The health plan price transparency data includes rates by procedure code negotiated with providers. Providers are identified through a tax identification number as well as all the associated national provider identifiers associated with the particular rate. Rates are also designated by specific arrangement types, service code, and procedure code modifiers. More details on the reporting requirements and data specifications can be found on the CMS TRANSPARENCY IN COVERAGE WEBSITE.
The data reported by payers is complex and significant in size. Some payers are reporting more than one rate for an individual NPI without differentiation of the type of service or other billing code modifiers. We’ve developed and validated algorithms that identify and score the rates with the highest likelihood of accuracy to clear the noise.