Chafie Health Data Solutions

ProviderKey offers provider identification services using an information processing system based on a National Healthcare Provider Database comprised of more than 15 proprietary tables containing more than 20 million records. Data in the ProviderKey system is managed by an artificial intelligence, rules-based methodology employing heuristic processes for evaluating, adding and retrieving data. ProviderKey incorporates any unique data gleaned from the provider and claims data processed through the system even if the data contains errors. The unique data elements are connected to one or more healthcare providers and every identifying data element, or combination of data elements, is assigned a ID KEY and indexed. Unique data include alternate and erroneous spellings of Healthcare Provider Database names, addresses, degrees, specialties, phone numbers, identification information and affiliations.

To her patients, she’s simply Dr. Jones. But in payor databases due to misentry, misspelling or misunderstanding she and her small practice have over 30 unique listings. ProviderKey assigns Dr. Jones a single ID KEY, which then vigilantly watches for her next bad data entry and automatically corrects it.
ProviderKey delivers an integrated database listing of:

physicians
hospitals
nurses
dentists
mental health specialists
pharmacies
laboratories
ancillary providers
equipment suppliers

along with related addresses, phone numbers, specialties and identification information, network contracts and provider affiliations.

The system retains all data along with related misspellings, data entry errors and historical information.

Multiple data elements are incorporated in the following tables:

Names: Table of all names and every variation (example – Jane J Jones, Jane Jones, Jan Jones, JS Jones, J Jones and Jana Jones could all be the same person). All names are parsed into First, Middle, Last Names, Suffix and Degree and proper cased. The correct name of a person, organization or facility is ranked and linked to all variations of the name ever found in any provider network database or claims record as well as other sources.

Addresses: All addresses are verified using US Postal Service standards. All alternatives to every address are stored and the verified proper address is ranked along with the type of location (practice, business or both). All addresses incorporate effective and termination dates and all historical addresses are maintained.

Specialties: The system maintains an ever-expanding table of physician and provider specialties and categories incorporating over 24,000 variations. The specialties used by every provider are related to a standard provider category specialty and sub-specialty. Every specialty variation used by a provider is stored with the actual primary specialty ranked and scored based on the source data and frequency of use. The system maintains a cross-reference to its standard specialties and all the proprietary specialty lists maintained by most provider networks. Specialty criteria may contain as few as 20 selections or more than 850.

Data from approximately 100 PPO networks are cleaned, standardized and incorporated into the ProviderKey database.

Additions and changes for each release of the National Provider ID database are incorporated by ProviderKey.

Applications access the ProviderKey database on a real-time, near real-time and batch basis using web services and batch record interfaces.

Phone Numbers: Phone number and the type (practice, business or both and fax) are stored for each provider with a corresponding address.

Provider Networks: Provider network affiliations along with effective and termination dates are maintained.

Source IDs: Source IDs for all providers are maintained, including National Provider ID, state licenses and PPO network-specific IDs – plus e-mail addresses if available.

Affiliations: Hospital, physician group and medical group affiliations are maintained.

Unique ID: Each provider record including address, specialties and provider network affiliation, is assigned a unique ID KEY by the system. This ID KEY insures the identification of a provider for a unique data set and matches are scored based upon each combination of a name with the associated address, specialty and network affiliation. Every variation of every name and related data is assigned a unique ID KEY and linked to the correct primary name and address of a provider.

Clients access the database through an interactive web browser, batch record submissions or computer-to-computer through a web service.

System to create a custom provider network (a Custom Provider Network – CPN) by redefining a PPO network(s) by geography and specialties.
Web provider finder for plan members giving access to a custom provider network.
Provider in-network resolution for claims administration.
Match provider network data to historical records in a claims system.
Identification of providers for a claim and tagging the record with a unique ID and clean provider data.
Cleaning provider network data and formatting for use by client systems.
PPO network provider access and name-matching reports.

ProviderKey - A Chafie Health Data Solutions, LLC Product
7557 Rambler Road, Suite 626. Dallas, TX 75231