Matching Patient Records
ZOLL Billing creates claims from NEMSIS and Dispatch imports. When Billing receives an import, a weighted algorithm is used to look for an existing matching patient. The algorithm consists of a set of criteria, each assigned a number of points. The points are added to determine if the imported patient is an exact match or no match.
In the weighted algorithm, each of the following matching criteria is given a number of points:
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Social security number: 19
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Personal information:
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Date of birth: 30
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Sex: 0
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First name: 9
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Middle name: 2
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Last name: 34
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Address:
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Address line 1: 6
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Address line 2: 2
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City: 6
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State: 5
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Zip: 6
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Exact match: The new patient record is considered an exact match of an existing record when the combined weights of the above criteria is 79 or greater.
After finding an exact matching patient, the system then looks for existing claims associated with that patient.
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NEMSIS import:
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Claim found with the same DOS and run number: TBD will display on the Imported Claims page. When the user clicks TBD, a duplicate message will display.
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Claim found with the same DOS but different run number: TBD will display on the Imported Claims page. When the user clicks TBD, a merge message will display.
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Claim found with different DOS: A new claim will be created for the patient.
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Dispatch import:
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Claim found with same DOS and run number: TBD will display on the Imported Claims page. When the user clicks TBD, a duplicate message will display.
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Claim found with different DOS: A new claim will be created based on the import. If there is an exact patient match and no claims exist for the patient, then a claim will be created based on the import. There will not be a merge message for a dispatch import.
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When user clicks on TBD, the possible match trigger (not exact match), which is above criteria to be greater than 60.
If there is a single matching patient, then patient matching section is not shown.
If multiple matches are found:
If a single match is found:
