Data Dictionary

The following fields are located at various places in the Payerset platform. Reach out to [email protected] with any questions or clarifications.

Payer Transparency

Provider

Field	Description	Original Source
Parent Organization	High-level rollup of organizations that makes it easier to filter and group NPIs. These can represent large hospital systems, ownership groups, groups of facilities, and more. Note this can be separate from NPPES data and NPPES organizations should be used in conjunction with the Parent Organization in getting correct NPIs for analysis.	Payerset
Organization	Indicates the healthcare organization or facility where the service was provided. There can be multiple NPIs for a given organization.	Payerset (derived from NPPES)
NPI	Represents the National Provider Identifier, a unique 10-digit number assigned to healthcare providers. This field is essential for linking pricing data with provider-specific details. There can be multiple NPIs per provider/organization.	Payer MRF
State	Indicates the U.S. state where the NPI is registered in NPPES.	NPPES
County	Indicates the U.S. county where the NPI is registered in NPPES.	NPPES
City	Indicates the U.S. city where the NPI is registered in NPPES.	NPPES
Taxonomy	Represents the categorization of healthcare providers based on their specialties and services.	NUCC
Primary Taxonomy Code	The main code used to identify a provider’s specialty or service category.	NUCC
Taxonomy Display Name	User-friendly name to describe a provider’s specialty or service category. This is the display name of the Taxonomy Code.	NUCC
Taxonomy Classification	Offers a detailed categorization of the provider’s area of expertise.	NUCC
Taxonomy Specialization	Indicates a further level of specialization within a broader taxonomy classification.	NUCC
TIN Type	Specifies the type of Tax Identification Number (TIN) used, such as an individual provider or EIN.	Payer MRF
TIN Value	The actual Tax Identification Number associated with the billing entity. It is helpful for uniquely identifying and cross-referencing providers or organizations. Note that this can differ within NPIs & organizations, respectively.	Payer MRF
Trade Category	Provides a high-level grouping of related healthcare services to segment and analyze data across broad service domains (for example, Home Health and Hospice). This field is is commonly used for macro-level filtering to isolate relevant NPIs.	Payerset
Trade Type	Additional layer of specificity within a trade category by describing the general nature of the services delivered (for example, in-home nursing care services).	Payerset
Trade Subtype	The most granular classification within Trade Categories & Types, identifying the specific service focus within a trade type.	Payerset

Health Plan

Field	Description	Original Source
Payer	Identifies the insurance provider or entity responsible for reimbursement.	Payerset (derived from Payer MRF & enriched)
Negotiated Type	Indicates the method or category of negotiation used to determine the pricing. Note that some Payers use these fields differently - we recommend always comparing directly to contracts when using this data for analysis. There are five potenital values: 1. Negotiated 2. Fee Schedule 3. Percentage 4. Per Diem 5. Derived	Payer MRF
Negotiation Arrangement	Describes the contractual terms for the negotiated rate. It is useful for understanding the structure and conditions of pricing agreements in your analysis. The potential values are: 1. FFS (fee-for-service) 2. Bundle 3. Capitation	Payer MRF
Plans	Lists the specific insurance plans associated with the negotiated rate.	Payerset (derived from Payer MRF & enriched)
Expiration Date	Indicates when the pricing data or contractual agreement is set to expire. Note that evergreen contracts can be represented by the YYYY value of 1999.	Payer MRF

Service

Field	Description	Original Source
Negotiated Rate	The agreed-upon price between the payer and provider for a particular service. Use this to evaluate cost efficiency and compare pricing across services and providers.	Payer MRF
Billing Class	Refers to the classification of billing codes based on service type or specialty. This field represents if a rate is Professional or Institutional. Note that the use of this field by individual Payers can be different based on their interpretation of CMS rules.	Payer MRF
Billing Code Category	Groups billing codes into broader categories based on service or procedure characteristics to more easily identify services for analysis.	Payerset
Billing Code Subcategory	Provides a more detailed classification within a broader billing code category to further identify specific services or sets of services.	Payerset
Billing Code Modifier	Adds additional context or specificity to a billing code, often indicating variations of a service. This can be additive to the original service or represent a different service variant depending on the code and payer.	Payer MRF
Billing Code	The standardized code representing a specific medical service or procedure.	Payer MRF
Billing Code Name	Provides a descriptive name associated with the billing code.	Payerset (derived from Payer MRF & enriched)
Billing Code Type	Defines the type of billing code, such as CPT, HCPCS, or ICD.	Payerset (derived from Payer MRF & enriched)
MRF Billing Code Name	The name of the billing code as it is written in the published MRF. Note that there is a separate Billing Code Name field that is cleaned and often easier to use.	Payer MRF
MRF Billing Code Type	Defines the type of billing code, such as CPT, HCPCS, or ICD as it is written in the published MRF.	Payer MRF
Billing Code Type Version	Specifies the version of the billing code in use, ensuring that comparisons are made within consistent coding standards.	Payer MRF
Place of Service Codes	Codes that identify the physical location where the service was provided, such as an outpatient clinic or hospital. This field represents the actual codes as they show in the data.	Payer MRF
Place of Service	Provides the descriptive name(s) corresponding to the place of service code(s).	Payerset
Facility vs. Non-Facility	Indicates whether the service was performed in a facility (e.g., hospital) or a non-facility setting (e.g., physician’s office). This distinction affects reimbursement rates and cost structures.	Payerset
Additional Information	Contains any supplementary details or notes regarding the rate data. This field can offer context or clarifications on contract arrangements or other nuances for that particular payer/provider/service combination.	Payer MRF

