I work in the healthcare industry so our 3 data domains are Providers, Claims, and Members.
Our Member model built out in DV is actually really good. But, I’m having issues with the Provider model.
Current Business Concepts for Provider we have:
Individuals - BK is NPI
Provider Organizations - BK is NPI + TaxId
Provider Organization Locations - BK is NPI + Provider Medicaid + Zip Code
So, every individual needs to be identified by an NPI, its sort of like their Social Security #. So, we are good on that front. The real issue is our Provider Organizations / Locations.
Ideally, an organization should have both NPI/Tax_Id. However, this is not always true in our source systems. For example, we have providers that only have the NPI, but no TaxId. Or only have the TaxId but no NPI. So, when I create the BKs for an organization, I allow these combinations to flow into the HUB… since i’m staying factual to the source systems.
I’m wondering if this is the correct way to go about it?
We are also in the process of changing to a new claims system, and all our providers in there must have NPI/Tax_Id. Which, will really help improve the model.
An example I wanted to talk about is where our main source system has only NPI for a provider record, but our secondary system has the NPI & TaxId. Currently, I bring both records into the HUB as 2 separate records. And then, I create a SAL in the business layer to link them together. Is this the correct way to do this?
NPI: 100 / Tax_Id: ’ ’ (source A)
NPI: 100 / Tax_Id: 123 (source B)
In the SAL, the provider record without the TaxId will become associated to the record with the TaxId.
I think there is enough in this topic so far, so i wont talk about the location stuff just yet.
Anyone have any input? We are also trying to get our main system cleaned up, so records without the TaxId they will go back in and input a value.
Thanks in advance,