Table of Contents
- I.1 Background
- I.2 Objective of the Duplicate Resolution Procedures
- I.3 General Definitions and Guidelines
- I.4 Determining if a Participant Has Multiple ID Numbers
- I.5 Manual Duplicate Resolution Procedure (Manually "Combining" Duplicates)
- I.6 Combining Data from Duplicate Records
- I.7 Beginning the Process of Manually Resolving Duplicates
Duplicates exist within Cornerstone for a variety of reasons - program conversions, Medicaid match process and creation by front-line users. Not finding a participant that already exists in Cornerstone when adding a participant will create a duplicate participant.
Users can avoid creating duplicates by following a consistent participant look-up procedure on the Participant Look-Up (PA01) screen (formerly Statewide Look-Up):
- To perform a broad search, do a participant look-up by entering the last name and first initial of the first name of the participant. By using only the first initial of the first name, and by omitting the middle initial, date of birth and sex, the search will be expanded and will help avoid "false" results. (Using this broad method will eliminate creating duplicates for participants whom might already be in Cornerstone, but whose first name might be misspelled or birth date might have been entered incorrectly.)
- After performing a broad search and verifying that the participant is not in Cornerstone, then perform a participant look-up by entering the exact last name and first name of the participant. In order to add a new participant on the Participant Enrollment (PA03) screen, the user must perform a look-up using the name exactly as it would appear on PA03.
- The participant look-up will search the local database first; if no possible matches are found locally, Cornerstone will automatically perform the statewide search. If the participant being searched has previously been flagged as a duplicate, ***DUP*** will appear in the last column on the right side of the Participant Look-Up (PA01) screen.
The definition of a "duplicate" situation is the same individual has more than one participant ID number in Cornerstone. The ID numbers can take the following forms:
- 1st 12 positions are exactly alike, but the 13th & 14th positions of the ID number are different, i.e., one number ends in '00' and another number ends in '01', '02', etc.
- 1st 12 positions are not alike because the participant name included the middle initial when one number was created and the name did not include a middle initial when the second number was created. However, sex code and date of birth are the same, and staff knows that it is the same participant.
- 1st 12 positions are not alike because the participant's first and/or last names were spelled differently when the ID numbers were created.
- 1st 12 positions are not alike because the participant date of birth or sex code was not the same when the ID numbers were created. However, the staff knows that despite the differences in the demographic information the participant is the same.
In some instances the duplicate participants may be enrolled in the same programs (PA15 Program Information screen) for both ID numbers. For example, Mary Smith, ID #S200-4507-4320-00, has a CM program record and Mary Smith, ID#S200-4507-4320-01, also has a CM program record. Both IDs may or may not have Medicaid/insurance information, birth information, health visit information, assessments, activities, case notes, referrals, etc. that were entered. In other cases, the programs associated with the different ID numbers may not be the same, i.e., one is CM and the other is WIC.
I.2 Objective of the Duplicate Resolution Procedures
These procedures are designed to assist local agency staff with resolving duplicate participant situations that have occurred in Cornerstone. Duplicates can exist within a site or between sites. That is, the participant could have duplicate ID numbers within the site (agency) only or there could be a duplicate ID number at another site (clinic).
All duplicates can and should be resolved. Some duplicates can be resolved by using the automated Duplicate Resolution (PA21/PA22) screens. NOTE: THE AUTOMATED DUPLICATE RESOLUTION PROCEDURE CAN ONLY BE USED WHEN THE DUPLICATES EXIST AT THE USER'S SITE. IT IS NOT POSSIBLE TO "COPY IN" A PARTICIPANT FROM THE PA01 SCREEN AND THEN USE THE PA21/PA22 SCREENS TO MERGE A DUPLICATE.
The automated merge process will not merge participants if the following conditions exist:
- Both participants are enrolled in WIC.
- Both participants are enrolled in Case Management or Healthy Start Case Management, both with a status of "N" (new Medicaid recipient) or both with a status of "A" (active). All other CM or HSCM statuses will merge.
- Both participants are enrolled in Healthy Families Illinois program with a status of "A" (active).
- Both participants are enrolled in Early Intervention.
I.3 General Definitions and Guidelines
- When there are duplicate participant ID numbers for the same person, the procedures in this document refer to the subsequently created ID number(s) for the duplicate(s) that was/were created after the original. By definition, when a participant has more than one Cornerstone ID, the duplicate ID number(s) is the one that was created/added after the original participant ID number was assigned.
