Resource Center
Payerset WebsiteSnowflake Marketplace
  • Payerset Resource Center
  • Using The Payerset Platform
    • Training & Onboarding
      • 🧑‍🎨Getting Started
      • 🏠Home Screen
      • 📊Creating a Rate Comparison
      • 💲Creating a Fee Schedule
      • 📈Analyzing your Data
      • Hospital MRF - Standard Charges [BETA]
    • Data Dictionary
  • Hospital Transparency
    • MRF Links by State
  • Data Lake
    • Data Dictionary
      • EIN to NPI Map
    • NPI Data from NPPES
    • Payerset Billing Code Classification
    • Taxonomy Data from NUCC
  • Payer Transparency
    • 🟡Aetna
    • 🟢Alliant Health Plans
    • 🟢Always Health Partners
    • 🟢Ambetter (Centene)
    • 🟢AmeriHealth
    • 🟢AultCare
    • 🟢Avera Health Plans
    • 🟢AvMed Health Pledge
    • 🟢Baylor Scott and White Health Plan
    • 🟢Blue Cross of Idaho
    • 🟢Blue Cross Blue Shield Alabama
    • 🟢Blue Cross Blue Shield Arizona
    • 🟢Blue Cross Blue Shield Arkansas
    • 🟢Blue Cross Blue Shield Florida
    • 🟢Blue Cross Blue Shield Illinois
    • 🟢Blue Cross Blue Shield Kansas
    • 🟢Blue Cross Blue Shield Kansas City
    • 🟢Blue Cross Blue Shield Louisiana
    • 🟢Blue Cross Blue Shield Massachusetts
    • 🟢Blue Cross Blue Shield Michigan
    • 🟢Blue Cross Blue Shield Minnesota
    • 🟢Blue Cross Blue Shield Mississippi
    • 🟢Blue Cross Blue Shield Montana
    • 🟢Blue Cross Blue Shield Nebraska
    • 🟢Blue Cross Blue Shield New Mexico
    • 🟢Blue Cross Blue Shield North Carolina
    • 🟢Blue Cross Blue Shield North Dakota
    • 🟢Blue Cross Blue Shield Oklahoma
    • 🟢Blue Cross Blue Shield South Carolina
    • 🟢Blue Cross Blue Shield Tennessee
    • 🟢Blue Cross Blue Shield Texas
    • 🟢Blue Cross Blue Shield Triple-S
    • 🟢Blue Cross Blue Shield Vermont
    • 🟢Blue Cross Blue Shield Wyoming
    • 🟢Blue Shield California
    • 🟢Capital Blue Cross
    • 🟢Capital Health Plan
    • 🟢CareFirst
    • 🔴CareSource
    • ⚪Centene
    • 🟢Christus Health Plan
    • 🟢Cigna
    • 🟡Common Ground Healthcare
    • 🔴Community Care of North Carolina
    • 🟢Community Care of Oklahoma
    • 🟠Community Care Plan
    • 🟢Community Health Choice
    • 🟠Community Health Options
    • 🟢ConnectiCare
    • 🟢Contra Costa
    • 🟡Cook Children's
    • 🟠Dean Health Plan
    • 🟠Denver Health Medical Plan
    • 🟢Elevance (Anthem)
    • 🟢Emblem Health
    • 🟢Excellus BlueCross BlueShield
    • 🟢Fidelis (Centene)
    • 🟠Florida Complete Care
    • 🟡Geisinger
    • 🔴Group Health Cooperative of Eau Claire
    • 🟢Group Health Cooperative of SC Wisconsin
    • 🟢Harvard Pilgrim Health Care
    • 🟠HMAA (Hawaii Management Alliance Association)
    • ⚪HCSC
    • 🟢Hally Health Alliance
    • 🟢Health Alliance Plan (HAP)
    • 🟢Healthfirst
    • 🟢HealthNet (Centene)
    • ⚪HealthNow New York
    • 🟢HealthPartners
    • ⚪Hennepin Health Plan (MN)
    • 🟢Highmark Blue Cross Blue Shield Delaware
    • 🟢Highmark Blue Cross Blue Shield Pennsylvania
    • 🟢Highmark Blue Cross Blue Shield West Virginia
    • 🟢Highmark Blue Cross Blue Shield Western New York
    • 🟢Highmark Blue Shield of Northeastern New York
    • 🟢Highmark Blue Shield Pennsylvania
    • 🟢HMSA (Hawaii Medical Service Association)
    • 🟢Horizon Blue Cross Blue Shield New Jersey
    • ⚪Humana
    • 🟢Independence Blue Cross
    • 🟢Independent Health
    • 🟠Inland Empire
    • 🟢Kaiser Permanente
    • 🟢Lifewise Assurance Company
    • 🟢Managed Health Network (Centene)
    • 🟢Martin's Point
    • 🟢McLaren Health Plan
    • 🟡Medcost
    • 🟢Medica
    • 🟢Medical Mutual of Ohio
    • 🟡Meritain (TPA)
    • 🟢Midwest Health Plan
    • 🟡Moda Health
    • 🟡Molina
    • 🟢MVP HEALTH
    • 🟢Neighborhood Health Plan (RI)
    • 🟢Ohio Health Choice Plan
    • 🟢Optum
    • 🟢Oscar
    • 🔴PacificSource
    • 🟢Paramount
    • 🔴Partners Healthcare
    • 🟢Physicians Health Plan of N. Indiana
    • 🟢Physicians Health Plan (University of Michigan)
    • 🟢Point 72 Health
    • 🟢Premera Blue Cross
    • 🟢Presbyterian Health Plan
    • 🟢ProMedica Health System
    • 🟢Providence Health Plans
    • 🟢QualChoice (Centene)
    • 🟢Quartz Benefits
    • 🟢Regence
    • 🟢Sanford Health Plan
    • 🟢Security Health Plan
    • 🟡Select Health
    • 🟡Sentara (Optima)
    • 🔴Sharp Health Plan
    • 🟠Spectrum / Priority Health
    • 🟢SummaCare
    • 🟠The Health Plan of the Upper Ohio Valley
    • 🟢The Jefferson Health Plan
    • 🟢Tufts Health Plan
    • 🟢Ucare
    • 🟢UnitedHealthcare
    • 🟢Univera Healthcare
    • 🟢UPMC Health System
    • 🟠Valley Health Plan
    • 🟠VIVA Health
    • 🟢WellCare (Centene)
    • 🟢Wellmark
    • 🔴Wellsense
    • 🟡Wisconsin Physicians Health (WPS)
  • Information & Requests
    • Request a Payer
Powered by GitBook
LogoLogo

© 2024 - Payerset - All Rights Reserved

On this page
  • Payerset Notes
  • Compliance Scorecard - September 2024
  • Schema: UNITED_HEALTHCARE
  • Additional Observations

Was this helpful?

Export as PDF
  1. Payer Transparency

UnitedHealthcare

This data contains the price transparency machine-readable files provided by United that have been normalized into easy-to-use tables.

PreviousUcareNextUnivera Healthcare

Last updated 1 month ago

Was this helpful?

Payerset Notes

Table of Contents

Compliance Scorecard - September 2024

Overall Rating: 4/5 - Good

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.

Overall Assessment: Despite the very large volumes and questionable interpretation of the assignment, UnitedHealthcare consistently puts out accessible, properly-formatted files with complete data.

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:

🟢

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

https://mrf.payerset.com/united-healthcare
https://docs.google.com/spreadsheets/d/1P5ggBP6y9OeMmIUpHKE1hys0_0sCuC72rAobbowh9t4/edit?usp=sharing