BCDA v3 – Clarification on Missing Members (BENE_MBI_ID) Compared to BCDA v2

[Ashvani goyal]

Hi BCDA Team,

We are currently validating the member data received through BCDA v3 against the corresponding data from BCDA v2 and identified a discrepancy in the member population.

We found that some BENE_MBI_IDs available in BCDA v2 are not present in the BCDA v3 Patient data for the same ACO/data period.

We can provide a list of the affected BENE_MBI_IDs along with the relevant dates/data details for your investigation.

Please let us know if there are any specific BCDA v3 resources, filters, or FHIR attributes that we should use to determine why these members are not being returned.

Thanks & Regards,
Ashvani Goyal

[Beneficiary Claims Data API (BCDA) Community]

Hi Ashvani,

Thank you for reaching out about differences in the enrollees included in you BCDA jobs for the same ACO. In general, there are many potential reasons why an enrollee could be included in one job request and not another. Possible explanations include:

1. Updated attribution: BCDA regularly receives updated attribution information for each model entity. Making job requests at different times could mean your ACO's roster has been updated between job requests.
2. Different endpoints: If you are using the _since parameter in your job requests, the /Group/all and /Patient endpoints will return different resources

   1. Using _since with /Patient will return resources updated after the date provided for existing and newly attributed enrollees.

   2. Using _since with /Group will return resources updated after the date provided for existing enrollees and all resources for newly attributed enrollees.
3. Updated data sharing preferences: If a Medicare enrollee opts out of sharing data with ACOs and other model entities, BCDA will honor their preference and suppress their data from job requests.

If you would like help understanding which of these cases might apply to your recent job requests, please share the Job IDs for each of the requests.

Thanks,

The BCDA Team

[Ashvani goyal]

HI Team,

Thank you for the detailed explanation.

We reviewed the possible scenarios and performed additional testing on our side.

We tried the job requests using the /Group endpoint both with and without the _since parameter. However, we are still seeing cases where certain enrollees are missing from the BCDA v3 response, specifically where we have not received the expected BENE_MBI_ID.

We would like to provide you with specific samples so that you can investigate the missing enrollees and determine whether this is related to attribution updates, _since behavior, or data-sharing preferences.

Could you please open a case for this issue so that we can securely provide the sample MBI values for your investigation?

Thanks,
Ashvani