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).
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=