NPPES NPI Registry
Monthly full + weekly delta
~10M providers + taxonomies + addresses + endpoints. Master DB `npi.*`.
Capability · Canonical catalogs
The master-data spine.
The canonical model is the single internal vocabulary. Master-data catalogs are loaded once for the platform, then projected onto every tenant. Translation lives only at the edge — there is no canonical-shim layer.
Topology
What lives in master, what lives in tenant.
Two-database design: a single master DB holds platform-wide reference data (NPPES, code catalogs, payer registry, companion guides); each tenant has its own database for charges, claims, ledger, rules, audit. Connection strings sealed in Key Vault.
Rendering diagram…
The pipeline
Inbound artifact → ledger entry, end to end.
Every claim follows the same canonical pipeline. The rule kinds that run at each stage are annotated on the edges — this is the same diagram that drives the application's claim-status UI.
Rendering diagram…
Catalogs
The platform's reference library.
Twenty-plus catalogs, grouped by status. The live ones are loaded today; the partials are seeded for behavioural-health Medicaid and on the active master-data roadmap; the rest are sequenced behind concrete differentiators.
Showing 25 of 25 catalogs.
NPPES URL templates
Per env
Editable without a redeploy via `/platform/nppes`.
CARC / CAGC / RARC
As-needed (CAQH CORE)
Adjustment + remark codes; master `rcm_reference.code_set_adjustment_*`.
POS — Place of Service
Rare
Seeded; master `rcm_reference.code_set_place_of_service`.
TOB — Type of Bill
Rare
UB-04 type-of-bill codes; master `rcm_reference.ub04_code`.
Revenue codes
Rare
Seeded; revenue × procedure compatibility on the roadmap.
Modifier catalog
Quarterly
HA-HZ + state U1-UD; master `rcm_reference.code_set_modifier`.
State rate codes
Per-state amendments
Ohio + multi-state seed; master `rcm_master.state_rate_code`.
Companion guides + routing
Per-payer amendments
Master `rcm_master.companion_guide` + `companion_guide_rule`.
Commercial payer registry
Per-amendment
UHC, Aetna, Cigna, Anthem, BCBS Federation, Humana, Centene.
Group-billing rules
Per-payer
Group-size rate adjustments, supervision rules, session triggers.
NCCI PTP + MUE (BH subset)
Quarterly (CMS)
BH-seeded today; full CMS NCCI replaces $5K-$15K/yr/customer commercial scrubbers.
CPT / HCPCS catalog
Quarterly
Schema exists; ingester active on the roadmap.
ICD-10 catalog
Annual (Oct 1)
Schema exists; annual ingester on the roadmap.
HHS OIG LEIE Exclusions
Monthly full + daily delta
~75K active exclusions; pre-claim provider check.
State Medicaid fee schedules
Quarterly-annual
Per-state fee-schedule pipeline (PA pilot under way).
Transparency in Coverage rates
Monthly (~5 TB JSON per major payer)
Customer-facing rate-renegotiation advisory — no incumbent BH-Medicaid platform offers anything close.
NUCC Provider Taxonomy
Semi-annual (Jan + Jul)
Taxonomy refresh + reconciliation against NPPES endpoints.
SAM.gov Exclusions
Daily (API)
Federal exclusion enrichment.
State 1915(c) HCBS Waiver service defs
Per-waiver renewal
Codified waiver service definitions for I/DD + ABA + Adult Day.
Customer-derived service scope
Daily per tenant
Pre-req for the TiC storage filter; bounds the rate-feed footprint per customer.
State Medicaid exclusion lists
Monthly
Per-state exclusion lists alongside LEIE and SAM.gov.
SAMHSA OTP Directory
Quarterly
Cross-reference OTP authorisations against the federal directory.
CMS LCD/NCD coverage database
Continuous
Local + national coverage determinations.
DEA controlled substances
Annual
Practitioner cross-reference for OTP + SUD.
NPPES is loaded once. Not once per customer.
Keep going