MCheck Suspect Agent

Health Plan Rules Engine · Provider Directory

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Total rules
100
System
97
Suspect Reports
3
Pending review
2
IDSourceBusiness DescriptionCategoryDimensionProvider Type# RecordsPriorityStatusAction
#17
Suspect Reports
Individuals missing networks compared to other individuals within same group and specialty
Probabilistic
NetworkCompletenessIndividuals500
High
In Review
APMC
Report
#18
Suspect Reports
Individual providers with active network and all reimbursements are terminated
Probabilistic
NetworkConsistencyIndividuals50
High
In Development
Report
#128
Suspect Reports
Individual providers missing networks when compared to similar providers
Probabilistic
NetworkCompletenessIndividuals603
High
Production
APMCSR
Records
#1
System
Organization provider has no associated address
Deterministic
AddressCompletenessOrganization50
High
Production
Report
#2
System
Organizations with Type 1 NPI but no relationships
Deterministic
RelationshipsValidityOrganization50
High
Production
Report
#3
System
Orgs with Type 1 NPI that are NON SOLO practices
Deterministic
RelationshipsValidityOrganization50
Medium
Production
Report
#5
System
Practice address without a valid remit
Deterministic
AddressCompletenessOrganization50
High
Production
Report
#7
System
Organization provider is not associated with any network
Deterministic
NetworkCompletenessOrganization50
High
Production
Report
#9
System
Professional group that does not have any individual association
Deterministic
RelationshipsCompletenessOrganization50
High
Production
Report
#10
System
Individual provider does not have a RLTD_PADRS segment
Deterministic
AddressCompletenessIndividuals50
High
Production
Report
Showing 110 of 100 (total 100)
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SystemSuspect Reports