- Generally, the person or agency that created the duplicate ID number should be responsible for resolving the duplicate. The user that caused the duplicate should correct the problem they created. Normally, the user should stop using the duplicate participant and flag it as a duplicate. The resolution process should reinforce the avoidance of the problem.
- All duplicates can and should be resolved, even if the duplicates are between different sites or agencies. Duplicates that cannot be resolved using the automated duplication resolution (PA21/PA22) screen, can and should be manually resolved.
- Duplicate resolution is not viewed as a program specific function since any combination of users and programs could be involved. A key to the resolution process is the knowledge of which participant is the duplicate and which site created it.
- Normally, the duplicate ID number will no longer be used and any useful information from the duplicate ID number should be added to the original ID number. Usually the duplicate will have less information since it was created more recently (by definition). It also is the one that should not have been created in the first place and it would seem unfair to ask users to stop using the original ID number when they have not done anything to warrant the change. The resolution should be consistent with avoiding the problem in the first place. If, the duplicate ID has more useful information and is being actively used, and all parties to the resolution process agree, then the original ID number can be terminated and information from the original ID number combined onto the duplicate ID number, making it the "kept" ID.
I.4 Determining if a Participant Has Multiple ID Numbers
- Go to the Participant Look-Up (PA01) screen and enter the participant's last name and first name. Any potential matches found in the local site will be displayed in the "Participant Browse - Local" pop-up window. If the correct participant is not displayed in the "Participant Browse Local" pop-up window, press Esc to continue and the system will automatically search statewide records. Any potential matches will be displayed in the "Participant Browse Statewide" pop-up window.
- After selecting one of the participant's ID numbers by highlighting it, press F1 HELP to display the programs in which the participant is enrolled under that ID number. Next select another of the participant ID numbers and look at the programs in which the participant is enrolled under that ID number.
- Review the Program Information (PA15) screen for each participant ID number to determine the program, program status, and the termination reason code. Make a note of this information, as it will be used to determine when the duplicate can be resolved (see the specific guidelines noted in section "Manual Duplicate Resolution Procedure (Manually "Combining" Duplicates)" below. For potential matches that appear in the "Participant Browse - Statewide" pop-up box, make a note of the site where the duplicate ID exists. It will be necessary to contact that site to determine where the duplicate was created, and therefore, who will be responsible for resolving the duplicate.
I.5 Manual Duplicate Resolution Procedure (Manually "Combining" Duplicates)
This procedure is to be used to resolve all duplicate participant situations that cannot currently be resolved using the automated PA21 and PA22 Screens.
As noted above, there are some duplicate situations in which a system merge of the duplicates cannot currently be used. For these situations it is possible for the Cornerstone user to "merge the duplicates manually" by terminating one ID number (identified as the "duplicate") and reentering data from that ID number to the ID number (identified as the "original") that the user has selected to "keep".
Note that if the participant ID number to be "kept" (used going forward) is from another site and not enrolled at the user's site, the user will need to enroll this participant at the user's location so that they can combine from the duplicate ID number to the "kept" ID number. Participant ID number, name, date of birth, sex and the "Residential" address information is "copied down" when the user locates the participant on the Participant Look-Up (PA01) screen and answers "yes" to the question "do you want to copy participant to local files" after selecting F9 = Enrollment.
This procedure has the following general objectives:
- To terminate the "duplicate" participant from all programs. This process should follow the normal participant termination procedures for each program. The termination reason code to be used is "11" Duplicate Record. NOTE: IT IS NOT POSSIBLE TO TERMINATE ACTIVE WIC RECORDS WITH TERMINATION REASON CODE 11.
- To activate the "kept" participant in the appropriate programs.
- To flag the "duplicate" participant so that it is known as a duplicate that is not to be used by other users of the system. Procedures for flagging the duplicate are spelled out below in the section "How to Begin the Process of Manually Resolving Duplicates".
- To combine information from the "duplicate" participant onto the "kept" participant ID.
Please note the following specific guidelines that apply:
- If the "duplicate" participant is actively participating in WIC, the manual duplicate resolution procedure can only be done at the time of initial certification or recertification. The certification eligibility criteria and food instruments that were issued to the duplicate participant must remain associated with the duplicate ID number until the certification period is over.
