Chafie Health Data Solutions

ProviderKey delivers data services that edit, standardize, manage and provide secure access to health care provider information. ProviderKey collects and loads all data from provider networks, claims, errors reported by insurers and monthly changes to the National Provider Identification database. All information including entry errors, invalid or old addresses and systems-generated errata are entered into integrated proprietary database applications that clean and standardize the data while managing all additions, changes and network terminations and claims.

Service Overview

ProviderKey utilizes an integrated, proprietary database consisting of:

physicians
hospitals
nurses
dentists
mental health specialists
pharmacies
laboratories
ancillary providers
equipment suppliers

Plus Related data:

addresses
phone numbers
specialties
identification codes
hospital affiliations
group affiliations
network affiliations
contracts

Applications access the ProviderKey database on a real-time, near real-time and batch basis using web services and batch record submissions.

Provider Finder – using a web browser, find a physician or a hospital with the results formatted for use by plan members or special formats for claims administrators or network researchers.
Provider Identification – identify providers using a variety of parameters including partial and erroneous data.
Claims Record Identification – uniquely identify the provider in a claims record and insert corrected and enhanced data.
Provider In-network Verification – in-plan validation of a provider for a specific PPO network on a specific date.
Provider Data Cleaning and Standardization – cleans, standardizes and removes duplicates within and between over 100 provider networks each month.
PPO Network Data Extracts – data may be extracted using browser-based criteria to meet any client needs.
Computer-to-Computer Web Services – all services may be utilized through computer-to-computer web services.
Provider Specialty Definitions – definitions of over 100 PPO specialty schemas and custom schemas developed by the client.

The ProviderKey database employs six subsystems to maintain the high integrity and quality of the data utilizing a rigorous set of proprietary rules. ProviderKey incorporates sophisticated logic to determine the matching of a processed data record within the database. The master database can only be accessed through the ProviderKey subsystems listed below:

Proper Names: A database of over 3 million proper names with proper capitalization. Processed names are matched to the database or added after review.

Organization Names: A database of 580,000 organizational names reviewed for proper spelling and unique capitalization.

Address Verification: Every address is United States Postal Service verified, spelling corrected and audited to conforming standards with all 9-digit zip codes retained. The latitude and longitude for each address is recorded.

Networks and Affiliations: ProviderKey maintains a table of all PPO networks, hospitals, physician groups and contractual affiliations submitted for every provider.

Specialty System: ProviderKey maintains a database of every provider specialty and abbreviation, plus the specialty codes derived from every PPO network and the National Provider Identification system. All providers are grouped into one or more categories, specialties and subspecialties. Specialties are cross-referenced using a methodology that allows retrieval of providers using schemas that span from 20 to over 850 definitions. Specialty schema lists may be tailored to meet client requirements.

Record Source: ProviderKey maintains a table that records the source of all data related to each network addition or change as well as other source data including claims and NPI data changes. The system can point to the specific file name, date and records of any change made by any network on any provider.

ProviderKey - A Chafie Health Data Solutions, LLC Product
7557 Rambler Road, Suite 626. Dallas, TX 75231