MCheck Suspect Agent
Health Plan Rules Engine · Provider Directory
Total rules
140
System
137
Suspect Reports
3
Pending review
2
All
System
Suspect Reports
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Columns
10/10
ID
Source
Business Description
Category
Dimension
Provider Type
# Records (% of total)
Priority
Status
Action
#17
Suspect Reports
Individuals missing networks compared to other individuals within same group and specialty
Probabilistic
Network
Completeness
Individuals
500
(6.80%)
High
In Review
TK
HM
Inspect
Approve
Push
#18
Suspect Reports
Individual providers with active network and all reimbursements are terminated
Probabilistic
Network
Consistency
Individuals
50
(0.68%)
High
In Development
Inspect
Push
#128
Suspect Reports
Individual providers missing networks when compared to similar providers
Probabilistic
Network
Completeness
Individuals
377
(5.13%)
High
Production
TK
HM
TP
Inspect
Push
#136
System
License data validation against State License Board Websites
Deterministic
Qualifications
Accuracy
Individuals
50
(0.68%)
High
Production
Inspect
Push
#1
System
Organization provider has no associated address
Deterministic
Address
Completeness
Organization
50
(0.68%)
High
Production
Inspect
Push
#2
System
Organizations with Type 1 NPI but no relationships
Deterministic
Relationships
Validity
Organization
50
(0.68%)
High
Production
Inspect
Push
#3
System
Orgs with Type 1 NPI that are NON SOLO practices
Deterministic
Relationships
Validity
Organization
50
(0.68%)
Medium
Production
Inspect
Push
#5
System
Practice address without a valid remit
Deterministic
Address
Completeness
Organization
50
(0.68%)
High
Production
Inspect
Push
#7
System
Organization provider is not associated with any network
Deterministic
Network
Completeness
Organization
50
(0.68%)
High
Production
Inspect
Push
#9
System
Professional group that does not have any individual association
Deterministic
Relationships
Completeness
Organization
50
(0.68%)
High
Production
Inspect
Push
#10
System
Individual provider does not have a RLTD_PADRS segment
Deterministic
Address
Completeness
Individuals
50
(0.68%)
High
Production
Inspect
Push
#12
System
Individual provider does not have a specialty
Deterministic
Profile
Completeness
Individuals
13
(0.18%)
High
Production
Inspect
Push
#13
System
Individuals w/o gender code
Deterministic
Profile
Completeness
Individuals
23
(0.31%)
Medium
Production
Inspect
Push
#15
System
Individuals not credentialed
Deterministic
Qualifications
Validity
Individuals
50
(0.68%)
Medium
Production
Inspect
Push
#16
System
PCP individuals having incorrect role code based on specialty and network
Deterministic
Network
Accuracy
Individuals
50
(0.68%)
High
Production
Inspect
Push
#19
System
Organization providers with active network and all reimbursements are terminated
Deterministic
Network
Consistency
Organization
50
(0.68%)
High
Production
Inspect
Push
#20
System
Individual providers with active network and having no reimbursements
Deterministic
Network
Consistency
Individuals
50
(0.68%)
High
Production
Inspect
Push
#21
System
Organization providers with active network and having no reimbursements
Deterministic
Network
Consistency
Organization
50
(0.68%)
High
Production
Inspect
Push
#22
System
Individual providers with multiple active addresses for same location
Deterministic
Address
Consistency
Individuals
50
(0.68%)
High
Production
Inspect
Push
#25
System
Individual providers having network with incorrect display indicator
Deterministic
Network
Accuracy
Individuals
50
(0.68%)
High
Production
Inspect
Push
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