Sometimes you can't find a provider in the Trella Health Solution. Many providers provide services under a different name, submit claims under a parent NPI, or just haven't updated their registry. In these cases, it is a challenge to match up a name from a sign on a building or an address from a website. This is where the NPPES NPI database comes to the rescue.
Remember that (at present) the metrics in the Trella Health Solutions are generated from normal Medicare claims. If you can't find a provider, the most likely reason is that the provider has not submitted Medicare Claims. Other possible reasons that a provider is not included (or easy to find) in the Solutions:
- Many facilities are part of a network, and their claims are submitted under a different NPI. See Why can't I find the hospital I'm looking for?
- Often, Physicians don't update their Registry information, so their claims metrics are available in a different state. In those cases, the physician will appear in sources tables on detail pages, but if you don't have access to the state in which the physician is registered, you won't be able to view the detail page for that physician. Send an email to your CSM or support for assistance. The NPPES NPI database will help you to find that physician and confirm their state of registry.
- Assisted Living Facilities, Nursing Homes, Veterans Hospitals and many others don't submit Medicare claims. The NPPES NPI database will help to identify the type of facility.
- Many facilities, SNFs in particular, submit claims under a business name that is not even similar to the name on the sign. The NPPES NPI registry helps to close the gap through an address search.
To use the NPPES NPI Database
Gather as much information as you can on the provider of interest. Searching Google might help. Even a ZIP code search will narrow the list to make the search results more easy to browse.
1 - Navigate to the following link: https://npiregistry.cms.hhs.gov/
The database search page looks like this:
We have added the name of a facility, the state and the NPI type for this example:
2 - Click on Search
The results of this search look like this:
Note that this identifies the NPI of the facility we desired. We could take this immediately to the Solution and search for this facility in the facility page.
3) Click on the NPI to view the details.
Here is the detail page provided for the chosen facility:
4) Evaluate what you find - what to look for
When you use any of the information you find here to search the Trella Health Solution, make sure that you have the Market (State) set to match the state found in the Primary Mailing address.
- Other Name: Doing Business As - IF there is an entry in this field, this is the name we use in the Solution. If there is nothing in this field, we use the name at the top. You can search the Trella Health Solution on the Facilities page using this name.
- NPI - Since this number is unique, if the provider isn't eliminated by one of the reasons mentioned above, you should be able to use this to find the provider on the appropriate page.
- Enumeration date - Although this is rare, some providers are too young to be in the most recent data set. If a provider has an enumeration date within the last four to six months, it is highly likely that they will not appear until the next data release.
- Primary Practice Address - This is the address we use to place a provider's data in the Solutions. Facilities don't tend to move, but physicians infrequently have an outdated primary practice from where they actually practice. This would put their metrics in a different Market (State.)
- Taxonomy - This section will help you to identify the type of provider. This will help to determine whether a provider is likely to be in the Trella Health Solutions or whether the provider doesn't apply - e.g an assisted living facility.
Searching for a name or NPI in the Solutions
If you are searching for a physician, the search field on the Physicians page will allow you to search for any physician in any Market to which you have access.
When you are trying to find a facility by name or NPI, it is best to make sure that you have clicked on the "All Facilities" tab on the Facilities Page. This tab includes all facilities in the Market (State) that have relevant metrics.
The "All Facilities" tab will not include organizations featured in the Solution. That is, you will not find hospices in the All facilities Tab in the Hospice Solution. The same is true for home health agencies in the Home Health Solution and SNFs in the SNF Solution.
Here is the result of adding the NPI we found in the NPI Registry to the facilities page.
A couple of Tips
When searching the NPPES NPI Database
- Add the State or city to the search if possible.
- Start with a name Search - If you don't know the NPI, this approach narrows the search results best. Obviously searching for "Smith" under an individual will not be very limiting.
- If you search by a known city, you can browse for a provider that matches a known address.