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Configurations for Healthcare

Match rules for Healthcare

Learn what match rules are preconfigured in entity types for Reltio for Healthcare .

Reltio for Healthcare brings together systems including patient records, payment, and insurance systems. Many of these systems duplicate patient and provider information. Match rules define the criteria Reltio uses to determine whether two records are duplicates.

Provider Organization and Practitioner entity types are highly likely to be duplicated, so match rules help you reconcile any variations. Insurance plans, on the other hand, tend not to have duplicates, so they do not need match rules.

Some preconfigured entity types in the Reltio for Healthcare data model come with match rules. For general information on match rules, see topic Reltio match and merge. For details on the preconfigured entity types that come with Reltio for Healthcare, see Entity types for Healthcare.

Location entity type match rules (Healthcare)

This table identifies the Reltio for Healthcare match rules for the Location entity type. Use these match rules to create a record for an address.

LabelDescriptionMatch queries
Exact (Addr1, City, State, Country, Zip5, Verification Status) EOAN(Addr2, Zip4)Automatically merges records when the full address OR the when the address line 2 and Zip code are an exact match or are null. 
(
Exact on
Address Line 1
and
City
and
State
and
Country
and
Zip/Zip5
and
Verification Status
)
and
(
Exact Or All Nullon
Address Line 2
and
Zip/Zip4
)
and
Equals on
Verification Statusvalues : Verified,Partially Verified

Payer entity type match rules (Healthcare)

This table identifies the Reltio for Healthcare match rules for the Payer entity type. Use these match rules to create a record for a specific payment providers.

LabelDescriptionMatch queries
Exact (Name, Addr1, City, Zip5) EOAN (Addr2)Automatically merges when the name, address line 1, city, and Zip code are an exact match AND when address line 2 is an exact match or is null. 
(
Exact on
Name
[Comparator class:OrganizationNamesComparator]
[Match token:OrganizationNameMatchToken]
and
Address/Address Line 1
[Comparator class:AddressLineComparator]
[Match token:AddressLineMatchToken]
and
Address/Zip/Zip5
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
and
Address/City
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
)
and
Exact Or All Nullon
Address/Address Line 2
[Comparator class:AddressLineComparator]
[Match token:AddressLineMatchToken]
Exact(City, State) Fuzzy (Name, Adl)Creates a potential match when there is exact match on city and state as well as a fuzzy match on name and address line 1. 
(
Exact on
Address/City
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
and
Address/State
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
)
and
(
Fuzzy on
Name
[Comparator class:OrganizationNamesComparator]
[Match token:OrganizationNameMatchToken]
and
Address/Address Line 1
[Comparator class:AddressLineComparator]
[Match token:AddressLineMatchToken]
)

Person entity type match rules (Healthcare)

This table identifies the Reltio for Healthcare match rules for the Person entity type. Use these match rules to create a record for a specific person.

LabelDescriptionMatch queries
Exact (FirstName, LastName, Email, Phone) EOAN (Suffix)Creates a potential match when the first name, last name, email address, and phone are an exact match AND the suffix is an exact match or is null. 
(
Exact on
First Name
[Comparator class:DoubleMetaphoneComparator]
[Match token:DoubleMetaphoneMatchToken]
and
Last Name
[Comparator class:DoubleMetaphoneComparator]
[Match token:DoubleMetaphoneMatchToken]
and
Phone/Formatted Number
[Comparator class:PhoneNumberComparator]
[Match token:ExactMatchToken]
and
Email/Email
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
)
and
Exact Or All Null on
Suffix Name
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
Exact (FirstName, LastName, Identifier/Type, Identifier/ID)Creates a potential match when the first name, last name, identifier ID, and identifier type are an exact match. 
(
Exact on
Last Name
[Comparator class:DoubleMetaphoneComparator]
[Match token:DoubleMetaphoneMatchToken]
and
First Name
[Comparator class:DoubleMetaphoneComparator]
[Match token:DoubleMetaphoneMatchToken]
and
Identifiers/ID
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
and
Identifiers/Type
[Comparator class:BasicStringComparator]
[Match token:ExactNumberMatchToken]
)
Exact (LastName, FirstName, SSN)Automatically merges records when the first name, last name, and Social Security Number are an exact match. 
(
Exact on
Last Name
[Comparator class:DoubleMetaphoneComparator]
[Match token:DoubleMetaphoneMatchToken]
and
SSN
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
and
First Name
[Comparator class:DoubleMetaphoneComparator]
[Match token:DoubleMetaphoneMatchToken]
)
Fuzzy (FirstName) Exact (LastName, Addr1, City)Creates a potential match when the last name, address line 1, and city are an exact match AND the first name is a fuzzy match. 
(
Exact on
Last Name
[Comparator class:DoubleMetaphoneComparator]
[Match token:DoubleMetaphoneMatchToken]
and
Address/City
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
and
Address/Address Line 1
[Comparator class:AddressLineComparator]
[Match token:AddressLineMatchToken]
)
and
Fuzzy on
First Name
[Comparator class:DoubleMetaphoneComparator]
[Match token:DoubleMetaphoneMatchToken]
Grouping - Exact (Last Name & Address)Automatically groups records when the last name and address are an exact match. 
(
Exacton
Last Name
[Comparator class:DoubleMetaphoneComparator]
[Match token:DoubleMetaphoneMatchToken]
and
Address/Address Line 1
[Comparator class:AddressLineComparator]
[Match token:AddressLineMatchToken]
and
Address/City
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
and
Address/Zip/Zip5
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
and
Address/State
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
and
Address/Address Type
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
and
Address/Country
)

Practitioner entity type match rules (Healthcare)

This table identifies the Reltio for Healthcare match rules for the Practitioner entity type. Use these match rules to create a record for a specific healthcare practitioner.

