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Page Properties


Number

0023

Submitting Entities

99EBD1, 95448B

Add Date

Update Date

 

Update

Updated description

Description

Arkansas QualChoice (SE 95448B) serves as the TPA for the Arkansas Employee Benefits Division (SE 99EBD1).  Periodically, the same claims will be found in both 95448B and 99EBD1.  It is important to understand that this can occur so data from one of the two submitters can be excluded  depending on the analytic requirements. 

Action / Resolution

Find the SE 99EBD1 member records related to the SE 95448B member records by grouping on Hash ID (created by concatenating APCD Unique ID (ME998) and member gender (ME013)) when ME001 = 95448B and Group Name (ME032) = ARBenefits.

Use the member numbers (ME107) from this grouping to find claims. Include additional fields to satisfy the grouping:

When MC001 = 95448B and MC004, MC005, MC012, MC059 match MC004, MC005, MC012, MC059 when MC001 = 99EBD1.

Note, this TPA uses different masking routines for the carrier-specific unique member ID (MC137), therefore it is not possible to find these duplicate claims by member.

Category 1

Merged SE & Overlap

Category 2

TPA

Tip / Issue

Tip