Issue: Duplicated Submission - Arkansas Employee Benefits Division (EBD) and HMO Partners, Inc. (95442)
- Kenley Money
- Kathleen Hart (Unlicensed)
Number | 0045 |
|---|---|
Submitting Entity (SE) | 99EBD1 |
Add Date | Feb 8, 2020 |
Update Date | Jan 27, 2021 Mar 6, 2023 |
Update | Updated description. |
Description | HMO Partners, Inc. (Arkansas BlueCross and BlueShield) (SE 95442) serves as TPA for the Arkansas Employee Benefits Division (SE 99EBD1) and is testing submission of data for SE 99EBD1 creating duplicate member records. |
Active/Resolved | Resolved |
Action / Resolution | With the replacement of EBD data with TPA data, this tip is no longer required. Tip: TPA and PBM Replacement Data for EBD - Original for data from APCD update 22D forward. It is advised that data users omit all member records from SE 95442 (HealthAdvantage) where the value in the Employer Name field (ME082) begins with ASE or PSE. Find the SE 95442 member records related to the SE 99EBD1 member records by grouping on Study ID (created by concatenating APCD Unique ID (ME998) and member gender (ME013)). Drop the SE 95442 records where the Employer Name field (ME082) begins with ASE and PSE. NOTE: A similar situation exists for SE 95448B however it is not the same issue. This prxmatch SAS function could be helpful: prxmatch("/(A|P)SE[^A]/i",ME032_GroupName) =1 |
Category 1 | Merged SE & Overlap |
Category 2 | TPA |
Tip / Issue | Issue |