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Number

0035

Submitting Entity (SE)

70408

99HSM1

Add Date

Update Date

 

Update

Added SQL code example.

This issue has been resolved moving forward (from the update date) however it still exists within data pulled from past versions of the APCD. This issue will remain active until previously fulfilled data files are no longer being used. Also, the original title referenced submitting entity 99HSM1.

Description

Carrier specific unique member id values are formatted differently on enrollment data and medical/pharmacy claims data for Submitter 99HSM1.  Enrollment data and claims data cannot be linked together at this time using the carrier specific unique member ID. However, there is a workaround that can be employed to match member data to claims data: Concatenate MC006 (PC006) with MC137 (PC107), separating the values with a hyphen to create the new claims level member id.  Join this to the member table on ME107 to find matches.

 The Arkansas APCD team is working with the submitter to resolve this issue.

Example joining member to pharmacy claims:

SELECT COUNT(DISTINCT ME107)
FROM APCD_DW.dbo.Stagemember A
LEFT JOIN APCD_DW.dbo.StagePharmacy B
ON A.ME107 = PC006+'-'+PC107 AND A.ME001 = B.PC001
WHERE PC107 IS NOT NULL AND ME001 = '99HSM1'

Active/Resolved

Active

Action / Resolution

Category 1

Member/Subscriber IDs

Category 2

Member to Claim Linkage

Tip / Issue

Issue

Tip