Tip: Flagging beneficiaries in D-SNP plans
Number | 0166 |
---|---|
Submitting Entity (SE) | Medicare and Medicaid |
Add Date | Oct 3, 2024 |
Update Date |
|
Update | Included in October 2024 Data Tips email |
Description | How to identify Medicare members in D-SNP plans. For data requesters who qualify to get Medicare Fee-for-service data through the Arkansas APCD, these rules can be used to identify Medicare beneficiaries who have Dual Eligible Special Needs Plans (D-SNPs). Dual Eligible Special Needs Plans (D-SNPs) are Medicare Advantage plans for people who are eligible for both Medicare and Medicaid. There is no clear flag identifying Medicare beneficiaries as D-SNPs. The following rules have to be applies to flag them. Select beneficiaries with D-SNP contracts.
Code sample for January: select a.[BENE_ID],
a.[DUAL_STUS_CD_01],
a.[PTC_CNTRCT_ID_01],
a.[HMO_IND_01],
b.FIDE_SNP,
b.SNP_TYPE,
a.[BENE_ENROLLMT_REF_YR],
[MONTH] = '01'
,CONCAT(a.[MYEAR],'-01') as YEARMO
INTO #tmp_DSNP_JANUARY
FROM [dbo].[MCR_BEN_SUM] a
inner join #tmp_SNP_PLAN b (from #1)
on a.[PTC_CNTRCT_ID_01] = b.[CONTRACT_ID]
and a.[BENE_ENROLLMT_REF_YR] = b.[BENE_ENROLLMT_REF_YR]
where (b.[FIDE_SNP] = 'Y' or b.[SNP_TYPE] = 'D')
and b.PLAN_TYPE = '01'
group by a.[BENE_ID],
a.[DUAL_STUS_CD_01],
a.[PTC_CNTRCT_ID_01],
a.[HMO_IND_01],
b.FIDE_SNP,
b.SNP_TYPE,
a.[BENE_ENROLLMT_REF_YR]
|
Active/Resolved | Active |
Action / Resolution |
|
Category 1 | Medicare |
Category 2 | D-SNP |
Tip / Issue | tip |
HMO Indicator
| Dual Status Code | Contract ID |
[HMO_IND_01] | [DUAL_STUS_CD_01] | [PTC_CNTRCT_ID_01] |
[HMO_IND_02] | [DUAL_STUS_CD_02] | [PTC_CNTRCT_ID_02] |
[HMO_IND_03] | [DUAL_STUS_CD_03] | [PTC_CNTRCT_ID_03] |
[HMO_IND_04] | [DUAL_STUS_CD_04] | [PTC_CNTRCT_ID_04] |
[HMO_IND_05] | [DUAL_STUS_CD_05] | [PTC_CNTRCT_ID_05] |
[HMO_IND_06] | [DUAL_STUS_CD_06] | [PTC_CNTRCT_ID_06] |
[HMO_IND_07] | [DUAL_STUS_CD_07] | [PTC_CNTRCT_ID_07] |
[HMO_IND_08] | [DUAL_STUS_CD_08] | [PTC_CNTRCT_ID_08] |
[HMO_IND_09] | [DUAL_STUS_CD_09] | [PTC_CNTRCT_ID_09] |
[HMO_IND_10] | [DUAL_STUS_CD_10] | [PTC_CNTRCT_ID_10] |
[HMO_IND_11] | [DUAL_STUS_CD_11] | [PTC_CNTRCT_ID_11] |
[HMO_IND_12] | [DUAL_STUS_CD_12] | [PTC_CNTRCT_ID_12] |