Enclarity ProviderPoint for Claims Indexing solves business intelligence’s immediate and ongoing need to identify and link unique providers across claims stored in databases or a data warehouse, regardless of changes to name and business affiliation, TIN, Provider ID, practice or billing information over time. With Enclarity ProviderPoint for Claims Indexing, your organization will benefit from more accurate and complete data analysis of provider claims, billing, treatment patterns, fraud detection, pricing and practice outcomes across claim records.

 

Solving a fundamental problem for data warehouse owners

 

Claims that are housed in a payer database or warehouse are difficult to aggregate across specific providers. Frequently, different provider IDs are assigned to the same provider to account for variations in name, specialty and address. Tax Identification Numbers (TINs) are related to a billing and/or group practice; as a result, TINs are not reliable at a practitioner level, and you can’t always count on NPIs being available either. Without accurate and up-to-date referential data, it can be difficult to figure out which provider is the correct one across a claim. And that can mean less than optimal results when you’re trying to compile and discover business intelligence trends around specific provider practice patterns over time. If only there was a way to get a better sense of all of the claims submitted by specific providers over time so that you could accurately assess what each provider is treating and charging across all claims. With Enclarity ProviderPoint for Claims Indexing, you can. Right now.

 

ProviderPoint for Claims Indexing offers data stewards, data warehouse and business intelligence managers a clear method to accurately and completely link as well as aggregate claim data at a provider level, to perform provider practice analyses on submitted claims.

 

Put the power of accurate information in the hands of your business intelligence staff to aggregate claim data

 

ProviderPoint for Claims Indexing offers a unique approach to identify and aggregate providers across claims. To accurately distinguish individual providers, we apply the Enclarity Persistent Key, which identifies a provider regardless of the variations in name or address changes. Here’s how:

 

• To ensure that business intelligence can unify processed claims with your master provider file, we’ll append the Enclarity Persistent Key to it. Alternatively, Enclarity Provider SelectFile® can be used as the master data file.
• Enclarity standardizes the provider information within the claim. We compare the information against our Master Provider Referential Database, the largest, most accurate and up-to-date collection of information about healthcare providers.
• Then, we apply the Enclarity Persistent Key to each claim. We can do this either in a batch mode or as a real-time application.
• The Enclarity Persistent Key can be used to aggregate claims over time.

 

 

Be confident that your organization has the information it needs to perform complete, accurate analysis and reporting.

 

• Link multiple providers to a single address with Enclarity’s Persistent Key
• Recognize the same provider across time and claim transactions regardless of variations in address, billing information, etc.
• Utilize our Master Provider Referential Database to maintain and assure that changes in information are linked to a practitioner persistent identifier
• Detect and report on practice patterns at a specific practitioner level
• Detect and report on practice patterns for a specific group practice
• Detect and report on practice patterns for a specific address
• Improve fraud detection, case management and fee schedule analysis at a practitioner level

 

ProviderPoint for Claims Indexing is part of a growing family of Enclarity hosted solutions that dramatically improve the quality and integration of your healthcare provider information, and give you greater insights to make your operations more productive.