Submitting
Entity (SE)
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Subject
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Update
Date
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Resolution
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Description
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All
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Alias Fields
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2019-03-01
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Informational
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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.
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All
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APCD Unique ID
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2019-03-01
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Informational
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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.
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All
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Current Age Fields
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2019-03-01
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Active
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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.
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All
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Data Coverage
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2019-03-01
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Informational
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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.
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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.
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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.
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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).
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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.
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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:
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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 “2”for each of these fields, while a second SE has submitted the value “5”for 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.
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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 ages matches, review the relationship code and/or the member suffix/person code. When these ages matches and relationship codes indicate“self”or “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
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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.
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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.
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Submitting Entity: 99HSM1 |
Subscriber DOB and Age |
2019-03-01 |
Active |
Subscriber date of birth data received from SE 99HSM1 contained the value “9999-12-31”on 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.
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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.
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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.
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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.
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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.
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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.
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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
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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.
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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
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Submitting Entity: 99HSM1 |
Member/Claim Linkage |
2019-08-30 |
Active |
Carrier specific unique member id values are formatted differently on enrollment data and claims data for Submitter 99HSM1. Enrollment data and claims data are still viable as stand-alone file types but cannot be linked together at this time. The Arkansas APCD team is working with the submitter to resolve this issue. |
Submitting Entity: All Submitters |
Missing Member Date of Birth |
2019-09-10 |
Informational |
If Member Date of Birth (ME014) is not present on a member/enrollment record, the APCD Unique ID (ME998) should be used with caution. If the submitting entity could not access member date of birth for the record, there is no guarantee that it was used correctly for the APCD Unique ID. This affects less than .001% of the member records. |
Submitting Entity: 79413B |
Misplaced Member ID |
2019-11-12 |
Active |
SE 79413B placed its unique member id in ME009, not ME107. This will be corrected in the APCD build released in January 2020. Recommended workaround: Where ME001 = '79413B', use ME009 instead of ME107, carrier specific unique member id. |
Submitting Entity: 79413D and 12567 |
Merged submitters and how to link data |
2019-12-5 |
Informational |
SE 12567 was merged with SE 79413D and stopped submitting member and claims data in 2015. During the transition year, member and claims data was sometimes included in one or both of the submitting entities. Also, the carrier specific unique member ID (ME107) for SE 12567 enrollment data is corrupt.
When linking member data to claims data, it is recommended that claims records for SE 12567 be linked to member records for SE 79413D. The member record on 79413D will not represent the correct enrollment period. To find the correct enrollment period, use the APCD Unique ID (ME998) on the SE 79413D record to find the corresponding member record for SE 12567. Be sure to concatenate the ME998 value with gender ME013.
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