Issue: Cigna B Medical Claims Versioning

0053

67369

Jul 30, 2020 

Sep 10, 2021

Resolved issue.

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.

Resolved.

Versioning rules developed and applied. Data requesters having data fulfilled between January 2019 and September 2021 should still consider this issue.

Versioning

Data Quality

Issue