Partially Adjudicated Claims - Inpatient Claims, ER Claims,

[Somaiya Shakil]

Hi, 

I am limiting the partially adjudicated claims to inpatient only by filtering on records where serv-typ-cd field is not missing or equal to 3. Is this approach appropriate? Additionally, what is the best way to get to ER claims? 

Thanks,

Somaiya

[Beneficiary Claims Data API (BCDA) Community]

Hi Somayia,

Thanks for the question!

Depending on the Location of Bill, the same value for a service type code may have different meanings. For example, on UB-04 claim forms, these two codes are concatenated and referred to as the Type of Bill. Please refer to the LOB-CD and SERV-TYP-CD tabs in BCDA's partially adjudicated claims data dictionary for more info on these two codes.

You can identify claims specifically related to Emergency Room services by the revenue center code (Claim.item[N].revenue.coding[N].code). Per ResDAC, the codes for Emergency Room services are 0450-0459 (Emergency room) or 0981 (Professional fees-Emergency room). You may also be interested in the Admission Type Code which indicates the priority of the inpatient services rendered. A value of 1 indicates "Emergency".

Hope this is helpful, and please let us know if you have any further questions.
The BCDA Team

[Somaiya Shakil]

Thank you for the response. 

On inpatient claims, does "claims" include patient discharge reason? I am not seeing it mentioned in the BCDA partially adjudicated data dictionary. 

[Beneficiary Claims Data API (BCDA) Community]

Hi Somayia,

At this time, our Claim resource does not include patient discharge information, though it is available in the EOB resource (as adjudicated data only). While it is not currently part of our partially adjudicated claims data, we welcome insight into how this field could better serve your organization's goals.

The BCDA Team

[Somaiya Shakil]

Thanks for the response. Our organization is using partially adjudicated data to review inpatient and ER claims where having information on the admissions and discharges are useful.

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