Duplicate Records

[Somaiya Shakil]

Hi,

I am working with the partially adjudicated claims and I am finding instances of records that are seemingly the same (mbi, service dates, provider, facility, diagnosis, etc.) but have differences in fields like ICN/DCN, frequency codes, billing amounts. I also see that dates are changing for https://bluebutton.cms.gov/resources/variables/fiss/recd-dt-cymd/ and https://bluebutton.cms.gov/resources/variables/fiss/curr-tran-dt-cymd/, which explain that something changed on these records. 

At this time, our ACO is looking at partially adjudicated claims for institutional claims. We want to make sure we don't overcount these records. Our approach for removing duplicates is to narrow down by  mbi, service dates, oscar number, primary diagnosis. This seems to be working at this time but I'd like to see if the BCDA group has a different suggestion.

Thanks,

Somaiya

[Beneficiary Claims Data API (BCDA) Community]

Hi Somaiya, 

Thanks for your question about duplicate claims. In some cases, this is the expected behavior for partially adjudicated claims as you will receive each update to a given claim, but we would expect changes in fields other than the ICN/DCN. 
In support of our investigation, please share the following:

1. The 5 character Entity ID for the organizations where you are seeing this behavior.
2. The last time a successful job was completed for your respective entity(ies).
3. Whether this is happening for both the Claim and ClaimResponse resources.

Feel free to add additional key details, and be sure not to include PII or other sensitive information.

In the meantime, we will look into the expected behavior for claim updates.

Thank you,

The BCDA Team

[Somaiya Shakil]

 

1. Our ACO ID is D0315.
2. The last pull we did was on 11/25/2025.
3. As mentioned previously, I am seeing that there are differences in several fields including date fields from the claim response data. I’m hoping to confirm that the approach of  using mbi, service dates, Oscar number and primary diagnosis is reasonable to narrow down to the most recent records for inpatient and ER claims or if I should consider any modifications. Appreciate any suggestions you can provide.

 

 

Hi Somaiya, 

Thank you,

The BCDA Team

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[Beneficiary Claims Data API (BCDA) Community]

Hi Somaiya,

Please use the Document Control Number (DCN) to uniquely identify a partially adjudicated institutional claim as it moves through the adjudication process. The claims sharing MBIs, service dates, and other fields you listed may be several related claims such as multiple claims covering those created to cover different services during the same episode of care (for example, anesthesia before a surgical procedure).

Similarly, the Internal Control Number (ICN) uniquely identifies a partially adjudicated professional claim.

Hope this helps!
The BCDA Team

[Somaiya Shakil]

Good morning,

 

I am seeing instances where even values for procedure codes, revenue codes, number of lines are identical but the control number different. Please let me know where to send examples.

 

Best,

Somaiya

To view this discussion visit https://groups.google.com/d/msgid/bc-api/50a2c347-eaca-4381-aa21-8f8db882f1bbn%40googlegroups.com.

 

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[Beneficiary Claims Data API (BCDA) Community]

Hi Somaiya,

We have reached out to via email to collect more information in support of our investigation.

Please let us know if you have not received the email.

Thanks,
The BCDA Team

[Somaiya Shakil]

Hello,

 

I see the email from CMS BCAPI with instructions on how to share examples of the duplicate records from the Claim/ClaimResponse resources. However, the email also says to use the box folder to share only EOB resources. Is it okay to post the Claim/ClaimResponse records to this box folder?

 

Thanks,

To view this discussion visit https://groups.google.com/d/msgid/bc-api/808d9151-8502-495d-8966-a719b6367b24n%40googlegroups.com.

 

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[Beneficiary Claims Data API (BCDA) Community]

Hi Somaiya,

Yes, please use the secure link you received via email from bc...@cms.hhs.gov to upload the affected Claim and ClaimResponse resources. Sorry for the confusion!

Thanks,
The BCDA Team

[Somaiya Shakil]

Please advice which of these locations to upload the duplicate examples to -

 

 

From: Beneficiary Claims Data API (BCDA) Community <bc-...@googlegroups.com>
Sent: Thursday, January 2, 2025 4:38 PM
To: Beneficiary Claims Data API (BCDA) Community <bc-...@googlegroups.com>
Subject: Re: [BCDA] Re: Duplicate Records

 

Hi Somaiya,

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[Beneficiary Claims Data API (BCDA) Community]

Hi Somaiya,

We have reached out to you via email to provide more detailed information on how to access Box. Please let us know if you have not received an email from bc...@cms.hhs.gov.

Thanks,
The BCDA Team