Partially Adjudicated - Average Processing Times

[Somaiya Shakil]

I am trying to determine how quickly professional and institutional claims become available in the 'system' for adjudication prior to actually being paid. I used the data dictionary called 'BCDA Partially Adjudicated Data Dictionary v1.0.0.xlsx' to review each of the date fields that seemed intuitive and I would like to confirm that my understanding of these are correct. 

At this time, I am utilizing historical partially adjudicates files. 

For professional claims, the date fields I have chosen for my analysis are 'claim receipt date'  (ClaimResponse.extension('https://bluebutton.cms.gov/resources/variables/mcs/claim-receipt-date').valueDate) and 'status date' (ClaimResponse.extension('https://bluebutton.cms.gov/resources/variables/mcs/status-date').valueDate). 

For institutional claims, the date fields I have chosen are 'Received Date'  (ClaimResponse.extension('https://bluebutton.cms.gov/resources/variables/fiss/recd-dt-cymd').valueDate) and 'Current Transaction Date' (ClaimResponse.extension('https://bluebutton.cms.gov/resources/variables/fiss/curr-tran-dt-cymd').valueDate). 

I bumped up partially adjudicated claims professional claims with the current CCLF5 using ICN and clm_cntl_num and partially adjudicated institutional claims with CCLF1 using mbi, service start date and provider oscar number to pull in paid dates. I did this to understand which date fields on the partially adjudicated files will give me what I am aiming to achieve based on common records between these realizing I won't find all records in the partially adjudicated files in CCLFs. 

My interpretation based on my review is that claims receipt date  and received date tell us that this is when claims are received from providers for processing and status date and current transaction date tell us when any type of adjudication activity takes place. On the institutional side, I see that current transaction date is greater than paid date in a few instances suggesting that these claims were possibly reprocessed. 

Please confirm if my interpretation is correct or if I need to consider alternate date fields, and what those are. 

Thanks

[Beneficiary Claims Data API (BCDA) Community]

Hi Somaiya,

Thanks for the question and detailed analysis! We're confirming with our upstream data partners that these date fields are the best suited for your analysis and we'll get back to you soon with an update.

Thanks,
The BCDA Team