🟡UnitedHealthcare
This data contains the price transparency machine-readable files provided by United that have been normalized into easy-to-use tables.
Payerset Notes
Table of Contents
https://mrf.payerset.com/united-healthcare
Compliance Scorecard - September 2024
Overall Rating: 4/5 - Good
Table of Contents
★★★☆☆
3/5
Are the MRFs kept up to date each month?
Is the Table of Contents link easily accessible?
Is the Table of Contents properly formatted?
File Accessibility
★★★★☆
4/5
Are there any barriers to downloading the files?
Do the Table of Contents links expire before publishing new links?
Data Quality
★★★★☆
4/5
Is the data present in the files complete
Are there significant gaps in any type of data
Is the payer compliant with the regulations
Schema: UNITED_HEALTHCARE
Rates Records: 2,220,454,683,340
Provider Records: 10,520,399,934
Additional Observations
Machine-Readable Price Transparency Files Review
MRFs Up-to-Date: ✔️ Yes, the MRFs are kept up to date each month.
Table of Contents Accessibility: ❌ The Table of Contents link is not easily accessible, it spans thousands of individual files that must be downloaded in multiple steps.
Table of Contents Formatting: ✔️ Yes, the Table of Contents is properly formatted once downloaded.
File Download Barriers: ❌ Yes, there is an API that sits in front of the files that limits the download speed and availability, making it very difficult to download the data quickly.
File Accessibility Percentage: 99.9% of the files are accessible.
API Issues
United has a new API in front of their files, which makes the download process much more difficult and slow. This can be circumvented, but there is definitely a hit to performance, and file metadata is no longer feasible to get prior to parsing the data.
Data Quality Issues
UnitedHealthcare publishes many MS-DRG codes with 4 digits, including a leading zero, causing them to be out of compliance in that regard (though we should assume this is not intentional). Additionally, many rates that are supposed to be tagged as institutional are instead tagged as professional which leads to confusing results. These issues must be fixed to get the maximum value out of this data for UnitedHealthcare.
These files are not accessible either:
An error occurred: 404 Client Error: Not Found for url: https://drive.google.com/uc?export=download&id=1CMgbN8PJVHFUbVVTp34NZOpEnhLFJjGs
An error occurred: 500 Server Error: Internal Server Error for url: https://transparency-in-coverage.uhc.com/api/v1/uhc/blobs/download?fd=2024-05-01&fn=2024-05-01_UMR--Inc-Third-Party-Administrator_REGENEXX%C2%A0-WONDR-HEALTH-AND-OC24HEALTH-DCI_UHC-CHOICE-PLUS---PREMIUM-DESIGNATION-ROW_TC_in-network-rates.json.gz
An error occurred: 500 Server Error: Internal Server Error for url: https://transparency-in-coverage.uhc.com/api/v1/uhc/blobs/download?fd=2024-05-01&fn=2024-05-01_Oxford_eviCore_in-network-rates.json
An error occurred: 500 Server Error: Internal Server Error for url: https://transparency-in-coverage.uhc.com/api/v1/uhc/blobs/download?fd=2024-05-01&fn=2024-05-01_UnitedHealthcare-of-California_INSURER_OPH-%EF%BF%BD-Optum-Physical-Health_OPH-193_in-network-rates.json.gz
An error occurred: 500 Server Error: Internal Server Error for url: https://transparency-in-coverage.uhc.com/api/v1/uhc/blobs/download?fd=2024-05-01&fn=2024-05-01_TheAlliance_AllianceComprehensiveWithBehavioralHealthAndChiropracticProviderExclusions_in-network-rates_json.zip
One interesting thing about UnitedHealthcare that we don't see in other payers is that they sometimes put multiple billing codes in the billing_code field. See the example below in which they put 29888 AND 29882 in the same field. We do not know the reason for this, but don't believe it is in compliance.
Additionally, many rates are "hidden" in custom billing codes with the CSTM-ALL billing code type. Payerset has created a CSV export of all of this data by state so anyone can view the data. The links are available in this Google Sheet:https://docs.google.com/spreadsheets/d/1P5ggBP6y9OeMmIUpHKE1hys0_0sCuC72rAobbowh9t4/edit?usp=sharing
Overall Assessment: Despite the very large volumes and questionable interpretation of the assignment, UnitedHealthcare consistently puts out accessible, properly-formatted files with complete data.
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