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Overview

This enrichment addresses the challenge of multiple rates for the same service by providing:
  • TIN Resolution: Standardizing organizational identifiers for consistent grouping
  • Payer-Specific Ranking: Applying payer-defined policies for rate selection
  • Multi-Dimensional Rankings: Ranking by provider count, rate amount, and care setting
  • Quality Indicators: Flagging best rates for different analytical scenarios
The process ensures that analysts can confidently select the most appropriate rates based on their specific use cases and payer requirements.

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Data Sources

NPI Registry

Source: National Provider Identifier database
Usage: TIN type classification for resolution logic
Coverage: Individual and organizational provider information

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Output Schema

The enrichment produces 14 columns providing comprehensive resolution and ranking information:

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Processing Logic

This enrichment helps solve a common problem: when multiple rates exist for the same medical service, which one should you use? The process works in three simple steps: Step 1: Group Similar Organizations
The system recognizes that different provider numbers might actually represent the same healthcare organization (like a hospital system), so it groups all rates from the same organization together. Step 2: Rank the Options
Within each group, rates are ranked by two factors: how many doctors accept them (more is usually better for patients) and how much they pay (higher rates may indicate premium networks). The system creates separate rankings for hospital-based and office-based care. Step 3: Apply Insurance Company Preferences
Each insurance company has its own strategy - some prefer rates accepted by the most doctors (broader coverage), while others prefer the highest-paying rates (premium positioning). The system applies these preferences to identify the “best” rate for each scenario.