Issue: Pharmacy Claim Versioning for 79413C
Number | 0042 |
|---|---|
Submitting Entity (SE) | 79413C |
Add Date | Jan 14, 2020 |
Update Date | Dec 15, 2020 Sep 10, 2021 |
Update | This issue has been resolved moving forward (from the update date) however it still exists within data pulled from past versions of the APCD. Updated resolution below. This issue will remain active until previously fulfilled data files are no longer being used. |
Description | Pharmacy claim versioning |
Active/Resolved | Resolved |
Action / Resolution | Updated: To use these data, the following workaround is recommended: Replace PC110 = ‘F’ with PC110 = ‘O’ for Original. When PC704 – Original Claim Number is NULL, populate it with the value in PC004 – Claim Number. Then group the update by PC704, PC005 and sort by PC017 – Paid Date. The update with the highest PC017 – Paid Date is the version to keep. NOTE: If there is a tie, consider disregarding the claim. Because the pharmacy claim numbers (PC004) are suffixed with the claim line numbers, the prescribed claim versioning rules for these SEs did not work correctly. These issues are being addressed with an anticipated resolution by June 2020. To use these data, the following workaround is recommended: Remove the last 3 digits (such as 001, 002, etc.) and the last dash ('-') off of PC004 values. This becomes the new PC004. Replace values in PC005 with the 3 digits from PC004 . Group claims by new PC004, new PC005 and select the claim line with the latest version number date (PC005B). For example: Member (PC107) Claim Number (PC004) Claim Line (PC005) New Claim Number New Claim Line Version Number Date (PC005B) Use? 4394904 14138121-01-90-001 1 14138121-01-90 001 01801 N 4394904 14138121-01-90-002 1 14138121-01-90 002 01801 Y 4394904 14138121-01-90-001 1 14138121-01-90 001 01810 Y |
Category 1 | Versioning |
Category 2 | Data Quality |
Tip / Issue | Issue |