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

2. Agenda Why Crosswalks? Major Steps to Building an NPI Crosswalk System
NPI Crosswalk Challenges
Crosswalk File vs. Crosswalk System
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3. 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:
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4. 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
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5. 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
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6. 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
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7. 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
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8. 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:
Legacy Record 2
Name: Dr. Jack Waite
Born:
Addr: 800 Broad St.
SLN: DE: MD029377F
Legacy ID: BCBS002 ??
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9. 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:
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
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10. 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

11. Contact Information
Matt Wallach Chief Marketing Officer
Dr. Michael Nelson Director, Product Marketing
For more information, visit or
© Copyright 2005 Health Market Science, Inc. All Rights Reserved.