Source of Coverage fields (ME018, ME019, ME020) flag the types of plans offered by the SE. When profiling these fields, some SEs may have differing results. For example:
SE 10155 has three combinations of flags: me001 me018 me019 me020 10155 1 1 2 10155 2 1 2 10155 1 2 2 This happens when different groups within a large SE are pulling data. These groups may be unaware of the presence of other plans and set the value to “2”(No), “3”(Unknown), “4”(Other), or “5”(Not Applicable).One SE has submitted the value “2”for each of these fields, while a second SE has submitted the value “5”for each of these fields. Additionally, some submitting entity systems may not flag these fields as having coverage when in fact claims are present for the enrollment period. A suggested methodology: The member (ME001+ME107) has medical coverage when ME018 = 1 or when ME018 <> 1 and ME018A = 1. The member (ME001+ME107) has pharmacy coverage when ME019 = 1 or when ME019 <> 1 and ME019A = 1. The member (ME001+ME107) has dental coverage when ME020 = 1 or when ME020 <> 1 and ME020A = 1.
Also, when a member uses a third party administrator (TPA) and pharmacy benefit manager (PBM), members should be identified using Study_ID (ME998+ME013). In these instances, the submitting entities will be different and flags for medical, pharmacy, and dental coverage won’t be represented on a single member record. Utilize the Arkansas APCD Universe Counts to identify submitters that submit only medical, pharmacy, or dental data. Study_ID should be used when relating members across these types of submitterswith new use methodology. Included in November 2023 Data Tips email |