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BCDA-8393 Update a few small things, add links #215

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Nov 5, 2024
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BCDA-8393 Update a few small things, add links #215

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2 changes: 1 addition & 1 deletion _includes/data/claims_data_avail.html
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<div>
<p>Since the Beneficiary Claims Data API (BCDA) shares fully adjudicated Medicare claims data (Part A, B, and D), claims data availability relies on how quickly a claim has been submitted, processed, and approved. Per Section 6404 of the Affordable Care Act, the maximum period for submission of all Medicare Fee-for-Service claims has been reduced to no more than 12 months (1 calendar year) after the date services were furnished. CMS typically receives claims 3-4 weeks after care has been provided. Once received by CMS, it is possible for claims to undergo more than one round of processing to make adjustments, edits, and cancellations. Data will only be available via the API once a claim has been approved. For more details on claims submission and approval timeframes, please review this <a href="https://www2.ccwdata.org/documents/10280/19002256/medicare-claims-maturity.pdf" target="_blank" rel="noopener" class="in-text__link">white paper</a> which outlines the lifecycle of a Medicare claim, as well as timeframes for submission and approval (pages 11, 12, and 22 have details on month-over-month statistics).
<p>Since the Beneficiary Claims Data API (BCDA) shares fully adjudicated Medicare claims data (Part A, B, and D), claims data availability relies on how quickly a claim has been submitted, processed, and approved. Per Section 6404 of the Affordable Care Act, the <a href="https://www.hhs.gov/guidance/document/systems-changes-necessary-implement-patient-protection-and-affordable-care-act-ppaca-1#:~:text=and%20transmitted%20securely.-,Systems%20Changes%20Necessary%20to%20Implement%20the%20Patient%20Protection%20and%20Affordable,Not%20More%20Than%2012%20Months" target="_blank" rel="noopener" class="in-text__link">maximum period for submission of all Medicare Fee-for-Service claims</a> has been reduced to no more than 12 months (1 calendar year) after the date services were furnished. CMS typically receives claims 3-4 weeks after care has been provided. Once received by CMS, it is possible for claims to undergo more than one round of processing to make adjustments, edits, and cancellations. Data will only be available via the API once a claim has been approved. For more details on claims submission and approval timeframes, please review this <a href="https://www2.ccwdata.org/documents/10280/19002256/medicare-claims-maturity.pdf" target="_blank" rel="noopener" class="in-text__link">white paper</a> which outlines the lifecycle of a Medicare claim, as well as timeframes for submission and approval (pages 11, 12, and 22 have details on month-over-month statistics).
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@carlpartridge carlpartridge Nov 1, 2024 •
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I couldnt find a specific link to section 6404 but did find this link which seems to be the point of the sentence generally: https://www.hhs.gov/guidance/document/systems-changes-necessary-implement-patient-protection-and-affordable-care-act-ppaca-1#:~:text=and%20transmitted%20securely.-,Systems%20Changes%20Necessary%20to%20Implement%20the%20Patient%20Protection%20and%20Affordable,Not%20More%20Than%2012%20Months
It wasnt clear in the ticket if this was worth adding or not so happy to change.

</p>
<p>Once a claim has been submitted, processed, and approved, BCDA receives the data on a weekly cadence, while Claim and Claim Line Feed (CCLF) files receive them monthly. New data is loaded from the <a href="https://www2.ccwdata.org/web/guest/home/" target="_blank" rel="noopener" class="in-text__link">CCW</a> every weekend. In the event of a delay, there will be an announcement in the <a href="https://groups.google.com/forum/#!forum/bc-api" target="_blank" rel="noopener" class="in-text__link">BCDA Google Group</a> with updates on when the data will be refreshed.
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6 changes: 3 additions & 3 deletions _includes/data/how_to_use_bcda_data.html
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<p>For adjudicated claims, BCDA serves data according to the bulk FHIR specification using three FHIR resources: ExplanationOfBenefit (EOB), Patient, and Coverage. This means that your claims data will be delivered through three FHIR resource types rather than 12 CCLF files.
</p>
<ul>
<li>The <strong>ExplanationOfBenefit (EOB)</strong> resource type provides similar information to what is provided in CCLF files 1-7. The EOB files contain lines within an episode of care, including where and when the service was performed, the diagnosis codes, the provider who performed the service, and the cost of care.</li>
<li>The <strong>Patient</strong> resource type provides similar information to what is provided in CCLF files 8 and 9. This is where you get your information about who your beneficiaries are, their demographic information, and updates to their patient identifiers.</li>
<li>The <strong>Coverage</strong> resource type provides information about beneficiaries’ insurance coverage, including information about dual coverage.</li>
<li>The <a href="https://www.hl7.org/fhir/explanationofbenefit.html" target="_blank" rel="noopener" class="in-text__link"> ExplanationOfBenefit (EOB)</a> resource type provides similar information to what is provided in CCLF files 1-7. The EOB files contain lines within an episode of care, including where and when the service was performed, the diagnosis codes, the provider who performed the service, and the cost of care.</li>
<li>The <a href="https://www.hl7.org/fhir/patient.html" target="_blank" rel="noopener" class="in-text__link"> Patient</a> resource type provides similar information to what is provided in CCLF files 8 and 9. This is where you get your information about who your beneficiaries are, their demographic information, and updates to their patient identifiers.</li>
<li>The <a href="https://www.hl7.org/fhir/coverage.html" target="_blank" rel="noopener" class="in-text__link"> Coverage</a> resource type provides information about beneficiaries’ insurance coverage, including information about dual coverage.</li>
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<p>For partially adjudicated claims two FHIR resources are available to REACH ACOs: Claim and ClaimResponse.
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2 changes: 1 addition & 1 deletion _includes/guide/type_parameter.html
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The _type parameter allows you to request different Resource Types from the API. Instead of receiving data from all three Resource Types when no _type parameter is specified, you will be able to use the _type parameter to submit one or more Resource Types. The API will then produce data from the specified Resource Types.
The _type parameter allows you to request different Resource Types from the API. Instead of receiving data from all Resource Types when no _type parameter is specified, you will be able to use the _type parameter to submit one or more Resource Types. The API will then produce data from the specified Resource Types.
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