Data Tips for Data Requesters

The following table contains information about data quality or data nuances that affect data in the Arkansas APCD. This information is provided at the Submitting Entity (SE) level where applicable, otherwise, the issue described affects all SEs. Data requestors should review and consider each of these as they move forward with their stated use of the data. Where possible, issues will be addressed in future Arkansas APCD releases. Issues categorized as Informationalcannot or will not be addressed. Resolution is being addressed for issues categorized as Active.” Resolved issues are categorized as Resolved.
 

Submitting

Entity (SE)

Subject

Update

Date

Resolution

Description

All

Alias Fields

2019-03-01

Informational

When system changes occur that result in changing member and/or subscriber IDs, the old IDs should be moved to the Alias fields at the end of each member or claim records. The new IDs should populate the original fields. The System ID field should be incremented by 1 to represent ID changes. Data user should use the System ID field as a

trigger to determine if a member ID changed.

All

APCD Unique ID

2019-03-01

Informational

APCD Unique ID (ME998), otherwise called the APCD Hash ID, can be used the align individuals across carriers. Refer to this document for more methodologies and instructions.

All

Current Age Fields

2019-03-01

Active

Each Arkansas APCD table — Member, Medical Claims, Pharmacy Claims, Dental Claims — contains a derived field representing the current age of the member. The value in this field is calculated based on the date the data was loaded into the database table and the member date of birth. It is possible that the ages differ between data tables. This calculation will be changed for the upcoming Arkansas

APCD build to ensure consistency among members’ current ages.

All

Data Coverage

2019-03-01

Informational

All required fields received from SEs have data coverage thresholds. For example, the Member ZIP Code field (ME017) must contain a valid ZIP code value on 99% of the records received. However, if an SE cannot provide valid ZIP codes to meet this threshold, they must either correct the data or submit an exception to lower the threshold. Therefore, it is possible that any given field may not be populated completely because of the data issues encountered by the SE.

 All  DOB/AGE  2019-03-01  Active  

The standard value delivered for data requests is age, calculated from a member’s date of birth. Data quality errors within SE systems can sometimes result in multiple dates of birth for the same carrier specific unique member ID (ME107, MC137, PC107, DC056). This could result in different age values for a member.

 All  DOB/AGE  2019-03-01  Active  

The field ME014_ENROL_AGE is calculated using the member date of birth (ME014) and member enrollment date (ME162A). The ME014_ENROL_AGE value has been found to be negative on approximately 15,500 member records (3,987 members). Negative ages result when the member enrollment dates (ME162A) are earlier than the member date of birth. This anomaly is present among 17 submitting entities. This is a result of either data quality issues or children member records having the parent’s enrollment dates.

Less than 100 member records have a calculated age based on enrollment date that is over 125. Approximately half of these problematic records have date of birth data quality issues.

 All  Masking  2019-03-01  Informational  

Carrier specific unique member IDs (ME107, MC137, PC107, DC056) and/or carrier specific unique subscriber IDs (ME117, MC141, PC108, DC057) are masked prior to the fulfillment of data requests. Therefore, the original ID value provided by the SE is not visible to the data requestor. ID values are masked consistently to ensure accurate ID linkages over time. This requirement applies to the associated Alias ID fields (ME107A, ME117A, MC117A, MC141A, PC107A, PC108A, DC056A, DC057A).

 All  Optional vs. Required Data Fields  2019-03-01  Informational  

If a data field is identified as optional in the data request element list, SEs were not required to submit data for that field. Some SEs submitted data for optional fields but there is no guarantee that data coverage is complete. Also, optional fields are not checked for data quality so the data within these fields could be incorrect. Use with caution.

 All  Provider Specialty  2019-03-01  Informational  

Two types of provider specialty codes are required for the Arkansas APCD.

 1. SE-specific provider specialty codes are included in the supplemental Lookup file received as part of the data request (if medical claims are included). This file provides SE-specific provider specialty definitions for fields Service Provider Specialty (MC032) and Billing Provider Specialty (MC212). Some SEs have no custom provider specialty codes and use CMS specialty codes instead.
 
2. CMS specialty codes or CMS taxonomy codes are required for PV019, PV020, AND PV021. If an SE cannot provide the CMS taxonomy code, it provides the associated 2 byte CMS specialty codes. CMS specialty codes can be found at this link: 
 All  Source of Coverage Fields (ME018, ME019, ME020)  2019-03-01  Active
 Source of Coverage fields (ME018, ME019, ME020) flag the types of plans   offered by the SE. When profiling these fields, some SEs may have differing   results.
 
