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demand-driven-open-data / ddod-intake

"DDOD Intake" tracks DDOD Use Cases using GitHub issues. View the main DDOD site here
http://ddod.us
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Need ability to link NPI and PECOS datasets #14

Open dportnoy opened 9 years ago

dportnoy commented 9 years ago

USE CASE Description: Need ability to link NPI and PECOS datasets and compare against the address information on the claims in utilization data.

Value: This base level of information accuracy is a prerequisite before a patient can do even a basic search (let alone one with insurance info, cost, quality, etc.) This is widely acknowledged, and every healthcare stakeholder participates, commonly through purchasing this data from the AMA or vendors like enclarity.

Challenge: It’s difficult to match across these datasets and not clear how to resolve discrepancies in addresses. Doctors don’t update their NPI listings, but CMS pays the bills and they get sent to addresses, so the claims have additional address info.

Specifications:

loranstefani commented 9 years ago

Could be skirted (at least in part) by publishing the Group PAC ID with NPPES. It's dropped into Physician Compare, but with nothing but the Group Name included to match on, makes it challenging to tie to NPPES. We've done some fuzzy address matching, but with limited success/confidence.

dportnoy commented 9 years ago

Created page for full use case specifications and solution: http://hhs.ddod.us/wiki/Use_Case_14