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Data ElementAPCD Dervied Medical Claim Match
Description

Indicates that a member record matches an existing medical claims record in the APCD if date Flag appended when a medical service occurred for this member during an active enrollment period for the member.  Methodology:  Date of service (MC059) is within member enrollment and disenrollment dates (ME162A and ME163A).

Values:  

1 = Medical claim matches member record during the member's  Medical claims were processed during member’s enrollment period

0 = Medical claim does not match member during the member's enrollment period  Medical claims were not processed during member’s enrollment period

TypeInteger
FormatTinyint
Length
Threshold100%
RequiredComputed
Tip / NotesThis is a derived field that should be used to supplement the submitting entity required field, ME018.
Rank18034