NPI compatibility Electronic Medical Billing – Opportunities payer is to streamline operations

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Motivation – Poor Provider Data Quality

demographic information provider’s dynamic nature. Providers move their offices, improve facilities, change their phone numbers are tied and stop exercising. Data quality is poor healthcare affects almost all aspects of the company’s Healthcare payer, diluted earnings and a member of the goodwill. Their applications, interfaces, databases, records and reports now use legacy provider identification. Publisher data often is not one but many different databases throughout the healthcare payer IT companies, including many varieties of the same hand record. Variants service and discrepancies generate as much as 12 percent of physicians checks again, raising the number of support calls, increasing the manual claims adjudication and prevent identification of billing fraud and abuse. For example, the cost of one check reissue one can reach $ 20 for opening / handling, investigating right hand, restoration and mailing stop

Opportunity -. HIPAA

1996 Health Insurance Portability and Accountability Act (HIPAA) established a national privacy and security standards for electronic health care transactions, including national identifier for providers, health plans and employers. Accordingly, May 23, 2007, health care providers and all health plans and such information will change both their processes and systems to implement HIPAA’s National Provider Identifier (NPI) regulations.

Successful transition to NPI is important to every aspect of the business and affect eligibility and authorization processing, provider enrollment, contracts and directories, said judgment and payment, reference and reporting. It

  • Simple communication and management
  • Facilitates efficient electronic dissemination of health information
  • optimizing analyze billing fraud and abuse
  • Adds collection efforts
  • reduces the cost of reissuing checks
  • improve the accuracy of provider directories and reduces support costs
  • Reduces cost claims court – the cost of auto-adjudicated claim is $ 0.40, a 10-fold less than the manually defined claim
  • .

Router – NPI

  • unique 10-digit identification number
  • Assigned for a life of service provider and de-activated only upon death, retirement, or identity theft
  • The multiple legacy provider identification number, including Medicare Upin, commercial payer IDS, and state Medicaid ID
  • Independent major changes hand information, such as location or practice specialty

payer Challenges

  • Clean – create a good provider records from the seat, standards, improve and integrate legacy data provider.
  • Cross Walk – Build a crosswalk between NPI and legacy provider name. Since many providers have multiple locations and membership, the crosswalk on NPIs to legacy provider identifiers used in different files provided could be a complex one-to-many mapping.
  • Keep – Actively manage and clean provider data records as they change in the future
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