TPA and PBM Replacement Data for EBD

0124

99EBD1, 95442

06 Mar 2023

TPA replacement data for EBD

EBD medical claims and pharmacy claims data submission has change. Older EBD claims data is still sourced from EBD while new data is now sourced by third party administrators (TPA). The breakdown is described here:

Medical Claims:

Medical claims data prior to 2015-01-01 are still sourced from EBD:

select records from medical claims
  where MC001 = '99EBD1' and MC059 < '2015-01-01'
  Note:  There are no records where MC001 = '99EBD1' and MC059 > '2015-01-01'

To find associated EBD member/enrollment data for medical claims prior to 2015-01-01:

select records from Member data
  where ME001 = '99EBD1' 
  and MC012 = ME013 (member gender)
  and MC013 = ME014 (member date of birth, else MC013_year = ME014_year)
  and MC137 = ME107 (carrier specific unique member ID)
  and MC059 (service from date) is between (ME162A (member enrollment date) 
  and ME163A (member disenrollment date))

Medical claims data from 2015-01-01 forward are no longer sourced from EBD and are now sourced from Arkansas Blue Cross and Blue Shield:

select records from medical claims
  where MC001 = '95442' and MC003 = 'EBD' and MC059 >= '2015-01-01'

To find associated EBD member/enrollment data for medical claims from 2015-01-01 forward:

select records from Member data
  where ME001 = '95442' and ME003 = 'EBD' 
  where MC001 = ME001 and MC137 = ME107

Pharmacy Claims:

Pharmacy claims data prior to 2022-06-01 are still sourced from EBD:

select records from pharmacy claims
  where PC001 = '99EBD1' and PC017 <= '2022-05-31'
  Note:  There are no records where PC001= '99EBD1' and PC017 > '2022-06-01'

To find associated EBD member/enrollment data for pharmacy claims:

select records from Member data
  where ME001 = '99EBD1' 
  and PC012 = ME013 (member gender)
  and PC013 = ME014 (member date of birth, else MC013_year = ME014_year)
  and PC107 = ME107 (carrier specific unique member ID)
  and PC017 (paid date) is between (ME162A (member enrollment date) 
  and ME163A (member disenrollment date))

Pharmacy claims data from 2022-06-01 forward are no longer sourced from EBD and will be submitted by its TPA MedImpact. These data are not available yet. Once available, selection criteria will be provided.

Therefore, medical claims and associated member data (whether from EBD or Arkansas Blue Cross Blue Shield) is available from 2013-01-01 through current. Pharmacy claims and associated member data is available from 2013-01-01 through 2022-05-31.

Linking between EBD and TPAs:

EBD, Arkansas Blue Cross and Blue Shield, and MedImpact member IDs do not match across source systems. Users must use the Hash ID methodology to join members across submitters. See Data Tip: Tip: APCD Unique ID, aka Hash ID

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