January 7, 2012

CMS Redacts NPI in PECOS File: Solution

The PECOS Ordering and Referring Report has been a tremendous resource for those of us who have to know whether a business partner is eligible to bill Medicare. A great example is the DME supplier who needs to know that the physician who orders a patient's medical equipment is authorized to do that; could cost him money when the claim is rejected. Well, that report has just gotten a mite less useful.

(UPDATE: Here's a press release we just sent on this issue, and a page on our website with details.)

Starting with the current release, CMS has blocked out the first 6 digits of the NPI number. It looks like ******1234. Utterly useless if you want to incorporate that file into your business systems. We have a solution!

CarePrecise specializes in healthcare record linkage projects. We collect data files from many sources and, using our QoRelate record "linking and shrinking" system, match them into our NPI database. The PECOS Ordering and Referring Report and the pending enrollment files are no exception. Our system can still tell you which providers are enrolled to bill Medicare or have a pending enrollment -- with their NPI number and a lot of additional information the PECOS reports never offered.

In fact, we not only match up NPI numbers with PECOS enrollment, we also do it with the federal List of Excluded Providers (LEIE), the now deprecated but still useful UPIN registry, state license numbers, phone and fax numbers, both mailing and practice addresses, economic data from the US Dept of Commerce, and much more. Now we can even tell you how many providers practice at the same location, and give you the providers who report as a multi-specialty or single specialty practice group.

It's all in CarePrecise Gold (and everything except the economic data is in our basic dataset, CarePrecise Access), for 3.5 U.S. healthcare million providers.

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