Tip: Submitting Entity Merge - Centene/Celtic and Qualchoice
- Kenley Money
- Kathleen Hart (Unlicensed)
Number | 0061 |
|---|---|
Submitting Entity (SE) | 80799, 70998A, 95448A, 95448B |
Add Date | Nov 19, 2020 |
Update Date | Jan 27, 2021 Mar 16, 2023 May 24, 2023 |
Update | Included in May 2023 data tip email. |
Description | Data duplication because of submitting entity acquisition - NOW RESOLVED |
Active/Resolved | Resolved |
Action / Resolution | The submitting entity, Celtic (80799) has acquired several plans from Arkansas QualChoice (70998A, 95448A). Member data is NOT duplicate between these submitting entities. Data users can use Study_ID (ME998+ME013) and enrollment periods to distinguish between members. The submitting entity, Celtic (80799). has acquired several plans from Arkansas QualChoice (70998A, 95448A). Celtic is in the process of submitting some data for these plans and in some instances duplicate member records can be found for both 80799 and 70998A, 95448A based on the Study ID (APCD Unique ID (ME998)+gender (ME013)) match. This primarily occurs with enrollment in 2018 forward. Also, the last eligibility, medical and pharmacy claim files for 95448B were through Q4 2019. Provider is the only file with data up to Q2 2020. However, their provider data is repeated and there is no date in PRV to determine the period ending. Group by Hash ID (created by concatenating APCD Unique ID (ME998) and member gender (ME013)) and eliminate the records where ME001 = 80799 and Health Plan (ME164A) = CELTIC INSURANCE. |
Category 1 | Merged SE & Overlap |
Category 2 | APCD Unique ID/Study ID |
Tip / Issue | Issue |