Tip: Calculated Services Indicator Flags (ME018A, ME019A, ME020A)

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Jan 29, 2021

Jan 10, 2022

Changed title from Tip: Calculated Coverage Indicator Flags (ME018A, ME019A, ME020A) to Tip: Calculated Services Indicator Flags (ME018A, ME019A, ME020A)

Included in Feb 2024 data tip email

ME018, ME019, and ME020 are set by the submitters to indicate if the plan represents medical, pharmacy, or dental. These flags are potentially set inconsistently due to reasons mentioned in https://achiapcd.atlassian.net/wiki/spaces/ADRS/pages/406552911. To enhance these flags, the AR APCD created three additional fields that represent if the claim was active within a plan's enrollment period. They are calculated only on matching existing data received in the APCD. These flags can change with each database update.

Flag Values are 0= no and 1 = yes based on match logic below.

Calculated Coverage Fields:

ME018A/ME019A/ME020A – the Medical/Pharmacy/Dental Claim match flag = 1 when the member record matches a medical/pharmacy/dental claims record using the following logic:
ME001 = MC001/PC001/DC001 - Submitter Entity ID
ME013 = MC012/PC012/DC012 - Member Gender
ME014 = MC013/PC013/DC013 - Member date of birth
ME107 = MC137/PC107/DC056 - Carrier Specific Unique Member ID
MC059 - Date of Service From/PC032 - Date of Fill/DC035 – Date of Service From is between ME162A - Enrollment Date and ME163A - Member Disenrollment Date

Active

Use these fields in conjunction with ME018, ME019 and ME020 to determine the coverage of the members.

Misc

Claim Type

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