99CAR1 - Caremark Member IDs with Multiple Dates of Birth and/or Genders
Newly identified data quality issues have been found affecting approximately 4% of the Caremark/CVS (99CAR1) member records. In some instances, a Member ID is used for more than one member associated with a subscriber. These Member IDs (ME107) have multiple Dates of Birth (ME014) or Birth Year (ME014_Year) and/or multiple Genders (ME013).
How to find these issues: Find members with multiple member IDs when grouped on subscriber ID, Birth Year and gender.
These issues occur at the client for which Caremark provides PBM services.
Workaround to create alternative Caremark (99CAR1) Member ID:
Finding member records:
Concatenate the Subscriber ID (ME117), Member Gender (ME013) and Member Date of Birth (ME014) or Member Birth Year (ME014_Year). Use this value instead of the information in Member ID (ME107) to group member records. Alternatively, the APCD_Unique_ID (ME998) and Member Gender (ME013) could be used to group individuals within the member/enrollment data.
Finding associated claims:
Once the member records have been selected above, select the associated pharmacy claims by joining the Member data to the Pharmacy claims on Subscriber (ME117/PC108), Date of Birth (ME014/PC013) or Year of Birth (ME014_Year/PC013_Year) and Gender (ME013/PC012).
NOTE: The Pharmacy claims records do not contain Contract Number therefore the Subscriber Number (PC108) should be used at the claim level.
Active/Resolved
Active
Action / Resolution
Category 1
Member/Subscriber IDs
Category 2
DSG
Tip / Issue
Issue
Group 1:
Individual
ME107 (Member ID)
ME117 (Subscriber ID)
ME013 (Gender)
ME012 (Relationship Code)
ME014_YEAR (Birth Year)
Note
Mother
123400
1234
F
20
1975
In group 1, the mother is the subscriber. Member ID = subID+00
Father
123401
1234
M
1
1967
In group 1, the father is one of the dependents. Member ID = subID+01
Child 1
123402
1234
F
19
2002
In group 1, child 1 is one of the dependents. Member ID = subID+02
Child 2
123403
1234
F
19
2005
In group 1, child 2 is one of the dependents. Member ID = subID+03
Group 1:
Individual
ME107 (Member ID)
ME117 (Subscriber ID)
ME013 (Gender)
ME012 (Relationship Code)
ME014_YEAR (Birth Year)
Note
Mother
123401
1234
F
20
1975
In group 2, the mother is the subscriber. Member ID = subID+01, which is the same as the father's Member ID in group 1
Father
123402
1234
M
1
1967
In group 2, the father is one of the dependents. Member ID = subID+02, which is the same as child 1 Member ID in group 1
Child 1
123403
1234
F
19
2002
In group 2, child 1 is one of the dependents. Member ID = subID+03, which is the same as child 2 Member ID in group 1
Child 2
123404
1234
F
19
2005
In group 2, child 2 is one of the dependents. Member ID = subID+04.