- If the "duplicate" participant is enrolled in Early Intervention, the manual duplicate resolution procedure should be done at the time of initial intake or annual re-evaluation/assessment. If this procedure is done at a time other than initial intake or annual re-evaluation/assessment, service authorizations will need to be discontinued and re-entered.
- When combining duplicates that have Medicaid information, the user must first determine if the "kept" participant already has current Medicaid information with a DPA recipient number (RIN) that is exactly the same as the "duplicate" participant. It is not possible to have two Medicaid records with the exact same recipient number entered on two different Cornerstone ID's at the same time. The "kept" ID should always be the one that has the eligible (open) Medicaid record attached to it. System generated PA05 records (those with a 'Y' in the System Generated field) cannot be edited or deleted. Only non-System Generated PA05 records (those with an 'N' in the System Generated field) can be added, edited or deleted. Apply the following rules:
- If the Medicaid/Insurance (PA05) screen will be re-entered on the "kept" ID with the exact RIN as on the duplicate ID, first delete the PA05 screen from the duplicate ID before adding the Medicaid information to the "kept" ID.
- If there is an "open" Medicaid/Insurance record associated with the "kept" ID and the user wishes to keep using this record then Medicaid information from the duplicate ID will not be re-entered on the "kept" ID. On the duplicate ID, close the Medicaid/Insurance record by entering an "effective from" date equal to the current date on the PA05 screen.
- If there is an "open" Medicaid/Insurance record with the "kept" ID and the user wishes to use the record associated with the duplicate ID instead then Medicaid information from the duplicate ID will be re-entered on the "kept" ID. On the "kept" ID close the Medicaid/Insurance record by entering an "effective from" date equal to yesterday. The user must then delete the PA05 screen from the duplicate ID before adding the Medicaid information to the "kept" ID. When adding the record to the "kept" ID it will be necessary to use an effective date equal to today's date in order to prevent overlapping Medicaid records for the "kept" ID.
I.6 Combining Data from Duplicate Records
After the user has determined which ID number will be "kept", it will be necessary to combine the data from the ID number that will be merged (not kept) with the data on the participant ID that will be kept. Combining the data is accomplished by reentering the data onto the participant ID number to be kept. The data may include: Program Information (PA15); Medicaid/Insurance (PA05), Health Visit Information (PA08, PA09); Birth Information (PA11); Prenatal Information (PA07); Postpartum Information (PA10); Group Relationships (PA06), Household Members (PA16), System Cross-Reference (PA17); Actual Services (SV01); non-WIC Assessments (AS01); Referrals (RF01); Activities (SV02); Case Notes (CM04); Goals (CM02); Planned Services (CM03); Scheduled Appointments (SC02 and/or SC03); Immunizations (PA12); EI Program Data (PA35); and EI Participant Forms (CM10 - EICV & EILD templates).
The following rules apply when reentering data onto another ID:
- If family case management assessments are to be reentered (AS01 Screen), keep in mind that goals and planned services will be generated from these assessments. These goals and services may have been valid at the time the original assessment was completed but are no longer valid. Delete the "invalid" goals as necessary.
- If re-entering past services (SV01 screen) there are some very specific edits on this screen that may prevent some information from being re-entered. These edits apply to service date and program, category and/or age of the participant on the date of the service.
- If the ID to be kept has a valid prenatal record for the current pregnancy, DO NOT re-enter a prenatal record for the same pregnancy. This rule also applies to postpartum records. REMEMBER: each pregnancy can only have one prenatal and one postpartum record. Therefore it may not be necessary to re-enter prenatal/postpartum information onto the ID being kept if that information is already there. In some cases screens for the ID being kept may have blank fields that could be filled with information from the ID being duplicated out. The screens for the ID being kept can be edited and information updated as needed. NOTE: If the EDC date on the prenatal screen is changed on an active WIC, the scheduled termination date of the participant will likely be automatically be adjusted.
- Infants and children can have only one birth record. If the birth screen for the ID being kept has blank fields and the screen from the ID being duplicated out has information in those fields, edit the screen and update information as needed.
IMPORTANT NOTE: If the two participants have differences in Last Name, First Name, Middle Initial, DOB, gender or any other demographic discrepancies, make sure that the participant ID to be kept has the more accurate and complete information. Edit and update information on the enrollment screen, including residence address, as needed.
