With the introduction of NPI, a payer’s billing process is now going to be centered on the proper implementation of this new identifier. Incorrect matching of a provider’s NPI to proprietary identifiers will severely impact auto-adjudication first-pass rates. The increased volume of pended claims will create significant operational expense through the extended customer service cycle required to resolve each claim.
With all the challenges rising from the NPPES, including slow provider enumeration, incomplete data dissemination, and lack of data validation, payers are starting the NPI implementation process at a huge disadvantage. The ability to create accurate crosswalks between NPIs and proprietary identifiers is crucial to keeping the business running during and after the implementation. The ability to maintain first-pass rates in claims auto-adjudication relies on the accuracy and completeness of the crosswalks. Unfortunately, the creation of these crosswalks will be severely hampered both by challenges with the NPPES and by the poor data quality that plagues legacy provider systems.
Very simply, without a clean provider file from which to start and an external source of reference data to enable NPI crosswalking, the crosswalks will be inaccurate and incomplete. The result will be far from administrative simplification.
Health Market Science is uniquely positioned to address the data quality challenges that surround the implementation of NPI. Based on our market leading technology, comprehensive reference data, and our flexible deployment options, Health Market Science offers payers:
Despite a payer’s chosen implementation strategy, without a clean provider database, success will be limited. Health Market Science can rapidly clean inaccurate provider databases by directly processing NPI and other core billing identifiers against the most accurate and comprehensive source of healthcare provider information, the HMS MasterFile™. In addition, we can build the accurate crosswalk files required to feed the real-time systems that will translate incoming NPIs to the appropriate contract IDs. With these solutions, payers can ensure their first-pass rates will not plummet throughout the implementation of NPI.
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