1. 2010 UBO/UBU Conference Health Budgets & Financial Policy 1 Briefing: Data Quality Provider File Report Card/Details Report Date: 24 March 2010 Time: 1010–1200

2. 2010 UBO/UBU Conference Turning Knowledge Into Action Objectives Introduce the Air Force CHCS Provider File Facility Report Card Introduce the Provider Details Report Understand Provider File error criteria Provide tools to correct provider file errors Improve knowledge to resolve provider file errors 2

3. 2010 UBO/UBU Conference Turning Knowledge Into Action Overview CHCS Provider File Facility Report Card Provider Details Report Provider File Errors Provider File Error Criteria Provider File Error Examples Provider File Error Resolution 3

4. 2010 UBO/UBU Conference Turning Knowledge Into Action Provider File Facility Report Card What is the CHCS Provider File Facility Report Card? – Air Force specific initiative – Report produced to identify errors/discrepancies in the MTF’s CHCS Provider File – Performance measures capture and rank order by peer groupings – Report identifies eleven errors/discrepancies What is the Provider Details Report? – Excel spreadsheet that provides details of the flagged errors/discrepancies – Recent order entry activity provided for error prioritization 4

5. 2010 UBO/UBU Conference Turning Knowledge Into Action AFMOA DQ Provider File Roles/Responsibilities AFMOA SGAR/DQ Program Office Provide Analysis for MTF’s Guide MTF through data clean-up Conduct SAV as needed Facilitate training Provide best practices Help MTF focus efforts Provide performance measures 5

6. 2010 UBO/UBU Conference Turning Knowledge Into Action MTF DQ Team Provider File Roles/Responsibilities MTF Data Quality Team Action plan for provider file clean-up Share data to proper DQ teammates Report data at DQMC Provide feedback to AFMOA/DQ Identify training issues 6

7. 2010 UBO/UBU Conference Turning Knowledge Into Action 7 Provider File Facility Report Card Volume and error types will dictate cleanup strategies Monthly Error rates

8. 2010 UBO/UBU Conference Turning Knowledge Into Action 8 Provider File Facility Report Card Peer Group Comparison

9. 2010 UBO/UBU Conference Turning Knowledge Into Action Provider Details Report 9

10. 2010 UBO/UBU Conference Turning Knowledge Into Action CHCS Provider File Errors CHCS Provider File fields analyzed for errors – Naming Convention – NPI- Null – NPI – Duplicate – Signature Class/Provider Specialty Code (PSC) mismatch – Signature Class – PSC CHCS Provider File fields analyzed for errors – HIPAA Taxonomy – Primary Hospital Location – DEA/License # – Generic Provider – Potential Duplicates 10

11. 2010 UBO/UBU Conference Turning Knowledge Into Action Impacts of Provider File Errors What are the potential impacts of incorrect or null data in the CHCS provider file? – Patient Safety – Revenue – Workload – Data Integrity 11

12. 2010 UBO/UBU Conference Turning Knowledge Into Action Naming Convention Errors What criteria is used to identify naming convention errors? 12 Naming Convention First name has 3 characters or less First name has less than 4 characters and has a space Names that start with ZZ Characters other than Alpha, more than one comma or hyphen, more than 1 consecutive space, spaces before or after comma or hyphen

13. 2010 UBO/UBU Conference Turning Knowledge Into Action Naming Convention Error Examples Naming convention error examples – DOE,J (First name has 3 characters or less) – DOE,A BO (First name has 4 characters and has a space) – ZZDOE,JANE (Names that start with ZZ) – DOE,JANE. (Characters other than Alpha) – DOE,JANE,C (more than one comma or hyphen) – DOE, JANE C (more than 1 consecutive space) – DOE, JANE (spaces before or after comma or hyphen) 13

14. 2010 UBO/UBU Conference Turning Knowledge Into Action Naming Convention Error Resolution How to resolve the error? 1. Determine the correct legal name of the provider 2. If needed, use the Web sites below to confirm the correct provider name – https://nppes.cms.hhs.gov/NPPES/Welcome.do https://nppes.cms.hhs.gov/NPPES/Welcome.do – http://www.hcidealookup.org http://www.hcidealookup.org 3. If the provider name is correct, identify the naming convention error and correct in PRO (Provider File Enter/Edit) in CHCS – Example, remove period behind middle initial – Example, remove space between last name and first name 14

