Tip: Claims with Multiple Member Numbers
Number | 0142 |
|---|---|
Submitting Entity (SE) | All SEs |
Add Date | Nov 2, 2023 |
Update Date | Nov 15, 2023 |
Update | Included in November 2023 data tips email |
Description | Less than 1% of the distinct medical claims have more than one member number associated with them. Some systems will use the same claim number for different types of claims (facility vs professional). So for example the same claim number is used for a physician claim and also for a facility claim. There is not currently a definitive rule to separate these claims. Use with caution. select MC004, count(distinct concat(MC001, MC137)) as CntOf
from [claims data]
group by MC004
having count(distinct concat(MC001, MC137)) > 1
|
Active/Resolved | Active |
Action / Resolution | No current resolution |
Category 1 | Multi-Member ID |
Category 2 | Data Quality |
Tip / Issue | Tip |