ME018, ME019, and ME020 are set by the submitters to indicate if the plan represents medical, pharmacy, or dental. These flags are potentially set inconsistently due to reasons mentioned in IssueTip: New Use Recommendations for Source of Coverage Fields (ME018, ME019, ME020). To enhance these flags, the AR APCD created three additional fields that represent if the claim was active within a plan's enrollment period. They are calculated only on matching existing data received in the APCD. These flags can change with each database update. Flag Values are 0= no and 1 = yes based on match logic below. Calculated Coverage Fields:
ME018A/ME019A/ME020A – the Medical/Pharmacy/Dental Claim match flag = 1 when the member record matches a medical/pharmacy/dental claims record using the following logic: ME001 = MC001/PC001/DC001 - Submitter Entity ID ME013 = MC012/PC012/DC012 - Member Gender ME014 = MC013/PC013/DC013 - Member date of birth ME107 = MC137/PC107/DC056 - Carrier Specific Unique Member ID MC059 - Date of Service From/PC032 - Date of Fill/DC035 – Date of Service From is between ME162A - Enrollment Date and ME163A - Member Disenrollment Date |