Tip: Duplicated Submission in EBD (99EBD1) and Qualchoice (95448B)

99EBD1, 95448B

06 May 2019

Arkansas QualChoice (SE 95448B) serves as the TPA for the Arkansas Employee Benefits Division (SE 99EBD1).  Periodically, the same claims will be found in both 95448B and 99EBD1.  It is important to understand that this can occur so data from one of the two submitters can be excluded  depending on the analytic requirements. 

These claims can identified as follows:

Member Data:

When ME001 = 95448B and ME032 = ARBenefits

 or

 Medical claims: 

When MC001 = 95448B and MC004, MC005, MC012, MC059 match MC004, MC005, MC012, MC059 when MC001 = 99EBD1.

 Note, this TPA uses different masking routines for the carrier specific unique member ID (MC137) therefore it is not possible to find these duplicate claims by member.