Overview

The recommendedActions for a provider summarizes all the actions that QES recommends, based on the inspection results. There are seven recommended actions:

• Suppress: The client should remove this provider. Most Eligibility Group inspectors have a result of Suppress (two have a result of Investigate)

• Investigate: The data element is likely to need an update or a suppression, but the client should verify the information independently before doing so. Integrity Group inspectors have a result of Investigate.

• Update: A data element is inaccurate and requires an update to the client’s existing data using verified data discovered by the inspector. Validity Group inspectors that find the source provider data to be inaccurate have a result of Update.

• Supplement: The provider data element is missing a verifiable value and Quest can provide that value. Validity Group inspectors with verified data that find the source provider data to be missing have a result of Supplement.

• Enrich: Additional verified data can be added to the data element (the client’s own data for these data elements is not being validated). Enrichment Group inspectors with verified data have a result of Enrich.

• Standardize: A data element’s punctuation, spelling, and abbreviations can be standardized for outreach. A standardized value changes the format of the value only; it does not indicate that the value is valid or invalid.

• Retain: Keep the client-provided value. Retain does not inherently imply validity unless a verification for all inspectors has taken place.

The following JSON code snippet illustrates the structure of the recommendedActions object for a particular Provider when Quest recommends all seven actions for that provider. There is one object of the form <Action>Reasons for each recommended action: enrichReasons, investigateReasons, and so on. The values in each <Action>Reasons object are the names of the data elements that the action applies to. For example, the investigateReasons object in the following example indicates that you should investigate the SpecialtyCodes data element.

"recommendedActions": { 
   "enrichReasons": [ 
      "ADAFeatures", 
      "BoardCertification", 
      "Ethnicity", 
      "ProviderTelehealth", 
      "Race", 
      "Taxonomy" 
   ], 
   "investigateReasons": [ 
      "SpecialtyCodes" 
   ], 
   "retainReasons": [ 
      "EntityType", 
      "Gender", 
      "LocationPhone", 
      "NPI", 
      "PracticingAtOffice", 
      "ProviderLanguages", 
      "ProviderLicenses", 
      "TIN" 
   ], 
   "standardizeReasons": [ 
      "Address1" 
   ], 
   "supplementReasons": [ 
      "OrganizationWebsite" 
   ], 
   "suppressReasons":  [ 
      "NPIDeactivated" 
   ], 
   "updateReasons": [ 
      "GroupAffiliation", 
      "HospitalAffiliation", 
      "LocationFax", 
      "LocationOfficeHours", 
      "Prefix"
   ]
}