 For example:
 SE 10155 has three combinations of flags:
 me001 me018 me019 me020
 10155   1           1           2
 10155   2           1           2
 10155   1           2           2
 
 This happens when different groups within a large SE are pulling  data. These  groups may be unaware of the presence of other plans and  set the value to 2(No), 3(Unknown), 4(Other), or 5(Not Applicable).One SE has submitted the value 2for each of these fields, while a second SE has submitted the value 5for each of these fields. The Arkansas APCD team is working with these entities to resolve these issues. The recommended workaround for these SEs is to join the member data to the medical, pharmacy, and/or dental claims data on carrier specific unique member ID to determine the presence of those claim types.
 All  Subscriber/Member ID Linkage  2019-03-01  Informational  Where the carrier specific unique subscriber ID does not exist as a carrier specific unique member ID for a carrier, the following approach can be used to identify the subscriber among the member records.Group by carrier specific unique subscriber ID and carrier specific unique member ID. Then when the subscriber and member agematches, review the relationship code and/or the member suffix/person code. When these agematcheand relationship codeindicateselfor employee, and/or the person code matches the last two or three digits in the carrier specific unique subscriber ID,you probably have the subscriber.
 All  Unique Member Identification by SE  2019-03-01  Active  Because different SEs can use the same value structure for carrier specific unique member IDs, always concatenate the Entity Code (ME001, MC001, PC001, DC001) with the carrier specific unique member ID (ME107, MC137, PC107, DC056) and/or carrier specific unique subscriber ID (ME117, MC141, PC108, DC057) when querying individuals.
 All  Valid Value Identification  2019-03-01  Informational  Values present in the data that are not included in the Arkansas APCD Data Dictionary should be considered invalid. Where possible, the Arkansas APCD removes these values when appropriate. For example, extraneous values for Gender such as T” for Transgender will be replaced with NULL. No such checks are made on fields with widely varied values such as diagnosis codes, procedure codes, revenue codes, bill types, etc.
 All  Versioning  2019-03-01  Informational  Not all SEs provided instructions for “versioning”the process to update claims with changed information. If no versioning rules have been applied, the Versioning Method field (MC706, PC706, DC706) will be Null or will contain the value 8. Refer to the versioning application and use methodologies in the online reference, Arkansas APCD Versioning.
 All  Multiple Member IDs  2019-03-01  Informational  Because Arkansas Medicaid offers many different plan types that are managed from different systems, it is possible that members will have different carrier specific unique member IDs. When identifying members for Arkansas Medicaid, also utilize date of birth or age, gender, and the APCD Unique ID. 
 Submitting Entities:71420, 79413D  Member IDs and Subscriber IDs  2019-03-01  Active  Values for carrier specific unique member ID and carrier specific unique subscriber ID changed for most members from these SEs in 2018.When IDs change, the original value was placed in the Alias fields at the end of each records.The new value was placed in the Original ID fields.However, the System ID was not incremented to 1 and currently contains the value 0. Where the System ID value > 0 indicates an ID change, use the presence of data in the alias fields as the trigger.
Submitting Entities: 71420, 79413A,79413D,
95446
 APCD Unique IDs  2019-03-01  Active  The APCD Unique ID values for these SEs are incorrect and should not be used in identifying individuals across SEs.
 Submitting Entities: 71420, 79413D  Versioning  2019-03-01  Informational  SEs 71420 and 79413D utilize a custom versioning application that does NOT replace claim lines with changes or replacements. To find total costs for the claim, all claim lines must be aggregated.
 Submitting Entity: 62286A  Member/Claim Linkage  2019-03-01  Active
Several issues exist with member and subscriber dates of birth and carrier specific unique member IDs on all file types Member, Medical Claims, and Pharmacy Claims for this SE. These data cannot be used to associate members with claims data. Also, these issues render the APCD Unique ID (ME998) unusable. The Arkansas APCD team is working with the submitter to resolve this issue. 
 
To date, no issue has been found with the claims level utilization or cost data for this SE, however if plan data, member and/or subscriber demographics are required for analyses, it is recommended that this SE be omitted from analyses until further notice.
 Submitting Entity: 64246  Overall Data Issues  2019-03-01  Active  Data provided by SE 64246 has been found to contain multiple data quality errors. If data purchased includes this SE, it is advised to omit these data from any analyses until further notice.
 Submitting Entity: 67369D  Problematic APCD Unique ID Values  2019-03-01  Active  This SE submitted four months of data July through October 2017 with no values in ME998. The Arkansas APCD team is working with the submitter to resolve this issue. 
 Submitting Entity: 99EBD1  ICD Diagnosis and Procedure Codes  2019-03-01  Informational
Inconsistencies and truncation exist in this SE’s ICD Diagnosis Code and Procedure Code fields resulting from the third party administrator (TPA)transition from ICD9 to ICD10. Two issues occurred:1) the ICD10 codes were truncated to six characters, and 2) they were inconsistently populated between Diagnosis Code and Procedure Code fields. Once the issues were identified, the Arkansas APCD team determined that historical data could not be corrected. ICD9 codes were still available.Therefore, wherever possible, the Arkansas APCD team used ICD9 diagnosis codes and procedure codes, even after the 2015 transition. Toward the end of 2017, the ICD9 codes were no longer provided,so the ICD10 codes were used. These codes are still truncated to six characters.
 