15. 2010 UBO/UBU Conference Turning Knowledge Into Action NPI-Null Error What criteria is used to identify NPI-Null errors? 15 NPI NPI is null while signature class is not a 0 (clerk with limited ordering) or 1 (nurse) and provider specialty code (PSC) is not a 600 or a 900 NPI is null, signature class is null, specialty is not 600 or 900 and provider flag is set to provider

16. 2010 UBO/UBU Conference Turning Knowledge Into Action NPI – Null Error Examples NPI – null error examples – Doe,John C has a signature class of an HCP(3) with a null NPI – Doe,Jane K has a provider flag set to provider, PSC of 001 (Family Practice Physician), and a null NPI – Doe,John M has a provider flag set to provider, PSC of 708 (Optometrist), and a null NPI 16

17. 2010 UBO/UBU Conference Turning Knowledge Into Action NPI – Null Error Example 17

18. 2010 UBO/UBU Conference Turning Knowledge Into Action NPI-Null Error Resolution How to resolve the error? 1. Determine the correct NPI number 2. Use the Web sites below to confirm the correct NPI number – https://nppes.cms.hhs.gov/NPPES/Welcome.do https://nppes.cms.hhs.gov/NPPES/Welcome.do – http://www.hcidealookup.org http://www.hcidealookup.org 3. Populate the provider’s NPI number in PRO (Provider File Enter/Edit) within CHCS 18

19. 2010 UBO/UBU Conference Turning Knowledge Into Action NPI-Duplicate Error What criteria is used to identify NPI-duplicate errors? 19 Duplicate NPI NPI match, duplicates

20. 2010 UBO/UBU Conference Turning Knowledge Into Action NPI-Duplicate Error Example NPI duplicate error examples Duplicate providers – DOE,JOHN has a NPI number – DOE,JOHN R also has the same NPI number Provider had a name change – DOE,CARRIE has a NPI number – SMITH,CARRIE has the same NPI number 20

21. 2010 UBO/UBU Conference Turning Knowledge Into Action NPI Duplicate Error Resolution How to resolve the error? 1. Determine if the duplicate NPI’s are attached to a provider entered in CHCS more than once 2. Providers entered two or more times need to be merged 3. Merging provider entries needs to be completed through your site CHCS site administrators – Merging protocol may differ from one MTF to another – Some sites may submit work order tickets to MHS 21

22. 2010 UBO/UBU Conference Turning Knowledge Into Action NPI Duplicate Error Resolution cont… How to resolve the error cont… 1. Determine if the NPI has been entered for more than one provider and they are not duplicate providers 2. Use the Web sites below to confirm the correct NPI number for both providers – https://nppes.cms.hhs.gov/NPPES/Welcome.do https://nppes.cms.hhs.gov/NPPES/Welcome.do – http://www.hcidealookup.org http://www.hcidealookup.org 3. Populate the providers NPI number in PRO (Provider File Enter/Edit) in CHCS 22

23. 2010 UBO/UBU Conference Turning Knowledge Into Action Signature Class/PSC Mismatch Error What criteria is used to identify signature class/PSC mismatch errors? 23 Signature Class/PSC Mismatch Signature class of 3 (HCP), 4 (countersigning HCP), or 99 (outside provider) with a provider specialty code (PSC) of 900 or 600

24. 2010 UBO/UBU Conference Turning Knowledge Into Action Provider Class/Signature Class Relation How is the provider class related to the signature class? – The provider class determines level of signature class authority for the provider – The provider class is a direct link for clinical and ancillary order entry – The provider class has a corresponding signature class – You cannot see the corresponding signature class when you enter the provider class in PRO (Provider File Enter/Edit) 24

25. 2010 UBO/UBU Conference Turning Knowledge Into Action Provider Class/Signature Class Relation How is the provider class related to the signature class? – Corresponding signature class will be identified on your providers details report – CHCS administrators can modify or correct signature classes in CLS (Provider Class File Enter/Edit) – Users randomly add provider classes in CHCS which causes null signature classes – Review of provider class and corresponding signature classes are recommended 25

26. 2010 UBO/UBU Conference Turning Knowledge Into Action Provider Class Example 26

27. 2010 UBO/UBU Conference Turning Knowledge Into Action 27 Signature Class in CLS

28. 2010 UBO/UBU Conference Turning Knowledge Into Action Signature Class/PSC Mismatch Error Signature class/PSC mismatch error examples DOE,JOHN R has a signature class of HCP (3), yet has a PSC of a technician (900) – Technicians should not have HCP order entry access DOE,JANE C is an outside provider with a correct signature class of outside provider (99) but has a PSC of a nurse (600) – Outside provider should not have a PSC of a nurse or technician, incorrect PSC has been used 28

