Issue: Caremark Member IDs with Multiple Dates of Birth/Genders
- Kenley Money
Number | 0114 |
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Submitting Entity (SE) | 99CAR1 |
Add Date | Jun 28, 2022 |
Update Date | Dec 12, 2022 |
Update | In Dec 2023 data tips email. In October 2024 data tips email |
Description | 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 |
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Category 1 | Member/Subscriber IDs |
Category 2 | DSG |
Tip / Issue | Issue |
Group 1: |
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Individual | ME107 | ME117 | ME013 | ME012 | ME014_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: |
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Individual | ME107 | ME117 | ME013 | ME012 | ME014_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. |