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
Data Sources
NPI Registry
Source: National Provider Identifier database
Usage: TIN type classification for resolution logic
Coverage: Individual and organizational provider information
Usage: TIN type classification for resolution logic
Coverage: Individual and organizational provider information
Output Schema
The enrichment produces 14 columns providing comprehensive resolution and ranking information:| Field | Description | Example |
|---|---|---|
tin | Original Tax Identification Number from the source rate data for traceability and audit purposes. | "123456789" |
resolution_tin | Standardized organizational identifier - either the original TIN (if EIN) or the mapped EIN (if NPI), with fallback to original TIN for unknown types. Used for consistent organizational rate grouping and deduplication. | "987654321" |
billing_code | Procedure or service code used in ranking partitions for code-specific rate resolution. | "99213" |
npis_hash | Unique identifier for the specific set of providers associated with the rate, used for exact provider group rate resolution and validation. | "abc123def456" |
npis_length_rank | Ranking based on the number of NPIs associated with each rate, with rank 1 having the most providers within each partition group. Identifies rates with the broadest provider coverage. | 1 |
negotiated_rate_rank | Ranking based on negotiated rate amount, with rank 1 having the highest rate within each partition group. Identifies the highest-priced rates for each service and provider combination. | 2 |
is_best_rate | Primary rate selection flag based on payer-specific preferences. True for rates that rank #1 according to the payer’s preferred methodology (either most NPIs or maximum rate). | true |
is_best_non_fac_rate | Best rate selection specifically for office-based healthcare services. True for rates that rank #1 for non-facility services according to the payer’s resolution policy. | false |
is_best_fac_rate | Best rate selection specifically for hospital and facility-based services. True for rates that rank #1 for facility-based services according to the payer’s resolution policy. | true |
has_most_npis | Identifies rates with maximum provider network coverage. True for rates with the highest number of associated NPIs within each partition group, regardless of payer policy. | true |
has_max_rate | Identifies the highest-priced rates for benchmarking and analysis. True for rates with the highest negotiated amount within each partition group, regardless of payer policy. | false |
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 OrganizationsThe 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.