June 15, 2020
QoRelate™ Record-Linkage Technology version 7.1
Assimilating and cleansing data from multiple sources is a mounting challenge. CarePrecise offers you an advanced solution for a trusted master record in today's environment of escalating regulatory requirements. Marrying your data with officially disseminated federal records on all HIPAA-covered healthcare providers boosts efficiencies and helps bring risks within tolerance. Developing a master file that brings so much up-to-date information together is frequently outside the core competencies—and budgets—of most organizations.
We invite you to compare our pricing and products with other solutions. CarePrecise is dedicated to offering the best products and the best value, and we've been hitting the mark since 2007.
Trusted Data from Authoritative Sources
Our goal is to continue adding key data points to our master healthcare provider data resource, of which CarePrecise Access Complete is a primary part, from new sources as they become available. Through filings of FOIA/FOIL requests and advocating for open information, this data is gradually becoming more and more available. But each source has its own format, its own coding methodology, and few if any common unique identifier fields by which to cross-match records between sources.
Linking records without unique identifiers
Let us introduce you to QoRelate™, our proprietary data "shrinking and linking" technology, to embrace each new data resource that comes available. Currently, we are working with the National Plan & Provider Enumeration System (NPPES) The Centers for Medicare and Medicaid Services (CMS) maintains this database. All healthcare providers who are HIPAA covered entities must obtain a National Provider Identifier (NPI) by reporting their information via the NPPES, and updating it when it changes. This represents virtually all of U.S. physicians, hospitals, and other providers who accept insurance or are associated with a hospital. —the official federal NPI registry—updated monthly by the Centers for Medicare and Medicaid Services, the PECOS The federal database containing information on healthcare providers who are eligible to bill Medicare (Provider Enrollment, Chain and Ownership System). (Medicare provider enrollment database), the federal List of Excluded Individuals/Entities (LEIE), List of Excluded Individuals/Entities (LEIE): The federal database maintained by the HHS Office of Inspector General containing information on providers who have been barred from billing Medicare due to fraud or controlled substance conviction, patient neglect or abuse, and other reasons. CarePrecise uses a proprietary record-linking system to attach active NPI numbers. demographic databases from the U.S. Department of Commerce and other free and fee-based sources, and are working to add many others. CarePrecise can offer a single database, keyed on the NPI number, combining providers' PECOS, NPPES, and LEIE data. Data is updated real-time, as federal sources release it, and distributed to our subscribers each month, in formats ready for immediate use within Microsoft Office applications, and for import into in-house systems.
Using QoRelate, we bring provider information all within this centralized framework, linked by the unique NPI number assigned by the federal government to each HIPAA-covered entity (about 6.2 million
healthcare providers, both individuals and organizations). PECOS status and exclusion status from the LEIE are part of every carePrecise NPI-keyed record.
New with version 7.1, released March 15, 2020, is improved methodology for matching records that have only name and address common fields, using advanced data conformation and new linkage loops, resulting in near-perfect positive linkage, and near zero false negatives.
The Healthcare Provider Data
Our database of more than
provider records is updated monthly, and is the most comprehensive and accurate healthcare provider data available anywhere. More than 200,000 edits are made to this dynamic database each month.
For details on the specific data fields included in CarePrecise healthcare data solutions, visit this link. The data is provided open source without restriction on the number of uses or exported records by the license holder,although redistribution is prohibited without the purchase of a special license. See our liberal End User License Agreement.
The CarePrecise Access Complete database includes all U.S. healthcare providers that are covered entities under HIPAA, representing nearly the entire cohort of providers in most categories (physicians of all specialties and subspecialties, hospitals, dentists, nurses, clinics, labs, pharmacies, etc.). HIPAA covered entities are required by law to report the National Plan & Provider Enumeration System database to obtain a National Provider Identifier (NPI) number. Enumeration is required in order to bill Medicare, write prescriptions, file electronic health insurance claims, or be listed as a referring provider on any other provider's electronic health insurance claim, or who have an affiliation with a hospital or other entity that files insurance claims. No provider may opt-out of this database or its distribution, and all are required to update their information when it changes. (Some sensitive data such as SSN is redacted and others may be opted-out on a provider-by-provider basis at the federal level.) There is also a strong economic incentive for providers to keep their data current, as these source databases and CarePrecise products are used throughout the healthcare industry to expedite Medicare and private plan claims processing and to assure proper reimbursement.
An example of the contribution QoRelate makes to our CarePrecise Access Complete product, records from the federal List of Excluded Individuals/Entities (LEIE, which lists providers who have been barred from billing Medicare due to fraud, patient abuse, or other convictions and delinquencies) can be matched to a provider NPI number in our master database, even though the LEIE itself contains no such unique code. In addition, QoRelate cleanses of the data, making sense of some of the more cryptic codes, and conforming mistyped entries to standards, e.g., 2-digit state codes, as well as eliminating duplicated data existing in multiple source databases to make it easy to use in a typical office computing environment. These techniques incorporate other provider data in a similar manner.
Custom Record Enhancement Services: Customer Data Integration
QoRelate and the CarePrecise Master Data Management (MDM) structure form the basis of our ability to enhance our customers' in-house data. Using our data matching system, we can input a client's database, match it to our master records, and send the client vastly enriched information on its provider records. For example, hospital clients use our service to identify personnel who do not have an NPI number, as well as those with outdated NPI records, to assist administration in assuring HIPAA compliance related to the NPI Final Rule.
Because we work exclusively within the healthcare domain, our system is optimized for linking healthcare records, and is the most advanced such system available. Contact us for pricing and additional information.
Private Record Linkage Services
As a third party vendor, CarePrecise offers record linkage services to organizations who may not wish to share all of their list data with a partner organization, but who need to identify the intersecting set of records for various reasons. Mergers and acquisitions, healthcare information exchanges (HIE), and list-share agreements are among the applications of private record linkage services. QoRelate processing relies in part on CarePrecise's exclusive CoLoCode™ capability.
Each project is unique and presents special challenges; contact us for pricing and additional information.
No record-linkage system can promise 100% match accuracy (unless 100% accurate common unique identifiers (CUI) are present in each data source). Where no CUI is available across all sources, record linkage processing must account for thousands, even millions, of variables, depending on the specific project. Match accuracy is measured in terms of false positives (the system claiming a match that is not really a match) and false negatives (the system failing to catch a match). QoRelate uses multiple record-linkage methodologies to bring accuracy on non-unique identifier projects to within 0.004% (four one-thousands of a percent) in false positives and 0.0003 (three ten-thousandths of one percent) on false negatives, depending on the project specifics. Further, the accuracy of the base data affects the ultimate usefulness and accuracy of matches. No objective level of match accuracy can be guaranteed, since each record linkage project relies in large part on the quality and accuracy of the base data—a set of variables that eludes objective measurement in most cases, even though processing aggressively conforms errors and variations in the data.