Key Takeaways

Great work! Lets go over some of the information regarding the provider data domain.

Agenda and Data Tables:

  • There are 3 tables that cannot be edited:
    • BCBSA New Taxonomy Codes 
    • BCBSA Provider Character Codes 
    • NUCC Specialty Codes 

Connecting Domain Data to the Search Review Data Specification Files:

  • Domain data values are used in specific data spec files; ie. ProviderFileRecrodLayout connects to Degree Codes, County Name, Accepting New Patients, Language Codes, Gender domain data tables
  • The code from the domain table is necessary for the value to be displayed in the UI
  • If there is not a code that supports a value you want in the UI, a code needs to be created 
  • Important considerations for domain data:
    • Specialty codes: separate codes exist for persons vs. facilities vs. groups 
    • Recognition values (quality badges): JCAHO hospital recognitions are not sent in the domain data; these are later added
    • Product category: can be used to include/exclude BCBSA national provider data from a Blue client’s products 

Deep Dive into Specialty Domain Data:

  • The specialty domain data file has various tabs for different fields and associated values 
  • In mapping your data to specific fields, we encourage you to identify and anchor on a specific element and look in your source system for a complementary element 
  • Reasons you may not get the search results you expect:
    • Search results are partly derived from the provider’s specialty; all providers need a specialty record to be returned in search
    • Specialty values are more than just the code you send in the data file and the name that displays in the UI
      • Need to know the Provider Type (P/O) and the Category Type 
    • Transparency in coverage cost connection: the provider type in the provider data has to align with the rate type in the rates data in order for providers to be returned in cost searches
    • Transparency in coverage cost connection: for the 500 Shoppable services, a provider’s specialty in the ProvSpecialty file must be mapped to the billing service code and the place of service 

Understanding Keyword Mappings:

  • Keywords bridge the gap between consumer language and medical terms; they include terms related to conditions, procedures, etc
  • Keywords are mapped to specialty names, areas of focus, and recognition values 
    • Keyword mapped to specialties are given a weighted value, placing where they are in the search results 

Connecting the Dots Between the Data & the UI:

1. Understand the data specification and how it interacts with the data domain 

2. Know your business needs 

3. Map those needs to the Data and the UI