SE_ID

Submitting Entity

Release Notes

Release Status

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

All Submitters

New Data Field - ME001_CAT - Type of Coverage

A new data point - Type of Coverage - has been added to the Member data that categorizes the type of coverage represented by the carrier and plan. This information can help the data users group data in high level coverage types. See the table below.

add claims association…This categorization is found on member data only. To associate claims with members based on type of coverage categorization, join the member data to claims data using the SE_ID and member number and select the claims where the service date is within the enrollment date.

For example:

Enrollment Submitting Entity ID (ME001) = Medical Claim Submitting Entity ID (MC001) and Enrollment Member ID (ME107) = Medical Claims Member ID (MC137) and Service From Date (MC059) is between enrollment date (ME162A) and disenrollment date (ME163A).

Enrollment Submitting Entity ID (ME001) = Pharmacy Claim Submitting Entity ID (PC001) and Enrollment Member ID (ME107) = Pharmacy Claims Member ID (PC107) and Fill Date (PC032) is between enrollment date (ME162A) and disenrollment date (ME163A).

Enrollment Submitting Entity ID (ME001) = Dental Claim Submitting Entity ID (DC001) and Enrollment Member ID (ME107) = Dental Claims Member ID (DC056) and Service From Date (DC035) is between enrollment date (ME162A) and disenrollment date (ME163A).

Informational

67369A

67369

67369F

67369B

99CIG2

Cigna

Values in the APCD_Unique_ID (ME998) are formatted incorrectly on all Cigna member records preventing matching members from other submitting entities. See Data Tip Cigna Entity Study ID Issue

Issue

60054M

Aetna

Aetna 60054M has been sunsetted and will no longer submit data. Any remaining open segments have been closed.

Informational

Arkansas Employee Benefits Division (EBD)

EBD data is managed by several entities. It is recommended that EBD data be grouped using ME001_CAT values representing EBD in the Type of Coverage table below.

This issue can still be applied if ME001_CAT is not available. Issue: Duplicated Submission - Arkansas Employee Benefits Division (EBD) and HMO Partners, Inc. (95442)

Informational

83472

Arkansas Blue Cross and Blue Shield

Less than 1% of medical claim records contain the value 9999-12-31 in Service date (MC059) and paid date (MC017). These are considered invalid and the submitting entity will resubmit to correct them in the future.

Issue

10155

Wellcare

The value ‘HM’ in Insurance Product Code (ME003) was corrected to be ‘HN’

Issue

99CAR1

Caremark

Caremark member records with ME162A = '2017-03-01' and ME163A = '2017-01-31' were confirmed to be invalid have been removed.

Informational

99HSM1

HealthSmart

Member disenrollment date (ME163A) was updated with 9999-12-31 when the value was previously 1900-01-01 or 2099-12-31.

Informational

All SEs

An issue was found Provider Birth Year and Month (PV033) where this field was being replaced with NULLs incorrectly in some cases. This has been resolved and the data has been repopulated.

Informational