Data Dictionary

Output Column

(Italics indicates column added by Serif Health)

This is the most common state across all NPIs in the source npi_list from the MRF. The state for each NPI is obtained using NPPES.

If a filter for "region" is set, then Signal will only return groups where the majority of the npi-list belongs to that region.

The most common NUCC primary taxonomy code for the NPIs in the npi_list field. The primary taxonomy for each NPI is obtained using NPPES

If a filter for "taxonomy" is set, then Signal will only return groups where the majority of the npi-list belongs to that taxonomy.

For negotiated_type there are five allowable values: "negotiated", "derived", "fee schedule", "percentage", and "per diem". The value are defined as:

negotiated: If applicable, the negotiated rate, reflected as a dollar amount, for each covered item or service under the plan or coverage that the plan or issuer has contractually agreed to pay an in-network provider, except for prescription drugs that are subject to a fee-for-service reimbursement arrangement, which must be reported in the prescription drug machine-readable file. If the negotiated rate is subject to change based upon participant, beneficiary, or enrollee-specific characteristics, these dollar amounts should be reflected as the base negotiated rate applicable to the item or service prior to adjustments for participant, beneficiary, or enrollee-specific characteristics.

derived: If applicable, the price that a plan or issuer assigns to an item or service for the purpose of internal accounting, reconciliation with providers or submitting data in accordance with the requirements of 45 CFR 153.710(c).

fee schedule: If applicable, the rate for a covered item or service from a particular in-network provider, or providers that a group health plan or health insurance issuer uses to determine a participant’s, beneficiary’s, or enrollee’s cost-sharing liability for the item or service, when that rate is different from the negotiated rate.

percentage: If applicable, the negotiated percentage value for a covered item or service from a particular in-network provider for a percentage of billed charges arrangement. Note: percentage values entered into the negotiated_rate attribute are to be a whole number percentage of the negotiated arrangement (i.e. 40.5% should be entered as 40.5 and not .405).

per diem: If applicable, the per diem daily rate, reflected as a dollar amount, for each covered item or service under the plan or coverage that the plan or issuer has contractually agreed to pay an in-network provider.

Our approach is to resolve the entity name and address using the following waterfall:

First, aim to match on TIN (or the value in the "EIN" column).

If TIN is not present, then we aim to match on the first Type 2 NPI we see in the "NPI-List" column).

If a Type2 NPI match also fails, then we try to impute a Type 2 NPI by seeing if the EIN in the "EIN" column corresponds to one and only one Type2NPI.

If all matches fail, then we match on the first Type1 NPI we see in the NPI-list.