What is Roster Reconciliation

Roster Reconciliation Definition

Roster Reconciliation is the "Final Audit" of the provider-payer relationship. For Health System Executives, this process ensures they are actually getting paid for the doctors they employ. For Payers, it ensures they aren't paying for "Ghost Providers" who are no longer active. Operationally, reconciliation involves "Matching Logic"—the system looks for NPIs that exist in the roster but not in the payer system (New Adds) and NPIs that exist in the payer system but not in the roster (Potential Terminations). Strategically, reconciliation projects are often performed before major regulatory audits (like a CMS Triennial Review) to ensure that the public directory perfectly matches the clinical reality of the medical groups.

FAQs

What is an "Exception Report" in reconciliation?

It is a list of all providers where the roster and the payer database do not match, allowing staff to focus only on fixing the errors.

Why do "NPI Mismatches" occur during reconciliation?

Often due to typos in the roster or because a provider is using a "Type 2" (Group) NPI in one system and a "Type 1" (Individual) NPI in another.

How often should reconciliation occur?

Ideally, quarterly. Waiting a full year to reconcile rosters leads to thousands of data errors that become nearly impossible to fix all at once.