Tip: Submitting Entity Merge - United and Care Improvement
Number | 0040 |
|---|---|
Submitting Entities | 79413D and 12567 |
Add Date | Dec 5, 2019 |
Update Date | Jan 27, 2021 Jul 29, 2022 |
Update | Added example |
Description | SE 12567 was merged with SE 79413D and stopped submitting member and claims data at the end of 2015. Claims for members previously covered by SE 12567 are now in SE 79413D. During the merger, some claim records could be reported under 12567 while the member records had been moved to 79413D, hence, creating orphaned claims in 12567. Use PC107 from those orphaned claims to find ME107 in 79413D. Find the SE 79413D member records related to the SE 12567 member records by grouping on Study ID (created by concatenating APCD Unique ID (ME998) and member gender (ME013)). After grouping, retrieve for SE 79413D claims using member ID (ME107).
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Action / Resolution | Active. This will be applicable to all data requests. |
Category 1 | Merged SE & Overlap |
Category 2 | Member to Claim Linkage |
Tip / Issue | Tip |
Submitting Entity | Member ID | Claim Number | Year of Birth | Paid Date | Fill Date | Drug Name | Pharmacy | Script Number | APCD Unique ID (ME998) |
12567 | abc123ZX | 68326 | 1948 | 12/23/2014 | 12/23/2014 | LISINOP/HCTZ TAB 20-25MG | KROGER PHARMACY 25642 | 6744609 | 8PeHjqX7+t6Czo7ZQz64yZrfX06KhRGNg/QmySfN1Z= |
12567 | abc123ZX | 78236 | 1948 | 11/26/2014 | 11/26/2014 | LISINOP/HCTZ TAB 20-25MG | KROGER PHARMACY 25642 | 6744609 | 8PeHjqX7+t6Czo7ZQz64yZrfX06KhRGNg/QmySfN1Z= |
79413D | 60DD2q | 99921 | 1948 | 2/21/2015 | 2/21/2015 | LISINOP/HCTZ TAB 20-25MG | KROGER PHARMACY 25642 | 6744609 | 8PeHjqX7+t6Czo7ZQz64yZrfX06KhRGNg/QmySfN1Z= |
79413D | 60DD2q | 12063 | 1948 | 4/23/2015 | 4/23/2015 | LISINOP/HCTZ TAB 20-25MG | KROGER PHARMACY 25642 | 6744609 | 8PeHjqX7+t6Czo7ZQz64yZrfX06KhRGNg/QmySfN1Z= |
79413D | 60DD2q | 89278 | 1948 | 3/28/2015 | 3/28/2015 | LISINOP/HCTZ TAB 20-25MG | KROGER PHARMACY 25642 | 6744609 | 8PeHjqX7+t6Czo7ZQz64yZrfX06KhRGNg/QmySfN1Z= |
79413D | 60DD2q | 10398 | 1948 | 1/21/2015 | 1/22/2015 | LISINOP/HCTZ TAB 20-25MG | KROGER PHARMACY 25642 | 6744609 | 8PeHjqX7+t6Czo7ZQz64yZrfX06KhRGNg/QmySfN1Z= |
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