Tip: Duplicated Submission in EBD (99EBD1) and Qualchoice (95448B)

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99EBD1, 95448B

May 6, 2019

 Jan 27, 2021 Aug 17, 2022 Mar 6, 2023 Aug 28, 2023

Added information about NULL disenrollment dates (ME163A)

Arkansas QualChoice (QC) (95448B) served as the third party administrator (TPA) for the Arkansas Employee Benefits Division (EBD) (99EBD1) between 2013 and 2018.  These member data and claims data are also submitted through EBD. It is recommended that the data sourced from 95448B be omitted.

95448B no longer submits data for the Arkansas Employee Benefits Division (99EBD1). Several enrollment records contain NULL in ME163A making the enrollment record appear to be open and active for the submitter. For all data use, when ME001 = '95448B' and ME032 (Group Name) = 'ARBenefits' or ME001_CAT = ‘EBD_TPA’ and ME163A is NULL, substitute the value in ME163A with 2013-12-31.

To omit member and claims data where QC is the EBD TPA:

1. Identify member records duplicated between 99EBD1 and 95448B. Do this by grouping member records on Study ID (created by concatenating APCD Unique ID (ME998) and member gender (ME013)) where ME001 = 99EBD1 with member records where ME001 = '95448B' and ME032 (Group Name) = 'ARBenefits' or ME001_CAT = ‘EBD_TPA’

2. Select EBD medical claims: Use the member number (ME001, ME107) from the EBD records pulled in step 1 to select related medical claims: Join ME001 = 99EBD1 and ME107 = EBD member # to MC001 = 99EBD1 and MC137 = EBD member #

3. Select 95448B medical claims: Use the member number (ME001, ME107) from the 95448B records pulled in step 1 to select related medical claims: Join ME001 = 95448B and ME107 = QC member # to MC001 = 95448B and MC137 = QC member #

4. Identify QC medical claims to omit: Merge the output from steps 2 and 3 on MC004, MC005, MC012, MC059 and omit the records where MC137 = 95448B.

Merged SE & Overlap

TPA

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