Payer Transparency (TiC)

Data dictionary for the Payer Transparency in Coverage data for medical services. Below are the fields available for Data Lake customers.

There is an additional PLAN_MAP table that contains details about the Plans and Plan Types. This may or may not be included in your data output, depending on your license structure.

Field Name	Description / Sample Values	Original Source
ADDITIONAL_INFORMATION	Additional information relevant to rate	PAYER MRF
BILLING_CLASS	Institutional or Professional	PAYER MRF
BILLING_CODE	Billing code as-is in MRF	PAYER MRF
BILLING_CODE_MODIFIER	Modifiers for different rates (22-99, P1)	PAYER MRF
MRF_BILLING_CODE_NAME	Billing code name as-is in MRF	PAYER MRF
MRF_BILLING_CODE_TYPE	HCPCS, CPT, MS-DRG, etc	PAYER MRF
BILLING_CODE_TYPE_VERSION	Version of the billing code (2023, 2024)	PAYER MRF
EXPIRATION_DATE	Expiration date of the rate (12/31/2024)	PAYER MRF
NEGOTIATED_RATE	Negotiated Rate value	PAYER MRF
NEGOTIATED_TYPE	Fee schedule, negotiated, percentage, per diem	PAYER MRF
NEGOTIATION_ARRANGEMENT	Fee for service (ffs) or Bundle	PAYER MRF
NPI	Provider ID	PAYER MRF
SERVICE_CODES	Location of service (11, 21, 22, etc)	PAYER MRF
TIN_TYPE	EIN or NPI	PAYER MRF
TIN_VALUE	Value of associated EIN or NPI	PAYER MRF
NPPES_CITY	City Name from NPPES	NPPES
NPPES_STATE	State Name from NPPES	NPPES
NPPES_ORGANIZATION_NAME	Organization Name from NPPES	NPPES
NPPES_ORGFRIENDLYNAME	Org Name + DBA Name if present	ADDED BY PAYERSET
NPPES_PRIMARY_TAXONOMY_CODE	Primary taxonomy derived using switches in NPPES file	ADDED BY PAYERSET
NUCC_TAXONOMY_GROUPING	High-level taxonomy grouping (Allopathic, Hospitals, Hospital Units, etc)	NUCC
NUCC_TAXONOMY_CLASSIFICATION	More granular taxonomy classification (Clinic/Center, Abmulance, Nursing Care, etc)	NUCC
NUCC_TAXONOMY_SPECIALIZATION	Most granular taxonomy (Adult Mental Health, Oncology, Orthopedic Surgery, etc...)	NUCC
PAYER	Payer column added for convenience	ADDED BY PAYERSET
PAYERSET_BILLING_CODE_NAME	Payerset standardized name of 21k+ billing codes	ADDED BY PAYERSET
PAYERSET_BILLING_CODE_CATEGORY	Payerset categorization of 21k+ billing codes	ADDED BY PAYERSET
PAYERSET_BILLING_CODE_SUBCATEGORY	Payerset subcategorization of 21k+ billing codes	ADDED BY PAYERSET
PAYERSET_BILLING_CODE_TYPE	Payerset categorization of billing code types	ADDED BY PAYERSET
PLAN_ID	Payerset-created Plan ID that links back to original plan via PLAN_MAP table	ADDED BY PAYERSET