Sunset of Electronic File Interchange (EFI) for National Plan and Provider Enumeration System (NPPES)

[Alan Viars]

Hello NPPES Community:

Are any folks on this group currently using Electronic File Interchange (EFI) to create/update NPPES records?  EFI is a SOAP-based web service and it is my understanding it has less than 10 active users.

We here at CMS are considering putting the the toe tag on this interface in favor of something a little more user friendly.

We would love to hear from current users on ways to make the process as easy and efficient as possible.

Thoughts?

Alan Viars

[David Zetter]

Alan-

Not using EFI, but would love to contribute more on the NPPES revamp. Have many ideas, such as removing provider ID repository within NPPES as this can just help provider identity theft. With Zabeen and Richard right now from PEOG in Chicago.

[Alan Viars]

Hi David:

I think you are referring to "other identifiers" section correct?  I'm not exactly sure how much it is used, but I venture to guess its not very much.

The "other identifiers" requirement is outlined in the NPI final rule and therefore its inclusion is mandated by federal regulation.

Best,

Alan

[Alan Viars]

David:

Maybe it would be worthwhile to start a thread on desired change in regulations? It is my understanding that reasonable changes to regulations can be made.

Alan

[Manjunath Salimani]

Alan- Likely since the provider community has attained some steady state/ saturation in terms of being enumerated, the EFI bulk enumeration is not as frequently used anymore. How many records are each of these 10 entites submitting on average per month?  

One option -Given EDI's popularity in the industry..this interface could be made an EDI compliant 274 transaction?  this would given the industry a more standards based integrating mechanism. Again if the volumes support the need. 

  

On Monday, April 28, 2014 1:22:27 PM UTC-4, Alan Viars wrote:

[Alan Viars]

Hello Manjunath:

Right now, the plan is for us to replace the bulk enumeration with a real time API (using JSON) and a bulk enumeration by file but using CSV instead of XML.

Is the EDI 274 specification open source / public ?

Best,

Alan Viars

[Manjunath Salimani]

Not open source per se. But can be obtained from www.wpc-edi.com for a small fee. I have attached a copy here. Back in 2004 changes were finalized to the EDI 274 standard to accommodate NPPES data requirements.  When talking to the industry at that time there was a strong preference to go with this transaction since most larger provider institutions have infrastructure to support this transaction with minimal development time. This transaction is supported by the same infrastructure that is used in most cases to process claims, beneficiary eligibility etc.  Other factors led to the current XML implementation.  I can see a CSV would definitely lower a provider's burden. Is the idea to provide/ use Excel with some VB scripting to provide local file/ some data schema validation?

[Darrell DeVeaux]

So we were/are an NPI EFIO, though havent used in a bit so unsure if they cancelled our account. We were submitting changes to NPPES on providers' behalf and using a more friendly UI to do so. So I guess for selfish reasons, my vote is to keep it BUT I don't think the UI has too much to do with the non-use anyway...

The problem, from my perspective, is the same now as it was 5 years ago which is that no one cares about or uses the information from the NPPES file EXCEPT for the NPI and whether it is active or not. Depsite the requirements that providers update their NPPES info within 30 days of changes virtually no one does this. I have sent CMS some summary reports in past which shows the volume of "last update date" changes from month to month. Given that there are stats that say 30-40% of providers change offices per year, even if we use that to say that they change some demographic info, then we should see about 1million changes per year or ~100K per month. Run a report on last update date from last NPPES and see how many were modified in the last month?  Oh, and look at how many last update date = enumeration date!

Until the NPPES does things like accept multiple addresses, makes other identifiers more relevant, multiple phone numbers then UI changes are pointless. BTW, we had developed a method for them to do that and we using these one to many relationships for a lg health insurer for their directories.

So bottom line, and I haven't see all of the items Alan's team is working on yet and am sure a couple are in the works, but without one to many relationships AND CMS holding providers accountable for not changing their info on the file UI is moot.

BTW, we don't use as much anymore because the providers we were working with so no reason to keep the NPPES updated anyway.

- Darrell

On Monday, April 28, 2014 1:22:27 PM UTC-4, Alan Viars wrote:

[Janos G. Hajagos]

As CMS publishes more datasets that  use the NPPES I think providers may begin to care about the accuracy. The bottom line is that the current NPPES dataset is not being updated as frequently as it should be. It might be a good benchmark to track is the number of monthly updated NPI records to gauge the success of CMS changes. 

Janos

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[Alan Viars]

If/when PECOS data is made public it will make things more interesting because we would have other addresses too.  These addresses are generally considered more up to date than NPPES addresses.  These may or may not overlap with NPPES.

I should note that one way to improve data quality is to make it easier for others to update the information on the provider's behalf. "Surrogacy" through I&A will be fully functional in the new NPPES.

Alan Viars

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[Hack G]

I don't agree that changes to the UI are moot or pointless because its outdated or "nobody updates their records"

Its a chicken or egg problem we have - you can't expect owners of the NPI records to update information unless you remove as much friction as possible for them to update the data. Only then can you point the finger at the NPI owner and not the system for lacking in features, ease-of-use or accessibility

I commend CMS for putting attention to this and any efforts to modernize the systems. This will be required if FIRST, if we ever want to later complain about the data quality / accuracy 

Alan - are you aware of any plans for PECOS data to be released to the public?

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[Alan Viars]

I think PECOS data release is in process.  Please do not take this as an official announcement, but it my understanding it may be released by the end of the summer.  

When it is released I'll post a link here.  Lots of folks asking.

Alan

[David Zetter]

I do not foresee PECOS data ever becoming public and CMS has pretty much verified this in our PECOS power user group meetings.  This would defeat the efforts to fight fraud as there is too much information about the provider and their employers in PECOS, including PTANs, birthdates, SSNs, tax IDs, DEAs, etc.  Having any of this information made public would ONLY increase fraudulent claims.

As it is, CMS has created the surrogate program so that providers will not share login IDs and passwords with others to complete their enrollments, changes and updates. 

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[Alan Viars]

David:

It is my understanding that a PECOS data release, not including PII such as SSN, DOB,etc, is in the works.

ts my understanding the vast majority of fraudulent claims are made by those already authorized to make legitimate claims, not by 3rd parties.

How exactly would having this information public increase fraudulent claims?   I

Alan

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