Issue: Cigna B Medical Claims Versioning
Number | 0053 |
|---|---|
Submitting Entity (SE) | 67369 |
Add Date | Jul 30, 2020 |
Update Date | Sep 10, 2021 |
Update | Resolved issue. |
Description | Versioning issues exist for all data where paid date (MC017) is > 2017-02-28. To identify the most recent update, group the Claim Number (MC004) and Claim Line (MC005) together and sort by Paid Date (MC017). The MC004 – MC005 combination with the highest MC017 is the final version (NOTE: if there is a tie, record with positive Count of Services Rendered – MC061 is the one to keep, disregard the others). If the Claim Status (MC138) of that final version is B, D, or V and/or the Count of Services Rendered – MC061 is negative, disregard all versions of that Claim-Claim Line combination. Alternatively, analyses could use only historical data (MC017 <= 2017-02-28) which contain final paid claims.
|
Active/Resolved | Resolved. |
Action / Resolution | Versioning rules developed and applied. Data requesters having data fulfilled between January 2019 and September 2021 should still consider this issue. |
Category 1 | Versioning |
Category 2 | Data Quality |
Tip / Issue | Issue |