29. 2010 UBO/UBU Conference Turning Knowledge Into Action 29 Sig Class/PSC Mismatch Error Example

30. 2010 UBO/UBU Conference Turning Knowledge Into Action Sig Class/PSC Mismatch Error Resolution How to resolve the error? 1. Determine if the error is an incorrect signature class or an incorrect PSC Incorrect PSC 1. Use the Web sites below to confirm the correct PSC through the HIPPA taxonomy field within the Web sites – https://nppes.cms.hhs.gov/NPPES/Welcome.dohttps://nppes.cms.hhs.gov/NPPES/Welcome.do – http://www.hcidealookup.org http://www.hcidealookup.org 2. Correct PSC in PRO (Provider File Enter/Edit) in CHCS and ensure correlating HIPPA taxonomy code is correct 30

31. 2010 UBO/UBU Conference Turning Knowledge Into Action Sig Class/PSC Mismatch Error Resolution cont… How to resolve the error cont… Incorrect signature class 1. Determine if the provider class was assigned inappropriately; if so, correct provider class and the correlating signature class will populate or… 2. Determine if the provider class has a null signature class or an inappropriate signature class attached 3. Null and incorrect signature classes need to be reported to your CHCS site administrator – CHCS personnel assign a signature class to the provider class with a null signature class in the CLS (Provider Class File Enter/Edit) 31

32. 2010 UBO/UBU Conference Turning Knowledge Into Action Signature Class Error What criteria is used to identify signature class errors? 32 Signature Class Sig class is null and provider flag is set to provider Sig class is 0 (clerk with limited ordering) and provider flag is set to provider Sig class is 1 (nurse) and provider flag is set to provider

33. 2010 UBO/UBU Conference Turning Knowledge Into Action Signature Classes in CHCS “0” Clerk with Limited Ordering – This level of authority is used for administrative support personnel and must be countersigned prior to the order becoming active “1” Nurse – This level of authority can write and activate orders, but these orders must be also signed by a HCP “2” Provider Requiring Countersignature – Similar to a nurse signature class, orders can be written but a countersignature is required by a HCP 33

34. 2010 UBO/UBU Conference Turning Knowledge Into Action Signature Classes in CHCS cont… “3” HCP – This level is standard physician authority and is the highest level needed “4” Countersigning HCP – A generic countersignature authority which could be used to countersign all orders requiring countersignature “99” Outside Provider – Providers not on your MTF staff (civilian HCPs); but may write prescriptions for patients entitled to benefits from your MTF. This signature class is used for outside prescriptions 34

35. 2010 UBO/UBU Conference Turning Knowledge Into Action Signature Class Examples The signature class is linked to the provider class field Below are examples of provider classes with their appropriate corresponding signature class 35 PROVIDER CLASSSIGNATURE CLASS External Provider99 (Outside Provider) Physician3 (HCP) Technician1 (Nurse) Nurse1 (Nurse) Clerk0 (Clerk with Limited Ordering) First Year Resident2 (Provider Requiring Countersignature)

36. 2010 UBO/UBU Conference Turning Knowledge Into Action Signature Class Error Examples Signature class error examples – You will be able to view these errors on the Provider Details report – You will not be able to view the signature class in the provider enter/edit file in CHCS 36 Provider FlagProvider ClassSignature Class ProviderNurse General Duty 1 (Nurse) ProviderChampusField is null ProviderFCDAField is null ProviderTechnician1 (Nurse)

37. 2010 UBO/UBU Conference Turning Knowledge Into Action Signature Class Error Resolution How to resolve the error? 1. Determine if the signature class is null or incorrect with the correlating provider class – You will find this on the Provider Details Report Null and incorrect signature classes need to be reported to your CHCS site administrator for correction 1. CHCS personnel assign a signature class to the provider class with a null or incorrect signature class in the CLS (Provider Class File Enter/Edit) 37

38. 2010 UBO/UBU Conference Turning Knowledge Into Action Signature Class Error Resolution cont… How to resolve the error cont… Determine if the error is an incorrect signature class/provider class or incorrect flag Provider flag is set to provider with an incorrect signature class 1. Identify the correct provider class 2. Correct provider class in PRO (Provider File Enter/Edit) in CHCS Signature class is correct with an incorrect provider flag 1. Correct provider flag in PRO (Provider File Enter/Edit) in CHCS 38

