Page Comparison

SE_ID

Submitting Entity

Release Notes

Release Notes

47155

Delta Dental

An internal system change at Delta Dental resulted in a data submission gap in which updated records were not received when an enrollment segment closed. 

Replacement data has been received and applied to years 2015 forward, correcting disenrollment dates (ME163A) to close segments appropriately.

NOTE:  Years 2013 and 2014 are still problematic and cannot be corrected.  This workaround is suggested:  Pull the available claims for members and assess the latest paid date to understand when the members were last active.  Determine if the time since the last paid date represents what could be an inactive member. 

Updated status:  Segments are still being received as open that should be closed.  Use with caution

until final resolution is in place.  The referenced data tip provides suggested workaround.

See Data Tip 0080.

Informational

65676

Lincoln

Issues were discovered with disenrollment dates for Lincoln.  These have been resolved.

Informational

83470, 95442

Arkansas BlueCross BlueShield

Previous build: This submitting entity was transitioning to a new dental claim processing system.  Issues exist with newer data pulls.  The only dental claim data available is through December 2021. 

Resolution in place: Arkansas Blue Cross Blue Shield dental data has been corrected and resubmitted.

Informational

99EBD1

Arkansas Employee Benefits Division (EBD)

EBD medical claims and pharmacy claims data submission has changed. Older EBD claims data is still sourced from EBD while new data is now sourced by third party administrators (TPA). This is applicable to data from this update forward.

Projects utilizing data from previous updates should not use this information. See Data Tip/Issue: Issue: Duplicated Submission - Arkansas Employee Benefits Division (EBD) and HMO Partners, Inc. (95442)

The methodology to distinguish between EBD data and TPA data gong forward is described here:

Member Data:

Member Data Group 1: All EBD member/enrollment data sourced from EBD for 2014-12-31 back is usable for both EBD medical and pharmacy claims in that time period.

To select these member data:

select records from member data
  where ME001 = '99EBD1' and ME162A <= '2014-12-31' and 
  ME163A >= '2013-01-01'

Member Data Group 2: Only EBD member/enrollment data sourced from EBD and associated with EBD Pharmacy claims is usable for 2015-01-01 to 2022-05-31:

select records from Member data
where ME001 = '99EBD1' and ME162A <= '2022-05-31' and 
  ME163A >= '2015-01-01'

Member Data Group 3: To find EBD member/enrollment data from Arkansas Blue Cross Blue Shield (EBD TPA for medical claims) for 2015-01-01 forward:

Select records from member data
  where ME001 = '95442' and ME003 = 'EBD'
Note:  These member records can be associated with medical
claims and/or pharmacy claims or they may have no associated
claims at all.

Future Member Data: Member data associated with EBD pharmacy data managed by its pharmacy benefit manager, MedImpact (99MCD2 99MDI2 and 99MCD399MDI3), are still being finalized.

Medical Claims:

Medical claims data from 2014-12-31 back are still sourced from EBD:

select records from medical claims
  where MC001 = '99EBD1' and MC059 <= '2014-12-31'
  Note:  There are no records where MC001 = '99EBD1' 
  and MC017 > '2015-01-01'

To find associated EBD member/enrollment data for medical claims 2014-12-31 back:

select records from Member data
  where ME001 = '99EBD1' 
  and MC012 = ME013 (member gender)
  and MC013 = ME014 (member date of birth, else MC013_year = ME014_year)
  and MC137 = ME107 (carrier specific unique member ID)
  and MC017 (Paid Date) is between (ME162A (member enrollment date) 
     and ME163A (member disenrollment date))
  or MC059 (Date of Service) is between (ME162A (member enrollment date)
     and ME163A (member disenrollment date))
  
  Note: MC017 is recommended because the DSG submission 
  requirement specify MC017.  MC059 will yield different
  counts.
  

Medical claims data from 2015-01-01 forward are no longer sourced from EBD and are now sourced from Health Advantage (Arkansas Blue Cross and Blue Shield). There is no field to flag a claim as EBD so the medical claims must be matched to the member data to identify it as an EBD claim.

select records from Member data
where MC001 = '95442' and ME001 = ‘95442’
  and ME003 = ‘EBD’  
  and ME107 = MC137 (Member Number)
  and ME006 = MC006 (Group number)
  and ME009 = MC008 (Contract number)
  and ME013 = MC012 (Member Gender)
  and MC059 >= ‘2015-01-01’ or MC017 >= ‘2015-01-01’ 
  (MC017 is recommended because the DSG submission 
  requirement specify MC017.  MC059 will yield different
  counts.)

Pharmacy Claims:

Pharmacy claims data 2022-05-31 back are still sourced from EBD:

select records from pharmacy claims
  where PC001 = '99EBD1' and PC017 <= '2022-05-31'
  Note:  There are no records where PC001= '99EBD1' 
  and PC017 > '2022-06-01'

To find associated EBD member/enrollment data for pharmacy claims:

select records from Member data
  where ME001 = '99EBD1' 
  and PC012 = ME013 (member gender)
  and PC013 = ME014 (member date of birth, else MC013_year = ME014_year)
  and PC107 = ME107 (carrier specific unique member ID)
  and PC017 (paid date) is between (ME162A (member enrollment date) 
  and ME163A (member disenrollment date))

Pharmacy claims data from 2022-06-01 forward are no longer sourced from EBD and will be submitted by its pharmacy benefits manager, MedImpact (99MDI2, 99MDI3). These data are not available yet. Once available, selection criteria will be provided.

Therefore, medical claims and associated member data (whether from EBD or Arkansas Blue Cross Blue Shield) is available from 2013-01-01 through current. Pharmacy claims and associated member data is available from 2013-01-01 through 2022-05-31.

Linking between EBD and PBMs:

EBD, Arkansas Blue Cross and Blue Shield, and MedImpact member IDs do not match across source systems. Users must use the Study ID methodology to join members across submitters. See Data Tip: Tip: APCD Unique ID, aka Hash ID

Informational

60054A

Aetna

Aetna 60054M has been sunsetted and its active members have moved to 81973. Approximately 13% of the member segments remain open. It can be assumed that where ME163A = ‘9999-12-31’, ME163A should be considered ‘2018-12-31’. Permanent resolution is in development.

Note: Users must use the Hash ID methodology to join members across submitters. See Data Tip: Tip: APCD Unique ID, aka Hash ID

Informational

99MCD1

16244

Arkansas Medicaid

Empower Healthcare Solutions, LLC (PASSE)

Arkansas Medicaid and PASSE submitting entities will be submitting the the 4 digit Medicaid State Aid Category called the iC Aid Category Code in ME910, MC910, PC910 and DC910. The traditional 2 digit value is the first two characters in the iC Aid Category Code value. Refer to this reference:

https://humanservices.arkansas.gov/wp-content/uploads/MMIS_BenefitPlans.pdf

Empower Healthcare is the first PASSE entity to submit this value. Remaining PASSE entities will submit in upcoming submissions.

Informational.