Bug report - EOB.payment.amount bug in small percentage of cases

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

Hi BCDA team,

We have detected the following data bug for CARRIER and DME ExplanationOfBenefit Resources. In a small (<0.1%) of EOB Resources,  the EOB.payment.amount value is incorrectly populating. Specifically, the behavior appears to be replicating just a single line item's payment amount, rather than the sum of all line items.

Providing an exact snippet from one production Resource below (ID redacted) to illustrate -- in this case total EOB.payment.amount.value is shown as 12.86 but should in fact be 1016.83. We have a csv of impacted Resource IDs as well if useful for you to investigate/debug to confirm on your end. Not sure how/why this is happening upstream, particularly since it's rare but ongoing (not limited to some past period, we have several happening each month it appears). Even at relatively limited incidence, this definitely impactful/worth fixing.

{

"resourceType": "ExpanationOfBenefit",

"id": XXXXXXXXXXXXXXXXXXXXXX,

"benefitBalance": [{

  "type": {

    "coding": [

      {

        "code": "https://bluebutton.cms.gov/resources/variables/nch_clm_prvdr_pmt_amt",

        "display": "NCH Claim Provider Payment Amount",

        "system": "https://bluebutton.cms.gov/resources/codesystem/benefit-balance"

      }

    ]

  },

  "usedMoney": {

    "currency": "USD",

    "value": 1016.83

  }

}],

"item": [

    {

      "productOrService": {

        "coding": [

          {

            "code": "J0897",

            "display": "Injection, denosumab, 1 mg",

            "system": "https://bluebutton.cms.gov/resources/codesystem/hcpcs"

          } ],

       },

      "adjudication": [       

        {

          "amount": {

            "currency": "USD",

            "value": 1003.97

          },

          "category": {

            "coding": [

              {

                "code": "paidtoprovider",

                "display": "Paid to provider",

                "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication"

              },

              {

                "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",

                "display": "Line Provider Payment Amount",

                "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication"

              }

            ]

          }

        }

      ]

    },

    {

      "productOrService": {

        "coding": [

          {

            "code": "96372",

            "display": "Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular",

            "system": "https://bluebutton.cms.gov/resources/codesystem/hcpcs"

          } ]

        },

        "adjudication": [

          {

            "amount": {

              "currency": "USD",

              "value": 12.86

            },

            "category": {

              "coding": [

                {

                  "code": "paidtoprovider",

                  "display": "Paid to provider",

                  "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication"

                },

                {

                  "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",

                  "display": "Line Provider Payment Amount",

                  "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication"

                }

              ]

            }

          }

        ]

    }

  ],

"payment": {

  "amount": {

    "currency": "USD",

    "value": 12.86

  }

}

}

Thank you as always for your hard work,

Jake

[Beneficiary Claims Data API (BCDA) Community]

Hi Jake,

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

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

Thanks,
The BCDA Team

[Jake Halpert]

Thank you so much, received/responded. 

[Jake Halpert]

Hi BCDA Team - hope you're having a successful end of the year. Know you're busy on many fronts, but have a reminder to check in on this bug RCA/fix to see if you've made progress on closing it out.

Thanks as always,

Jake

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[Beneficiary Claims Data API (BCDA) Community]

Hi Jake,

Thanks for sharing those claim IDs with us, and for reporting any unusual behavior you notice as always. We've completed the investigation with our upstream partners and confirmed that the data in these fields matches what the Chronic Conditions Data Warehouse (CCW) receives. No calculations or modifications to these values are being done by either of our teams. We could not find a consistent explanation for the occasional discrepancy, though more information on Fee-For-Service data files can be found here.

Thank you,
The BCDA Team

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

Interesting! So in fact the real ticket that needs to be raised is with the CCW management team upstream (not the BFD management team). Any idea how to relay this to the right people there for RCA and fix on that side?

Thank you as always for your diligence/collaboration,

Jake

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

Hi - don't want to lose sight of this since it does impact our users. Is there a way to open this with the CCW data quality team upstream of BFD? Would be good to make sure they are aware of this data issue.

Thank you as always,

Jake