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

Support: APCD Data Requests