I.7 Beginning the Process of Manually Resolving Duplicates
Step 1: Using the suggested guidelines, determine the participant ID number that should be kept.
For the ID number that will no longer be used:
Step 2: Determine which screens have data that will be re-entered onto the ID number being kept and "print screen" those screens. (If the participant was not previously enrolled at the site, they will need to be enrolled and any additional information would need to be provided from the other site or from the participant.) ALWAYS SCREEN PRINT THE MEDICAID/INSURANCE (PA05) INFORMATION THAT REPRESENTS THE PARTICIPANT'S CURRENT MEDICAID ELIGIBILITY.
Step 3: Edit the Participant Enrollment (PA03) Screen and enter a "D" (Duplicate) in the Medical Risk field. When the record is saved, the message "View Alerts DUPLICATE" will be displayed in the Participant Standard Processing Block (PSPB). An alert comment that reads "This participant has been identified as a duplicate by clinic number ______" has also been created and will be uploaded to the Central Office. This alert comment requires no acknowledgement and cannot be deleted. This step will "flag" the duplicate participant for other users of the system. Duplicate alerts can be viewed statewide using the F2 shared key. The site that identified the duplicate is also displayed in the alert message.
NOTE: NEVER CHANGE THE LAST NAME, FIRST NAME OR ADDRESS LINE OF THE PARTICIPANT TO "DUPLICATE", "UNKNOWN", ETC.
Step 4: Terminate the "duplicate" participant from all programs. This process should follow the normal participant termination procedures for each program (refer to program specific procedures). Edit the Program Information (PA15) screen and change the status from 'A' to 'T' and use termination reason code '11' (Duplicate Record) on all active program records. NOTE: WIC IS THE EXCEPTION. DO NOT TERMINATE AN ACTIVE WIC participant AS A DUPLICATE RECORD. WHEN THE PARTICIPANT IS DUE FOR CERTIFICATION/RECERTIFICATION, THE USER MAY CERTIFY UNDER THE PARTICIPANT ID THAT IS TO BE KEPT. FOR THE ID NUMBER NOT BEING KEPT, LET THE PARTICIPANT AUTO TERMINATE. For all programs except WIC, the participant can be re-activated under the ID number being kept. All other program status codes such as wait list or eligible should also be terminated since this participant ID will no longer be used.
Step 5: Refer to the guidelines in the section "Please note the following guidelines that apply" on page 7 for the appropriate action to take with the duplicate's information on the Medicaid/Insurance (PA05) screen.
Step 6: EI Records Only: For service authorizations that will not be kept, use "discontinued" and enter an End Date that reflects the termination date entered on the EI program record on the PA15 screen.
For the ID number that will be used:
Step 1: Using the screen prints, re-enter the participant information as appropriate onto the ID number that is being kept. If the participant needs to be re-activated into programs, follow the normal program activation procedures as outlined in the Cornerstone User Procedure Manual.
Step 2: Establish group relationships as necessary for the ID number that is being kept, following procedures outlined in the Cornerstone User Procedure Manual for creation/termination of group relationships.
Step 3: With the "kept" participant ID in the PSPB, go to the System Cross Reference List (PA17) screen. Record the participant ID number of the "duplicate" using the system code of "MDUP" (manually resolved duplicate).
Step 4: EI Records Only: When re-entering service authorizations on the record being kept, make sure the Begin Date is the day following the termination date that is being entered for the service authorizations not being kept. This will eliminate any gaps in billable service time.
REMEMBER: The participant ID that has been "duplicated out" will continue to be seen by the local site. To identify flagged duplicates, look for:
- ***DUP*** in the last column on the right side of both the Participant Browse Local and the Participant Browse Statewide, or
- "View Alerts Duplicate" in the participant window on any screen in the local site. The user can also see the alert comment "This participant has been identified as a duplicate by clinic number ___" in the local site on the Alert Comments (CM07) screen and statewide by accessing the F2 shared key on the Alert Comments (CM07) screen.
A REGIONAL REPRESENTATIVE IS AVAILABLE TO ASSIST THOSE WHO WORK WITH THESE PROCEDURES. PLEASE CONTACT THE ASSIGNED REPRESENTATIVE FOR TECHNICAL ASSISTANCE.