Decoding Provider Taxonomy Practical Uses for
Providers, Payers and Partners
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Decoding Provider Taxonomy
Practical Uses for
Providers, Payers and Partners
85 minutes; standard DVD format (NTSC, SD); chapter menu.
Includes accompanying CD-ROM with handouts in PDF format, slides in PPS format, and RTA resource links page.
Catalog ID: BI-TAX08A-0106
$395.00 USD
SHIPS JULY 2008
Provider taxonomy – a code that describes a type of healthcare facility or practitioner’s specialty or subspecialty – has taken on new significance as the healthcare industry marches toward implementation of the National Provider Identifier (NPI).
HITTG recently concluded a study of the NPI implementation, based on data from our National Provider Identifier Contingency Status Survey. The survey collected data from providers, billers, payers and clearinghouses, representing tens of millions of monthly claims. Among our healthcare providers and billers, 44.1% indicated they were encountering difficulty meeting payer requirements for their own taxonomy or taxonomies, and nearly a third said the same for the individual practitioner fields, such as Referring Provider.
Surprisingly, a much larger percentage of Health Plans indicated they were using Taxonomy as a component of their matching logic. Fully 50% said they looked at taxonomy code for individual providers and nearly 60% said they took billing provider’s taxonomy into consideration. This clearly indicates that, while payers may not necessarily be making provider taxonomy a mandatory requirement, they will use it to help with provider matching if one is sent.
For payers accustomed to assigning proprietary identifiers to their providers, taxonomy is seen as a possible “tie breaker” for reconciling one-to-many NPI matching problems. For providers attempting to balance the conflicting needs of multiple payers’ contracts and billing requirements, taxonomy could help them build an NPI strategy that satisfies them all. In fact, as payers begin to define their post-NPI companion guides, they may have to.
But are providers’ billing systems and payers’ routing and adjudication systems up to the challenge? Reports from the field suggest a perilous reliance on single-value databases, rudimentary matching algorithms and payer-assigned values. Unless both parties – and their vendors – grasp the challenge of dealing with the inherent ambiguities in the code set and the inevitability of conflicts between various payers’ expectations, taxonomy will become an unanticipated problem instead of a new solution.
With real-world experience in taxonomy implementation and over three years of subject matter research and analysis, Martin Jensen will share with participants how the code set can be used effectively in the context of multi-trading partner exchanges.
Contents
"One of the few people in the industry who can truly be called a leader in thought."
~Michael Apfel, Truman Medical Centers
Martin Jensen is Chief Analyst and a principal partner at Healthcare IT Transition Group, a consultancy whose clients include healthcare providers large and small, health IT software and service companies, and some of the nation's largest health plans. Recently, Marty has recently been involved in Health IT remediation projects in state Medicaid, vendor and payer organizations. His seventeen years in healthcare IT include work in health plan remediation and provider outreach, engagements with software vendors in product development and systems design, and over fourteen years in business analysis and project management for provider organizations. In 2007 Marty was honored with the Workgroup for Electronic Data Interchange (WEDI) Distinguished Service Award.
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