What Does "Unknown" Mean
When reviewing claim data, you may encounter fields labeled as "Unknown." This designation appears when we do not have the necessary information for a specific claim. There are two primary reasons for this:
- Missing Data on the Claim - In some cases, the claim itself does not contain the information. This can happen if the provider did not supply the data when submitting the claim or if certain fields were not required for that particular type of claim. Example: One claim can show Dr. Smith but a different claim may redact Dr. Smith therefore it's not that Dr. Smith is redacted from all claims.
- Redacted Data from Our Vendor - Our data vendors may redact specific information for privacy, security, or contractual reasons. This means that even if the data exists, it is not accessible within our system due to these restrictions.
Common Tables That May Show "Unknown"
Physician Analyze > Order Share by Organization Table: If the Organization NPI is not included in the claim submission or redacted from the HCPCS/CPT claim.
- Facility Analyze > Order Share: 0-30 Days Post Discharge: When the provider/supplier NPI is not included in the claim submission or redacted from the HCPCS/CPT claim.
- Facility Analyze > Order Share > Service Location by Code Set: 0-30 Days Post Discharge: When the service location is not included in the claim submission or redacted from the HCPCS/CPT claim.
- Organization Analyze > Order Share by Physician: If the Physician NPI is not provided or redacted from the HCPCS/CPT claim especially when it is not a required field.
How to Handle "Unknown" Values
By understanding why "Unknown" appears in the solution, you can take the appropriate steps to ensure accurate interpretation by understanding there are claims without an NPI.
If you have further questions, please contact our support team at Support@TrellaHealth.com
