Issue: United Health Care Student Resources Pharmacy Claim Versioning
- Kenley Money
- Kathleen Hart (Unlicensed)
Number | 0054 |
|---|---|
Submitting Entity (SE) | 79413C |
Add Date | Jul 30, 2020 |
Update Date | Sep 10, 2021 |
Update | Resolution noted. |
Description | Versioning issues have been found in the pharmacy claims data. To identify the most recent update, first map values in Claim Number (PC004) to Original Claim Number (PC704) when PC704 is NULL. Then group the Original Claim Number (PC704) and Claim Line (PC005) together and sort by Paid Date (PC017). The PC704-PC005 combination with the highest PC017 is the final version (NOTE: If there is a tie, consider omitting them). If the Claim Status (PC110) of that final version is B, D, or V, disregard all versions of that Original Claim-Claim Line combination. |
Active/Resolved | Resolved. |
Action / Resolution | Versioning rules developed and applied. |
Category 1 | Versioning |
Category 2 | Data Quality |
Tip / Issue | Issue |