支付金额大于支付的总金额

Question

我有一个Access DB，我正在为客户维护。

我有4张桌子。索赔，资格，药房和代码。

我使用的主键是PHID + SID =我链接到每个表的MemberID，然后代码表仅用于描述。请参阅下面的查询，以便更好地查看...

查询1：Member_Claims_Query

SELECT
Eligibility.GROUPID, 
Eligibility.PHID & '-' & Eligibility.SID AS MemberID, 
[Eligibility].[DOB] AS DOB, 
Eligibility.GENDER, 
Eligibility.RELATIONSHIP_CODE, 
MaxDiagDollars.HighestDiagPaid/SUM(Claims.PAID_AMT) AS ['%'],
MaxDiagDollars.HighestDiagPaid/SUM(Claims.PAID_AMT) as 'Percent',
ROUND(SUM(Claims.PAID_AMT)) AS TOTALPAID,
ROUND(Sum(IIf(Format(Serv_Beg_Date,'yyyy')='2011',Claims.PAID_AMT,0))) AS 2011TOTALPAID, 
ROUND(Sum(IIf(Format(Serv_Beg_Date,'yyyy')='2012',Claims.PAID_AMT,0))) AS 2012TOTALPAID, 
ROUND(Sum(IIf(Format(Serv_Beg_Date,'yyyy')='2013',Claims.PAID_AMT,0))) AS 2013TOTALPAID
FROM (Claims 
INNER JOIN Eligibility 
ON (Claims.[SID] = Eligibility.[SID]) AND (Claims.[PHID] = Eligibility.[PHID])) 
INNER JOIN (SELECT PHID, SID, MAX(TotalPaid) AS HighestDiagPaid 
FROM (SELECT [PHID], [SID], DIAG_CODE1, SUM(PAID_AMT) AS TotalPaid FROM Claims GROUP BY [PHID], [SID], [DIAG_CODE1])  AS [%$##@_Alias] GROUP BY PHID, SID)  AS MaxDiagDollars ON ( MaxDiagDollars.[PHID]=Eligibility.[PHID] ) AND ( MaxDiagDollars.[SID] = Eligibility.[SID] )
WHERE Eligibility.DOB < DateAdd( 'y', -2, DATE())
GROUP BY 
Eligibility.GROUPID, Eligibility.PHID & '-' & Eligibility.SID, [Eligibility].[DOB], Eligibility.GENDER, Eligibility.RELATIONSHIP_CODE, MaxDiagDollars.HighestDiagPaid
HAVING SUM(Claims.PAID_AMT)>10000 and  MaxDiagDollars.HighestDiagPaid/SUM(Claims.PAID_AMT) <= 0.80;

此查询应该采用每位会员支付的总金额并给出总金额付款，然后每年分手。

查询2：Member_By_Diag

SELECT 
Eligibility.PHID & '-' & Eligibility.SID AS MemberID, 
Claims.Diag_Code1, 
ROUND(Sum(Claims.PAID_AMT)) AS TotalPaid, 
ROUND(Sum(IIf(Format(Serv_Beg_Date,'yyyy')='2011',Claims.PAID_AMT,0))) AS 2011TotalPaid, 
ROUND(Sum(IIf(Format(Serv_Beg_Date,'yyyy')='2012',Claims.PAID_AMT,0))) AS 2012TotalPaid, 
ROUND( Sum(IIf(Format(Serv_Beg_Date,'yyyy')='2013',Claims.PAID_AMT,0))) AS 2013TotalPaid
FROM 
(Claims 
INNER JOIN Eligibility 
ON (Claims.[SID] = Eligibility.[SID]) AND (Claims.[PHID] = Eligibility.[PHID])) 
INNER JOIN Pharmacy 
ON (Eligibility.SID = Pharmacy.SID) AND (Eligibility.PHID = Pharmacy.PHID)
GROUP BY 
Eligibility.PHID & '-' & Eligibility.SID,  Claims.Diag_Code1
HAVING count( [Pharmacy].[NDC] ) >4 and count(IIF(Claims.REV_CODE= '450',1,0) ) > 1
ORDER BY Eligibility.PHID & '-' & Eligibility.SID;

第二个查询基本上应该为每个成员获取代码，并通过诊断代码分解其数量。

查询3：combined_query

SELECT *
FROM (Member_Claims_Query AS a INNER JOIN Member_by_Diag AS b ON a.MemberID=b.MemberID) INNER JOIN Codes AS c ON c.DxCode = b.Diag_Code1;

问题 我的客户向我发送了一封电子邮件，说明Member_By_Diag查询中的总付费有时高于Member_By_Claim查询的总付费。然而他们的计算方法却是一样的。

我打开了数据库，写了一个简单的查询，看看有多少记录在b.Total_Paid（Member_By_Diag.Total_Paid）大于Member_Claims_Query.Total_Paid的地方返回。

在这种情况下，它返回了262/1278条记录。

SELECT * FROM Combined_Query WHERE b_TotalPaid > a_TotalPaid

此图片精确地描述了我与客户一起看到的内容。

如你所见。 a_TotalPaid＆gt; b_TotalPaid。但如果你查看我的查询，它们是一样的吗？这是一个问题小组吗？或加入问题？任何帮助将不胜感激。

Answer 1

可能有助于此的查询之间存在一些差异。主要的罪魁祸首是你的INNER JOIN语句和你的HAVING语句。这些可以很容易地排除会对TotalPaid字段产生影响的记录。如果没有原始数据集，我可以告诉你的不多，但你可能想要运行这些查询并使用删除和插入各种INNER JOIN和HAVING子句来查看哪一个正在删除导致你的记录总数不相等。

Answer 2

我很欣赏每个人的答案...你没有完全回答这个问题，但是Pharmacy的内部联接引起了这个问题，当我添加一个计数时，我专门用它来处理HAVING子句（*我注意到它实际上是在增加我的结果。对于Ex。如果一个成员有7个索赔，并且有6个药房记录，它会使它成倍增加42个记录使我的总付费极高，而且它们与索赔本身无关......因此是最终的问题。以下是Member_By_Diag查询中的解决方案：

    SELECT Eligibility.PHID & '-' & Eligibility.SID AS MemberID, Claims.Diag_Code1, Round(Sum(Claims.PAID_AMT)) AS TotalPaid, Round(Sum(IIf(Format(Serv_Beg_Date,'yyyy')='2011',Claims.PAID_AMT,0))) AS 2011TotalPaid, Round(Sum(IIf(Format(Serv_Beg_Date,'yyyy')='2012',Claims.PAID_AMT,0))) AS 2012TotalPaid, Round(Sum(IIf(Format(Serv_Beg_Date,'yyyy')='2013',Claims.PAID_AMT,0))) AS 2013TotalPaid, Count(*) AS Expr1
FROM (Claims INNER JOIN Eligibility ON (Claims.[SID] = Eligibility.[SID]) AND (Claims.[PHID] = Eligibility.[PHID])) INNER JOIN ***(SELECT PHID, SID, COUNT(NDC) AS RXCount FROM Pharmacy GROUP BY PHID, SID ORDER BY PHID, SID)  AS Pharmacy*** ON (Eligibility.SID = Pharmacy.SID) AND (Eligibility.PHID = Pharmacy.PHID)
GROUP BY Eligibility.PHID & '-' & Eligibility.SID, Claims.Diag_Code1
***HAVING Count(IIf([Claims].[REV_CODE]='450',1,0))>1***
ORDER BY Eligibility.PHID & '-' & Eligibility.SID;

这使美元看起来更合理。谢谢大家。