Selecting Unique Claims in the Outpatient File
For Outpatient claims, sort by patient_id, from_dt, link_num, and seg_num. Keep the first record in the sort (if first link_num;) in order to eliminate duplicate charge and payment amounts from the file.
It has been determined that the daily_dt on Version J of the Outpatient file, for years 2002 to 2008, is always set to 12/05/2009. CMS has explained that:
"during the Version 'J' work back in 2010/2011, the current contractor team was instructed by the former programmer to change the NCH Daily Process Date to the conversion date (on all history files that were being converted to the new format). The anomaly has been documented in the Version 'K' data dictionary limitation appendix."
It is further explained in the appendix that:
"This change impacts the linkage of Part A claims that have multiple segments (claims with more than 45 revenue center lines) on the Version 'J' claim files. The NCH Daily Process Date is used in conjunction with the NCH Segment Link Number to keep records/segments belonging to a specific claim together. There is the possibility that two different claims could now have the same NCH Daily Process Date and NCH Segment Link Number. This could cause users of the data to match claim records/segments together that should not be paired. We believe the chances of this occurring to be minimal."
Last Updated: 02 Mar 2015