CMS Launches Project to Make ACO Claims Data Accessible

As part of CMS (Centers for Medicare & Medicaid Services) Administer Seema Verma’s HIMSS19 speech on Feb. 12, she announced a new initiative that will enable MSSP ACOs to retrieve claims data for their beneficiaries.

During Verma’s speech, in which she broadly implored the private sector to follow the government’s lead on making health data more accessible, she said, “We are launching a project that uses the FHIR Bulk Spec to share Medicare claims data with ACOs [accountable care organizations]. And for those of you non-techies, this means we are sharing claims data for ACO participants in a bulk format. And I am pretty sure we are one of the first to use this!”

The Beneficiary Claims Data API (BCDA) will enable ACOs participating in the Shared Savings Program to retrieve Medicare Part A, Part B, and Part D claims data for their assigned or assignable beneficiaries, CMS explains on its website.

“This includes Medicare claims data for instances in which beneficiaries receive care outside of the ACO, allowing a full picture of patient care. When it is in production, the API will provide similar data to Claim and Claim Line Feed (CCLF) files, currently provided monthly to Shared Savings Program ACOs by CMS,” according to the website.

Currently, the project is a work in progress, according to CMS. The “test mode” phase has involved providing synthetic data that resembles the kinds of data MSSP ACOs will receive by connecting with this endpoint, so that they can try out different ways of interacting with the API before receiving live data. “Through conversations and test drives, we strive to learn what ACOs need from bulk beneficiary claims data, and create a process that meets their needs,” CMS stated.