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.
Action / Resolution
Find the SE 99EBD1 member records related to the SE 95448B member records by grouping on Hash ID (created by concatenating APCD Unique ID (ME998) and member gender (ME013)) when ME001 = 95448B and Group Name (ME032) = ARBenefits.
Use the member numbers (ME107) from this grouping to find claims. Include additional fields to satisfy the grouping:
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.
Category
EBD
Tip / Issue
Tip
No labels
0 Comments
You are not logged in. Any changes you make will be marked as anonymous. You may want to Log In if you already have an account.
0 Comments