Provider queries

Query provider identity, relationship, address, location, and MCO-window data used across bill and claim workflows.

Field	Value
Operation ID	OP-SD-21
Trigger	Provider lookup or update requests.
Inputs	Provider id, bill id, MCO id
Outputs	Provider data, updated audit stamp, bool
Primary components	ProviderQueryProvider
Entry point	Data/SAIF.Data/Queries/Providers/ProviderQueryProvider.cs

Steps

1. Apply identity codes NPI/ONPI, relationship type WRK, and address types PAY/PHY/COR (SD-BR-080, SQL-200, SQL-201, SQL-202, SQL-203, SQL-204, SQL-205). Data: PROVIDER_IDENTITY, PROVIDER_RELATIONSHIP, PROVIDER_ADDRESS.
2. The last-update user constant is "CMN0140" (SD-BR-081).
3. GetBillProviderLocationIds excludes bills with status "DIS" (SD-BR-082).
4. IsProviderInMco checks the MCO provider date window (SD-BR-083). Data: MCO_PROVIDER.
5. GetActiveWorkingRelationshipsForProvider ignores its providerLocationId parameter, a probable defect*.

Process flow

The following diagram visualizes this operation's control flow.

flowchart TD
    Start([Provider lookup or update requests.]) --> S1["`ProviderQueryProvider`"]
    S1 --> S2{"Rules satisfied?"}
    S2 -->|Yes| EndOk([Result returned])
    S2 -->|No| EndErr([Exception / empty result])

Failure and edge-case behavior

• Bill status "DIS": excluded from GetBillProviderLocationIds results.

Related documentation

• Operations and processes
• Business rules
• SQL catalog
• Database tables

Sources

• Data/SAIF.Data/Queries/Providers/ProviderQueryProvider.cs
• Data/SAIF.Data/Queries/Providers/ProviderQueryProvider.cs:35
• Data/SAIF.Data/Queries/Providers/ProviderQueryProvider.cs:41
• Data/SAIF.Data/Queries/Providers/ProviderQueryProvider.cs:50