MedImpact is a new pharmacy submitter in the 23B build. No versioning rules were provided. The MedImpact system creates a new claim number for every transaction, whether it is a duplicate, reversal, or back-out. This methodology will help manage MedImpact versioning until it is incorporated into a future database build.
Flagging Duplicates:
Where PC001 in (‘99MCD1’,’99MCD2’,’99MCD3’,’99MCD4’,’99MCD5’), group claims records by the fields in the table below. When all values are the same in all grouped records, use the record with the largest value in PC004.
Flagging Reversals:
Where PC001 in (‘99MCD1’,’99MCD2’,’99MCD3’,’99MCD4’,’99MCD5’), group claims records by the fields in the table below.
When the sum of the dollar fields (PC036, PC037, PC039, PC040, PC041, PC042, PC069) across all claim lines in the group = 0, don’t use any of the claim lines for that grouping. In other words, if a group has 2 claim lines, the sum of PC036 between the claim lines must = 0, the sum of PC037 between the claim lines must = 0, etc.
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