39. 2010 UBO/UBU Conference Turning Knowledge Into Action 39

40. 2010 UBO/UBU Conference Turning Knowledge Into Action PSC Error What criteria is used to identify PSC errors? 40 Provider Specialty Code (PSC) Null PSC with provider flag set to provider 1 st and 2 nd PSC is > 905 and provider flag is set to provider 1 st and 2 nd PSC is between 500 and 518 and provider flag is set to a provider

41. 2010 UBO/UBU Conference Turning Knowledge Into Action PSC Error Example 41

42. 2010 UBO/UBU Conference Turning Knowledge Into Action PCS Error Examples PSC Error Examples – Doe,John A has a null PSC – Doe,John A has a PSC of 999 (unknown) – Doe,John A has a 1 st PSC of 000 and a 2 nd PSC of 999 42

43. 2010 UBO/UBU Conference Turning Knowledge Into Action PSC Error Resolution How to resolve the error? 1. Determine the providers correct PSC through the provider’s HIPAA taxonomy code 2. Use the Web sites below to confirm the providers correct PSC – https://nppes.cms.hhs.gov/NPPES/Welcome.do https://nppes.cms.hhs.gov/NPPES/Welcome.do – http://www.hcidealookup.org http://www.hcidealookup.org 3. The Web sites provide the providers taxonomy code – Locate the taxonomy code on the spreadsheet titled PSC with Taxonomy Code – The taxonomy code will provide the correlating PSC 43

44. 2010 UBO/UBU Conference Turning Knowledge Into Action PSC Error Resolution cont… How to resolve error cont… – Populate correct PSC in PRO (Provider File Enter/Edit) in CHCS Provider Specialty Code with correlating HIPAA Taxonomy Code listing 44

45. 2010 UBO/UBU Conference Turning Knowledge Into Action HIPAA Taxonomy Error What criteria is used to identify HIPAA Taxonomy errors? 45 Taxonomy Code Null taxonomy code and has a provider flag set to provider Taxonomy code does not correlate with the PSC mapped taxonomy code

46. 2010 UBO/UBU Conference Turning Knowledge Into Action HIPAA Taxonomy Code Error Example 46

47. 2010 UBO/UBU Conference Turning Knowledge Into Action HIPAA Taxonomy Code Error Resolution How to resolve the error? 1. Determine the provider’s correct HIPAA taxonomy code through HCIdea or NPPES Web site – https://nppes.cms.hhs.gov/NPPES/Welcome.do https://nppes.cms.hhs.gov/NPPES/Welcome.do – http://www.hcidealookup.org http://www.hcidealookup.org 2. Determine if the PSC is incorrect or the HIPAA taxonomy code is incorrect 3. The Web sites provide the provider’s taxonomy code – Locate the taxonomy code on the spreadsheet titled PSC with Taxonomy Code – The taxonomy code will provide the correlating PSC 47

48. 2010 UBO/UBU Conference Turning Knowledge Into Action HIPAA Taxonomy Code Resolution cont… How to resolve the error cont… – Populate correct PSC or taxonomy code in PRO (Provider File Enter/Edit) in CHCS – There are multiple scenarios and fixes to resolve HIPAA Taxonomy Code errors – Use the HIPAA Taxonomy Code Error training slides to view which fix applies to your HIPAA Taxonomy errors 48

49. 2010 UBO/UBU Conference Turning Knowledge Into Action Primary Hospital Location Error What criteria is used to identify Primary Hospital Location errors? 49 Primary Hospital Location Sig class is not 99 (outside provider) but MEPRS code is FCC* Sig class is 99 and MEPRS code is not like FC**

50. 2010 UBO/UBU Conference Turning Knowledge Into Action Primary Hospital Location Error Examples Hospital Location Error Examples – Doe,John C is an outside provider with an FCCA (Support to Non-Federal External Providers) MEPRS code but has a signature class of 3 (HCP) – Doe,Jane A has a signature class of 99 (outside provider) but has a B*** MEPRS code – Doe,John K is an outside provider with an FCCA (Support to Non-Federal External Providers) MEPRS code but has a signature class of 1 (nurse), however, provider flag is set to Not a Provider 50

51. 2010 UBO/UBU Conference Turning Knowledge Into Action Primary Hospital Location Error Example 51