This issue cannot be corrected at the TPA.
 Submitting Entity: 99HSM1  Subscriber DOB and Age  2019-03-01  Active  Subscriber date of birth data received from SE 99HSM1 contained the value 9999-12-31on all records. Because date of birth is translated into current age, enrollment age, age at service, and age at fill, the values in these fields for this SE will be invalid. They should not be used in analyses until this data quality issue is resolved.
 Submitting Entities: 99EBD1, 95448B Duplicated Claims 2019-05-06  Informational  

Qualchoice (Entity 95448B) serves as the TPA for the Arkansas State Employee Benefits Division (99EBD1).  Periodically, the same claims will be found in both 95448B and 99EBD1.  It is important to understand that this can occur so data from one of the two submitters can be excluded  depending on the analytic requirements.  These claims can identified as follows:

Member Data:

When ME001 = 95448B and ME032 = ARBenefits
 
or
 

Medical claims: 

When MC001 = 95448B and MC004, MC005, MC012, MC059 match MC004, MC005, MC012, MC059 when MC001 = 99EBD1.

 
Note, this TPA uses different masking routines for the carrier specific unique member ID (MC137) therefore it is not possible to find these duplicate claims by member.
Submitting Entities:  12151, 70580, 95885, 73288  Inconsistent Member and Subscriber IDs 2019-05-06 Active

The internal systems for this submitting entity changed the logic supporting consistent carrier specific unique member id and carrier specific unique subscriber id values.  It is not possible to effectively group members and associated claims by these IDs and expect all claims for targeted individuals to be selected.  Utilize APCD_Unique_ID whenever possible until these issues are resolved.

 Submitting Entity:  70408 Incorrect Member ID 2019-05-13 Active Entity 70408 mapped the incorrect value into ME107 and DC056. It is possible to use the eligibility/member data for analyses by identifing uniqiue members by concatenating  ME998 and ME013.  However, no accurate linkage exists between eligibility/member data and dental claims data.
 Medical Marijuana Data Multiple Records per Individual  2019-07-09 Informational  

These data contain multiple records per individual, one for every month the individual has a valid Medical Marijuana card.  To find an individual’s enrollment start and end date, query the card-issue date to identify the earliest and latest date of enrollment.

Submitting Entity:  80799  PBM/Pharmacy Carrier Overlap 2019-07-11 Informational
Pharmacy claims received from both the submitting entity and its PBM.  This gives the researcher the opportunity to examine the same prescription claims from both sources, providing some insight into the differences between the PBM and pharmacy information.  
 
These claim line pairs can be identified by joining pharmacy claims with submitting entity ID 99CAR1 and 80799 by claim number and prescription fill date.  
Submitting Entity: All Submitters Active Member Identification 2019-07-16 Informational
Active and inactive data segments are identified using the Benefit Status field (ME063).   This is especially important when using Arkansas Medicaid data (ME001 = '99MCD1').
 
For example, when the submitting entity ID (ME001) = 99MCD1 and Benefit Status field (ME063) = A, the member segment is active.
 
Submitting Entity:  99MCD1 Product ID and Health Plan definitions 2019-07-29 Informational
Additional information supporting values for Arkansas Medicaid eligibility data elements Product ID (ME040) and Health Plan (ME164A) can be found on the Arkansas Medicaid website here.
 
Values for ME040 are found in the Legacy Aid Category column.
Values for ME164A are found in the iC Benefit Plan Description column.
Submitting Entity:  99MCD1 Arkansas Medicaid Policy Manuals 2019-07-29 Informational
Arkansas Medicaid provides several policy manuals that can be used as reference when working with its eligibility, member, and claims data.
 
