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TPA
Page Properties


Update

Added regular expression to help identify issue: prxmatch("/(A|P)SE[^A]/i",ME032_GroupName) =1)

Description

Number

0045

Submitting Entity (SE)

99EBD1

Add Date

Update Date

Update

Updated description.

Description

HMO Partners, Inc. (Arkansas BlueCross and BlueShield) (SE 95442) serves as TPA for the Arkansas Employee Benefits Division (SE 99EBD1) and is testing submission of data for SE 99EBD1 creating duplicate member records.

Active/Resolved

Active

Resolved

Action / Resolution

With the replacement of EBD data with TPA data, this tip is no longer required. TPA and PBM Replacement Data for EBD for data from APCD update 22D forward.

It is advised that data users omit all member records from

submitting entity (ME001 = 95442

SE 95442 (HealthAdvantage) where the value in the Employer Name field (ME082) begins with ASE or PSE. 

These data will be replaced in a later build. 

Find the SE 95442 member records related to the SE 99EBD1 member records by grouping on Study ID (created by concatenating APCD Unique ID (ME998) and member gender (ME013)). Drop the SE 95442 records where the Employer Name field (ME082) begins with ASE and PSE. NOTE:  A similar situation exists for SE 95448B however it is not the same issue.

This prxmatch SAS function could be helpful: prxmatch("/(A|P)SE[^A]/i",ME032_GroupName) =1

Category 1

Merged SE & Overlap

Category 2

TPA

Tip / Issue

Issue