, will only be available for institutional (FISS) claims. Examples for both institutional (FISS) and professional (MCS) claims are provided below:

Institutional (FISS)

"item": [
    {
      "detail": [
        {
          "quantity": {
            "value": 1,
            "unit": "ML",
            "system": "http://unitsofmeasure.org/",
            "code": "ML"
          }
        }
      ]
    }
  ]

Professional (MCS)

"item": [
    {
      "detail": [
        {
          "quantity": {
            "value": 1
          }
        }
      ]
    }
  ]

Claim Admission Type Code

Available for institutional (FISS) claims, this field will indicate the type and priority of inpatient services. As with adjudicated claims and EoB resources, the field will map directly to the CCLF1 File's CLM_ADMSN_TYPE _CD and is located at Claim.supportingInfo[N].coding[N].code. An example is provided below:

Institutional (FISS)

{
  "supportingInfo": [
    {
      "category": {
        "coding": [
          {
            "code": "info",
            "display": "Information",
            "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory"
          },
          {
            "code": "https://bluebutton.cms.gov/resources/variables/clm_ip_admsn_type_cd",
            "display": "Claim Inpatient Admission Type Code",
            "system": "https://bluebutton.cms.gov/resources/codesystem/information"
          }
        ]
      },
      "code": {
        "coding": [
          {
            "code": "3",
            "system": "https://bluebutton.cms.gov/resources/variables/clm_ip_admsn_type_cd"
          }
        ]
      }
    }
  ]
}

What's next?

In the coming weeks, we'll be updating both of BCDA's synthetic Partially Adjudicated Claims Datasets with examples of the new fields. We'll also be adding the new fields and their CCLF mappings to the Data Dictionary for the Partially Adjudicated Claims Data.

Please don't hesitate to reach out with any questions or feedback.

Thanks,

The BCDA Team

[Beneficiary Claims Data API (BCDA) Community]

Hi BCDA Community,

The National Drug Code (NDC) and Admission Type Code fields are now available in partially adjudicated claims data for REACH ACOs! See yesterday's announcement for more detail on these new fields.

What's next?

In the coming weeks, we'll be updating both of BCDA's synthetic Partially Adjudicated Claims datasets with examples of the new fields. We'll also be adding the new fields and their CCLF mappings to the Data Dictionary for the Partially Adjudicated Claims Data.

Please don't hesitate to reach out with any questions or feedback.

Thanks,

The BCDA Team

[Beneficiary Claims Data API (BCDA) Community]

Hi BCDA Community,

We've updated the synthetic Partially Adjudicated Claims datasets with examples of the National Drug Code (NDC) and Admission Type Code fields and added their CCLF mappings to the Partially Adjudicated Claims Data Dictionary. See May's announcement for more detail on these new fields.

You can find synthetic claims with these new fields populated for enrollees in both the Large and Small REACH ACOs in the BCDA sandbox. Synthetic claims with these fields will belong to enrollees with MBIs from this list.

Follow our guide to get started with the BCDA sandbox and access synthetic claims data.

Thanks,
The BCDA Team