52. 2010 UBO/UBU Conference Turning Knowledge Into Action Primary Hospital Location Error Resolution How to resolve the error? 1. Outside provider with correct MEPRS code: – Correct the provider class/signature class in PRO (Provider File Enter/Edit) in CHCS – Use provider class of outside provider – Attaches a signature class of 99 2. Internal provider with correct provider class/signature class: – Identify the assigned location of the internal provider – Correct the MEPRS code in PRO (Provider File Enter/Edit) in CHCS 52

53. 2010 UBO/UBU Conference Turning Knowledge Into Action DEA/License # Error What criteria is used to identify DEA/License # errors? 53 DEA or License Sig class of 99 (outside provider) with a null DEA# and null license # with a provider flag set to provider Provider class of outside with a null DEA# and null license # with a provider flag set to provider

54. 2010 UBO/UBU Conference Turning Knowledge Into Action DEA/License # Error Examples DEA/License # Error Examples: – Doe,John A has a provider flag of provider but does not have a DEA number or license number A DEA or license number is a required field in the provider profile DEA number is preferred Populating the DEA number will allow for future search criteria in the HCIdea Web site 54

55. 2010 UBO/UBU Conference Turning Knowledge Into Action DEA/License # Error Example 55

56. 2010 UBO/UBU Conference Turning Knowledge Into Action DEA/License # Error Resolution How to resolve the error? 1. Determine the outside providers DEA number or license number 2. Use the Web site below to confirm the license number – https://nppes.cms.hhs.gov/NPPES/Welcome.do https://nppes.cms.hhs.gov/NPPES/Welcome.do 3. Use the Web site below to confirm the DEA number or license number – http://www.hcidealookup.org http://www.hcidealookup.org 4. Populate the providers DEA number or license number in PRO (Provider File Enter/Edit) in CHCS 56

57. 2010 UBO/UBU Conference Turning Knowledge Into Action Generic Provider Error What criteria is used to identify generic provider errors? 57 Generic Provider Customized list of words/phrases that are associated with generic provider names, example - tech, clinic, university, doctor, room, etc...

58. 2010 UBO/UBU Conference Turning Knowledge Into Action Generic Provider Error Examples Generic Provider Error Examples: – CENTER,SUPPORT – TECH,EYE – CHCSII,NURSE – UNIV OF ALAMBAMA – DEPARTMENT,RADIOLOGY – AAABGAB,DOCTOR – CHILDRENS HOSPITAL 58

59. 2010 UBO/UBU Conference Turning Knowledge Into Action Generic Provider Error Resolution How to resolve the error? 1. Generic providers need to be reviewed – Who is using this clinic? – What is it being used for? 2. Use of generic providers should be avoided – Provide your CHCS site administrators with a list of generic providers that need to be inactivated or terminated – Follow up to ensure the duplicate providers have been inactivated or terminated 59

60. 2010 UBO/UBU Conference Turning Knowledge Into Action Potential Duplicate Error What criteria is used to identify potential duplicate errors? 60 Potential Duplicate Duplicate NPI's and matching first names Null NPI's that have exact name matches with other providers with or without null NPI's

61. 2010 UBO/UBU Conference Turning Knowledge Into Action Potential Duplicate Error Examples 61 Provider NameNPI Doe,John1234567890 Doe,John A1234567890 Doe,Jane CNull Doe,Jane C0987654321 Doctor,John ANull Doctor,John ANull

62. 2010 UBO/UBU Conference Turning Knowledge Into Action Potential Duplicate Error Resolution How to resolve the error? 1. Providers that have been entered two or more times need to be merged 2. Merging provider entries needs to be completed through your site CHCS site administrators – Merging protocol may differ from one MTF to another – Some sites may submit work order tickets to MHS 62

63. 2010 UBO/UBU Conference Turning Knowledge Into Action Useful Tips 1. When researching data on the NPPES and HCIdea Web site, copy and paste Example, copy the NPI number from the NPPES Web site and paste directly into the NPI field in PRO Reduces potential errors Increases your efficiency 2. Search by DEA number on the NPPES Web site If DEA number is available, you will see it on your Provider Details report Useful in finding a provider if name is incorrect in the provider file 63

64. 2010 UBO/UBU Conference Turning Knowledge Into Action Training Material Slides that provide step by step instructions to correct provider file errors are available on Vector Check https://vc.afms.mil/afmoa/sga/sgar/sgardq/default.aspx Current training slides available – NPI Error – Naming Convention Error – HIPAA Taxonomy Code Error – PSC Error 64

65. 2010 UBO/UBU Conference Turning Knowledge Into Action 65 Questions? Data Quality Umbrella Data Quality Foundation