QuestAnalytics-ManagingYourProviderNPIData

MANAGING YOUR PROVIDER NPI DATA

QUESTIONS TO ASK YOUR TEAM Always keep these in mind.

Do we have Deactivated Providers in our data that are being included in our network analysis, listed in our provider directory and in our HSD table?

WAYS TO IMPROVE YOUR PROVIDER DATA

To help your members receive the information and care they need.

REMOVE
DEACTIVATED
NPIs

Providers who have reactivated under a new NPI, retired or passed, need to be removed from your directory and correctly managed in your database. We recommend you review your data at least once a week and remove all deactivated providers.

Are there Invalid or Missing NPIs we are not getting credit for in our network analysis? Most often this results from entry error.

CORRECT
INVALID OR
MISSING NPIs

A best practice is to take out these providers until you have the correct NPI information.

Which providers do we have mislabeled as accepting Medicare Advantage when in fact they do not?

CORRECT PROVIDERS
MISLABELED AS ACCEPTING
MEDICARE ADVANTAGE

Then, measure the adequacy of your MEDICARE ADVANTAGE

Audit your data to see If any providers have decided to Opt-Out of Medicare Advantage. If they have, you will want to update your database and directory. Then, measure the adequacy of your network to identify any new gaps.
!

How many providers are listed on the Office of the Inspector General’s List of Excluded Providers?

REMOVE PROVIDERS
ON THE OIG
EXCLUSION LIST

Providers listed here should be removed from your data and directory immediately.