Crosswalking Challenges with NPI

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Presentation transcript:

Crosswalking Challenges with NPI Matt Wallach Chief Marketing Officer Health Market Science, Inc.

Agenda Why Crosswalks? Major Steps to Building an NPI Crosswalk System NPI Crosswalk Challenges Crosswalk File vs. Crosswalk System © Copyright 2005 Health Market Science, Inc. All Rights Reserved.

Two Main NPI Implementation Strategies Why Crosswalks? Two Main NPI Implementation Strategies Once healthcare companies have committed to NPI compliance, the first major decision is which implementation approach to take: Big bang approach Crosswalk approach Mike: © Copyright 2005 Health Market Science, Inc. All Rights Reserved.

Big Bang Approach to Compliance Why Crosswalks? Big Bang Approach to Compliance Requires changing all legacy systems to accept NPIs ahead of the compliance dates NPI 837 Claim NPI NPI © Copyright 2005 Health Market Science, Inc. All Rights Reserved.

Crosswalk Approach (Payer Perspective) Why Crosswalks? Crosswalk Approach (Payer Perspective) Allows companies to maintain existing systems through NPI implementation and update them over time…on their own schedule Crosswalk Files 837 Claims © Copyright 2005 Health Market Science, Inc. All Rights Reserved.

Crosswalk Approach – Major Steps Building an NPI Crosswalk System Crosswalk Approach – Major Steps Cleanse legacy provider data Gather NPIs Match NPIs into cleansed legacy data to create accurate cross-references Create crosswalk files with perspective Load crosswalk files into business rules engine where logic is executed against incoming/outgoing data Repeat steps 1-5 © Copyright 2005 Health Market Science, Inc. All Rights Reserved.

NPI Crosswalk Challenges Matching NPIs to Legacy Data will be Extremely Challenging due to NPPES Dynamics NPPES Dynamic What It Means for Matching 1) Lack of data Lots of unmatched records Hard to determine when matching is complete 2) Lack of data verification Data entry errors will persist through the life of the NPPES, making matching more difficult 3) Lack of data availability NPPES data released will be insufficient for reliable matching 4) Duplicate records Hard to determine which NPI is correct 5) Complex, Many to Many relationships NPI will need to be continuously matched through a data integration/matching process into legacy healthcare databases Many to Many, Many to One, and One to Many relationships mean off-the-shelf data integration software will not be able to create the crosswalks © Copyright 2005 Health Market Science, Inc. All Rights Reserved.

Matching NPPES and Legacy Systems NPI Crosswalk Challenges Matching NPPES and Legacy Systems Legacy Record 1 Name: Dr. John Wayte Born: 6/12/1945 Addr: 123 Main St. SLN: PA: MD016399E Legacy ID: BCBS001 Legacy systems have duplicates and incomplete data NPPES has a different name and address State License # is incorrect in NPPES These records are impossible to match accurately in this manner How would a payer create the NPI to Legacy ID crosswalk? NPPES ?? Name: Jonathan Waite Born: 7/12/1945 Addr: 456 Andrew St. SLN: PA: MD016388E NPI: 1234567893 Legacy Record 2 Name: Dr. Jack Waite Born: Addr: 800 Broad St. SLN: DE: MD029377F Legacy ID: BCBS002 ?? © Copyright 2005 Health Market Science, Inc. All Rights Reserved.

External Data is Required to Match NPPES NPI Crosswalk Challenges External Data is Required to Match NPPES Legacy Record 1 Name: Dr. John Wayte Born: 6/12/1945 Addr: 123 Main St. SLN: PA: MD016399E Legacy ID: BCBS001 Name 1: Jack Waite Name 2: John Wayte Name 3: Jonathan Waite Born: 07/12/1945 Addr 1: 123 Main St. Addr 2: 456 Andrew St. Addr 3: 800 Broad St. Addr 4: 1200 Main St. Addr 5: PO Box 123 SLN1: PA: MD016399E SLN2: DE: MD029377F Yes NPPES Name: Jonathan Waite Born: 7/12/1945 Addr: 456 Andrew St. SLN: PA: MD016388E NPI: 1234567893 External Data Legacy Record 2 Name: Dr. Jack Waite Born: Addr: 800 Broad St. SLN: DE: MD029377F Legacy ID: BCBS002 Yes These records can only be matched through the use of an external source of reference data © Copyright 2005 Health Market Science, Inc. All Rights Reserved.

A Crosswalk System is Required Crosswalk File vs. Crosswalk System A Crosswalk System is Required A single crosswalk file will not be sufficient for any company to successfully implement NPI Crosswalk files must have both perspective and timing The perspective of a crosswalk depends upon the downstream user The accuracy of a crosswalk is dependent upon timing The NPI Crosswalk System must meet the following requirements: Able to easily load multiple sources of provider information Use external data source to increase match rates and match accuracy Use sophisticated matching algorithms that work with healthcare data Have flexible extraction capabilities able to create multiple crosswalk files with perspective and timing Be fully integrated with a business rules engine to run the logic Mike: © Copyright 2005 Health Market Science, Inc. All Rights Reserved. Confidential Information

Contact Information Matt Wallach Chief Marketing Officer 610-994-5126 mwallach@healthmarketscience.com Dr. Michael Nelson Director, Product Marketing 610-994-5156 mnelson@healthmarketscience.com For more information, visit www.healthmarketscience.com/npi or www.npiright.com. © Copyright 2005 Health Market Science, Inc. All Rights Reserved.