Issue: Enrollment record versioning for Anthem

0164

60217

Oct 3, 2024

Included in October 2024 Data Tips Email

The Arkansas APCD utilizes custom methodology to flag the most relevant - or active - member enrollment record for any plan.

The original rules for Anthem (60217) no longer work as the data within the product number (ME040) is populated differently.

The versionrank rules have been updated to exclude ME040. Anthem data will be corrected in the 24B build in December 2024.

For data users who have data prior to that, interim rules to determine the usable member enrollment record are:

Medical plans: Group enrollment records where ME001 = ‘60217’ and ME018 = 1 on

• Carrier Specific Unique Member ID (ME107)

• Group Number (ME006)

• Contract Number (ME009)

• Enrollment Date (ME162A)

The record with the latest Disenrollment Date (ME163A) that is not 9999-12-31 should be the kept record. If all records in the group contain the value 9999-12-31 in Disenrollment Date (ME163A), any of the records can be used as the active record.

Pharmacy plans: Group enrollment records where ME001 = ‘60217’ and ME019 = 1 on

• Carrier Specific Unique Member ID (ME107)

• Group Number (ME006)

• Contract Number (ME009)

• Enrollment Date (ME162A)

The record with the latest Disenrollment Date (ME163A) that is not 9999-12-31 should be the kept record. If all records in the group contain the value 9999-12-31 in Disenrollment Date (ME163A), any of the records can be used as the active record.

Dental plans: Group enrollment records where ME001 = ‘60217’ and ME020 = 1 on

• Carrier Specific Unique Member ID (ME107)

• Group Number (ME006)

• Contract Number (ME009)

• Enrollment Date (ME162A)

The record with the latest Disenrollment Date (ME163A) that is not 9999-12-31 should be the kept record. If all records in the group contain the value 9999-12-31 in Disenrollment Date (ME163A), any of the records can be used as the active record.

Active

data quality

versionrank

issue