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PartyQualityInsight™ Provider Crosswalk
Healthcare Provider Cross Reference with NPPES NPI Maintenance

Health care plans, payers, clearinghouses, pharmaceutical companies, pharmacies and medical device manufacturers must have complete and accurate information about the healthcare providers they do business with. Yet they have no control over how providers comply with National Plan & Provider Enumeration System (NPPES) requirements. NPPES National Provider Identifiers (NPIs) do not have a one to one relationship with legacy identifiers for providers. There may be one or more NPIs that relate directly to one or more legacy identifiers. Providers may have Individual (type1) and /or Organizational (type2) NPIs. Organizational sub-part NPI assignments may reflect service location, specialty, licensing or billing relationships. Providers may have multiple names, addresses, affiliations and tax identifiers. Information about providers comes from Centers for Medicaid and Medicare Services (CMS), Drug Enforcement Administration (DEA), State Licensing agencies, the Social Security Administration (SSA) - and changes constantly.

The PartyQualityInsight™ Provider CrossWalk solves the provider reference data problem!

Leveraging IBM® InfoSphere™ technology the PQI Provider CrossWalk processes provider data from CMS, DEA, state agencies and other sources in the enterprise to determine the unique providers represented in your data. An easy to use browser interface delivers dashboards and details suitable for both business people and technicians. A comprehensive set of outputs and services is used to load, integrate and maintain high quality provider data for Provider Services, Claims, Health Care Analytics and Fraud and Abuse applications.

PQI Provider CrossWalk: a complete set of provider data quality, matching and integration functions

  • NPI Compliance and Validation – Ensure the 10 digit code complies with the format and the provider reference is valid.
  • Provider data quality and cleansing – Standardize, measure, validate and improve all the data associated with providers.
  • Provider probabilistic matching, survivorship and key persistence – Identify relationships and duplicates, create composite views and maintain a comprehensive provider cross reference.
  • NPI to Legacy CrossWalk – dynamically match legacy data to cross walk relationships between NPIs and legacy identifiers.

The PartyQualityInsight™ Provider CrossWalk, powered by IBM® InfoSphere™ software makes it possible to implement an internal provider data reference solution that connects external provider data with your internal applications. This means that all of your business functions that require accurate and complete information about healthcare providers access a single high quality cross reference. Higher first pass adjudication rates, better and more productive provider service, more accurate analytics and greater insight into fraud and abuse. Better provider data quality improves business performance!

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DataQualityFirst™, PartyQualityInsight™ and Cure Customer Data Disorder™ are trademarks of DataQualityFirst Inc. IBM®, Information Server®, InfoSphere™, QualityStage® and DataStage® are trademarks of the International Business Machines Corporation. Other company, product or service names may be trademarks or service marks of others.
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