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Issue: United Health Care Student Resources Pharmacy Claim Versioning

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Number

0054

Submitting Entity (SE)

79413C

Add Date

 

Update Date

Update

Description

Versioning issues have been found in the pharmacy claims data.  To identify the most recent update, first map values in Claim Number (PC004) to Original Claim Number (PC704) when PC704 is NULL. Then group the Original Claim Number (PC704) and Claim Line (PC005) together and sort by Paid Date (PC017). The PC704-PC005 combination with the highest PC017 is the final version (NOTE: If there is a tie, consider omitting them). If the Claim Status (PC110) of that final version is B, D, or V, disregard all versions of that Original Claim-Claim Line combination.

Active/Resolved

Active

Action / Resolution

Versioning rules are being developed for future application.  No ETA at at this time.

Category 1

Versioning

Category 2

Data Quality

Tip / Issue

Issue



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