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