Arkansas District of County Operations policies for Medicaid Eligibility
Arkansas Medicaid Policy Manual including coverage period information
Arkansas Medicaid program information quick reference guide
Submitting Entities:  83470, 80799, 70998A, 95448A, 99MCD1 Arkansas Works/Medicaid Expansion Population 2019-07-29 Informational
The Arkansas Works/Medicaid Expansion population can be identified as follows:
 
Commercial:  Submitting Entity ID (ME001) = 83470, 80799, 70998A, 95448A and HIOS ID (ME992) ends in 32 or 36
Medicaid:  Submitting Entity ID (ME001) = 99MCD1 and Product ID (ME040) = 06
 
Records for members enrolled in Arkansas Works will be present in both the commercial entity member data and the Arkansas Medicaid member data.  There is no  ID or key to link the records across submitting entities. If members must be linked across submitting entities, it is recommended that the Arkansas APCD Unique ID (ME998) be used.  Contact Arkansas APCD Technical Support for assistance as needed.
Submitting Entities:  All Submitters ICD9 or ICD10 designation 2019-08-02 Informational  

Diagnosis Codes

To verify if diagnosis codes provided in fields MC041 through MC053 are ICD9 or ICD10 and are valid, join the values in these fields to the ICD9 and ICD10 reference files located at the downloadable reference table link on the Arkansas APCD Data Dictionary page.  This link will provide a zipped file containing text files supporting key Arkansas APCD data elements including diagnosis codes.  The ICD diagnosis reference files within the downloadable ZIP file are:

  • Lookups_ICD9CM_DIAG_20190731.txt
  • Lookups_ICD10CM_DIAG_20190731.txt

Those codes that match the ICD9 reference file are ICD9 diagnosis codes. Those codes that match the ICD10 reference file are ICD10 diagnosis codes.

732 ICD diagnosis codes can be found on both the ICD9 and ICD10 reference files.  These are not interchangeable as they have different definitions.  When determining if an ICD code that is found on both tables is an ICD9 or ICD10 code, refer to the field MC915A on the claim record.  If the value in MC915A = 0, treat the value as an ICD10 diagnosis code. If the value in MC915A = 9, treat the value as an ICD9 diagnosis code.

The reference file contains the diagnosis codes found in both ICD9 and ICD10 code sets is also available:

  • Lookups_ICD10CM_ICD9CM_DIAG_OVERLAP_20190730.txt

Procedure Codes

To verify if procedure codes provided in fields MC058 through MC058L are ICD9 or ICD10 and are valid, join the values in these fields to the ICD9 and ICD10 reference files located at the downloadable reference table link on the Arkansas APCD Data Dictionary page.  This link will provide a zipped file containing text files supporting key Arkansas APCD data elements including procedure codes.  The ICD procedure reference files within the downloadable ZIP file 

  • Lookups_ICD9CM_PROC_20190731.txt
  • Lookups_ICD10CM_PROC_20190731.txt

Those codes that match the ICD9 reference table are ICD9 procedure codes. Those codes that match the ICD10 reference table are ICD10 procedure codes.

44 ICD procedure codes can be found on both the ICD9 and ICD10 reference Ffiles.  These are not interchangeable as they have different definitions.  When determining if an ICD code that is found on both tables is an ICD9 or ICD10 code, refer to the field MC915A on the claim record.  If the value in MC915A = 0, treat the value as an ICD10 procedure code. If the value in MC915A = 9, treat the value as an ICD9 procedure code.

The reference file contains the procedure codes found in both ICD9 and ICD10 code sets is also available:

  • Lookups_ICD10CM_ICD9CM_PROC_OVERLAP_20190731.txt
 
 
Appendix A: Arkansas APCD State and County Code Value Transformation Approach
 
The rules used to address state and county code transformations are described below. Note, where the state or county code cannot be validated and transformed to FIPS, the original source value was kept.
 
 
USPS ZIP Codes:
  • If the value in the USPS ZIP Code field is invalid, make the USPS ZIP code value NULL.
 
County Name/FIPS Code:
  • County FIPS codes are assigned based on valid USPS ZIP codes.
  • If the USPS ZIP code is invalid, county value is transformed to FIPS based on a state and county name match.
  • If the USPS ZIP code is invalid the value is replaced with NULL.
State Code:

If the value in the state field is AR and

  • The associated USPS ZIP code is valid AND in the range of AR USPS ZIP codes, the value in the state field is transformed to FIPS code = “05”.
  • The associated USPS ZIP code is NOT valid but in the range of AR zip codes, transform state to “05”.
  • The associated USPS ZIP code is valid but NOT in the range of AR zip codes, transform state value to the state FIPS of that USPS ZIP code.
 
If the value in the state field is a valid non-AR state and
 
  • The ZIP code is a valid USPS ZIP code and the state value corresponds with the state value associated with that USPS ZIP code, transform state to the state FIPS code of that state.
  •  The ZIP code is a valid USPS ZIP code but the state value does NOT correspond with the state value associated with that USPS ZIP code, the state code should be moved without transformation.
  •  The ZIP code is NOT a valid USPS ZIP code, the state code should be moved without transformation.
 
 If the value in the state field is NOT a valid state code, transform to NULL.