LabelDescriptionMatch queries
Exact (FirstName, LastName, Addr Type, Addr1, Zip5, VerificationStatus)Automatically merges records when the first name, last name, address type, address line 1, and zip code are an exact match. 
(
Exact on
First Name
[Comparator class:DoubleMetaphoneComparator]
[Match token:DoubleMetaphoneMatchToken]
and
Last Name
[Comparator class:DoubleMetaphoneComparator]
[Match token:DoubleMetaphoneMatchToken]
and
Address/Address Type
[Comparator class:BasicStringComparator]
[Match token:CustomMatchToken]
and
Address/Address Line 1
[Comparator class:AddressLineComparator]
[Match token:AddressLineMatchToken]
and
Address/Zip/Zip5
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
and
Address/Verification Status
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
)
Exact (NPI), Fuzzy (LastName)Creates potential match when the NPI values for identifier ID and identifier type are and exact match and the last name is a fuzzy match. 
Exact on
Identifiers/ID
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
and
Equals on
Identifiers/Typevalue : NPI
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
and
Fuzzy on
Last Name
[Comparator class:DoubleMetaphoneComparator]
[Match token:DoubleMetaphoneMatchToken]
Fuzzy (FirstName, LastName) Exact (Email or Phone)Creates a potential match when the first name and last name are a fuzzy match AND the email address or phone number is an exact match. 
(
(
Fuzzy on
Last Name
[Ignored in token]
[Comparator class:DoubleMetaphoneComparator]
[Match token:DoubleMetaphoneMatchToken]
and
First Name
[Ignored in token]
[Comparator class:DoubleMetaphoneComparator]
[Match token:DoubleMetaphoneMatchToken]
)
)
and
(
(
Exact on
Email/Email
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
or
Phone/Formatted Number
[Comparator class:PhoneNumberComparator]
[Match token:ExactMatchToken]
)
)
Fuzzy (FirstName, LastName) Exact (Identifiers/Type, Identifiers/ID)Creates a potential match when the first name and last name are a fuzzy match AND the identifier ID and identifier type are an exact match.
(
Exact on
Identifiers/Type
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
and
Identifiers/ID
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
)
and
(
Fuzzy on
First Name
[Comparator class:DoubleMetaphoneComparator]
[Match token:DoubleMetaphoneMatchToken]
and
Last Name
[Comparator class:DoubleMetaphoneComparator]
[Match token:DoubleMetaphoneMatchToken]
)

Provider Organization entity type match rules (Healthcare)

This table identifies the Reltio for Healthcare match rules for the Provider Organization entity type. Use these match rules to create a record for healthcare master accounts, companies, and businesses.

LabelDescriptionMatch queries
Exact (NPI) Fuzzy (Name)Creates potential match when the NPI values for identifier ID and identifier type are an exact match and the name is a fuzzy match. 
Exact on
Identifiers/ID
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
and
Equals on
Identifiers/Typevalue : NPI
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
and
Fuzzy on
Name
[Comparator class:OrganizationNamesComparator]
[Match token:OrganizationNameMatchToken]
Exact (Name, Addr1, City, Zip5) EOAN (Addr2)Automatically merges records when the name, address line 1, city, and Zip code are an exact match AND the address line 1 is an exact match or null. 
(
Exact on
Address/City
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
and
Name
[Comparator class:OrganizationNamesComparator]
[Match token:OrganizationNameMatchToken]
and
Address/Address Line 1
[Comparator class:AddressLineComparator]
[Match token:AddressLineMatchToken]
and
Address/Zip/Zip5
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
)
and
Exact Or All Null on
Address/Address Line 2
[Comparator class:AddressLineComparator]
[Match token:AddressLineMatchToken]
Fuzzy (Name) Exact (Identifier/Type, Identifier/ID, Addr1)Creates a potential match when the name is a fuzzy match AND the identifier ID, identifier type, and address line 1 are an exact match. 
(
Exact on
Address/Address Line 1
[Comparator class:AddressLineComparator]
[Match token:AddressLineMatchToken]
and
Identifiers/Type
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
and
Identifiers/ID
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
)
and
Fuzzy on
Name
[Ignored in token]
[Comparator class:OrganizationNamesComparator]
[Match token:OrganizationNameMatchToken]
Fuzzy (Name) Exact(Addr1, CIty, State, Zip5, Country)Create potential matches 
(
Exact on
Address/Address Line 1
[Comparator class:AddressLineComparator]
[Match token:AddressLineMatchToken]
and
Address/City
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
and
Address/Zip/Zip5
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
and
Address/State
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
and
Address/Country
[Comparator class:BasicStringComparator]
[Match token:ExactMatchToken]
)
and
Fuzzy on
Name
[Comparator class:OrganizationNamesComparator]
[Match token:OrganizationNameMatchToken]

Updated on December 9, 2024

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