## 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.