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

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Number

0023

Submitting Entities

99EBD1, 95448B

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Updated description

Description

Arkansas QualChoice (QC) (95448B) served as the third party administrator (TPA) for the Arkansas Employee Benefits Division (EBD) (99EBD1) between 2013 and 2018.  These member data and claims data are also submitted through EBD. It is recommended that the data sourced from 95448B be omitted.

Action / Resolution

To omit member and claims data where QC is the EBD TPA:

  1. Identify member records duplicated between 99EBD1 and 95448B. Do this by grouping member records on Hash ID (created by concatenating APCD Unique ID (ME998) and member gender (ME013)) where ME001 = 99EBD1 with member records where ME001 = 95448B and ME032 (Group Name) = ARBenefits.

  2. Select EBD medical claims: Use the member number (ME001, ME107) from the EBD records pulled in step 1 to select related medical claims: Join ME001 = 99EBD1 and ME107 = EBD member # to MC001 = 99EBD1 and MC137 = EBD member #

  3. Select 95448B medical claims: Use the member number (ME001, ME107) from the 95448B records pulled in step 1 to select related medical claims: Join ME001 = 95448B and ME107 = QC member # to MC001 = 95448B and MC137 = QC member #

  4. Identify QC medical claims to omit: Merge the output from steps 2 and 3 on MC004, MC005, MC012, MC059 and omit the records where MC137 = 95448B.

Category 1

Merged SE & Overlap

Category 2

TPA

Tip / Issue

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