Hospital Transparency

Field Name	Description / Sample Values	Original Source
Payer	Payerset-standardized payer name (mapped across hospitals).	Payerset
Plan Name	Payerset-standardized plan/network name.	Payerset
Additional Payer Notes	Free-text notes hospitals sometimes include for a payer or plan. e.g., “Only applicable to self-pay patients seen in ER,” “BCBS rates exclude lab fees”	Hospital MRF
Billing Code Category	Broad clinical grouping of the billing code. “Imaging”, “Surgery–Outpatient”, “Lab & Pathology”	Payerset
Billing Code Type	Coding system. “CPT”, “HCPCS”, “MS-DRG”, “APC”, “NDC”	Hospital MRF
Billing Code	Billing code exactly as published. “99213”, “0274”, “J9206”, “30145”	Hospital MRF
Billing Code Description	Description from file (often truncated/abbreviated). “Office/outpatient visit est low-level”, “Knee arthroscopy w/ meniscus repair”	Hospital MRF
Drug Category	Therapeutic class if row represents a drug. “Antineoplastic Agents”, “Analgesics”	Hospital MRF
Drug Unit Type	Brand / generic / biosimilar flag. “Brand”, “Generic”, “Biosimilar”	Hospital MRF
Drug Unit	Unit of measure for drug price. “mg”, “mL”, “tablet”	Hospital MRF
Gross	Hospital’s standard (chargemaster) price.	Hospital MRF
Discounted Cash	Hospital’s cash price offered to self-pay patients.	Hospital MRF
Methodology	Hospital’s narrative on how standard charges were derived. “Cost-to-charge ratio”, “Rate-setting committee approved”	Hospital MRF
Maximum	Highest negotiated rate among all payers/plans for this code.	Hospital MRF
Minimum	Lowest negotiated rate among all payers/plans for this code.	Hospital MRF
Setting	Care setting or place of service (hospital-reported). “Inpatient”, “Outpatient”, “Emergency Dept”, “Ambulatory Surgery”	Hospital MRF
Standard Charge Algorithm	Text describing how STANDARD_CHARGE_PERCENTAGE or STANDARD_CHARGE_DOLLAR was calculated. “Gross × 25%”, “Average of top 3 commercial contracts”	Hospital MRF
Standard Charge Amount Dollar	A flat-dollar “standard charge” (CMS-defined).	Hospital MRF
Standard Charge Percentage	Percent-based standard charge, if reported. “150% of Medicare OPPS”	Hospital MRF

Claims Data

Please note that the Claims data is only available with the upgraded Payerset Pricing Intelligence Solution. For more information, please contact [email protected].

Field Name	Friendly Name	Description / Sample Value
NPI	NPI	Unique 10-digit National Provider Identifier. e.g. 1043270564
SETTING	Setting	Derived from Type of Bill on the claim data, this is the Inpatient or Outpatient setting.
PLACE_OF_SERVICE_CODE	Service Code	Two-digit CMS Place-of-Service code. e.g. 11
PLACE_OF_SERVICE_NAME	Place of Service	Human-readable name for the POS code. e.g. Office
CHANNEL	Channel	High-level payer channel grouping. e.g. Commercial
SUBCHANNEL	Subchannel	Sub-segment within the channel. e.g. Fully Insured
PAYER	Payer	Name of the payer organization. e.g. UnitedHealthcare
BILLING_CODE	Billing Code	Procedure code billed (CPT / HCPCS / RC). e.g. 99213
BILLING_CODE_TYPE	Billing Code Type	Classification of the billing code. e.g. CPT
BILLING_CODE_DESCRIPTION	Billing Code Description	Short description of the procedure. e.g. Office/outpatient visit, established
MODIFIER	Billing Code Modifier	CPT/HCPCS modifier (if any). e.g. 25
MODIFIER_DESCRIPTION	Billing Code Modifier Description	Meaning of the modifier. e.g. Significant, separately identifiable E/M service
OPEN_CLAIMS_COUNT	Open Claims Count	Number of open (unadjudicated) claims. e.g. 42
AVG_CLAIM_AMOUNT	Avg Claim Amount	Average submitted claim charge. e.g. $123.45
MIN_REMIT_AMOUNT	Min Remit Amount	Minimum remitted (paid) amount. e.g. $10.00
MAX_REMIT_AMOUNT	Max Remit Amount	Maximum remitted amount. e.g. $1,200.00
AVG_REMIT_AMOUNT	Avg Remit Amount	Average remitted amount. e.g. $95.67
MEDIAN_REMIT_AMOUNT	Median Remit Amount	Median remitted amount. e.g. $80.00
REMIT_COUNT	Remit Count	Count of paid remits for the record set. e.g. 37
OPEN_CLAIMS_VOLUME_NPI_CODE_PAYER_PCT	# Open Claims Count Ranking (NPI, Billing Code, Payer)	Percentile rank of open-claim volume within the (NPI, Billing Code, Payer) cohort. e.g. 93.2
REMITS_VOLUME_NPI_CODE_PAYER_PCT	# Remit Count Ranking (NPI, Billing Code, Payer)	Percentile rank of remit count within the same cohort. e.g. 88.7

Medicare Data

Inpatient Data

Field Name	Friendly Name	Description / Sample Value
NPI	Provider NPI	Unique 10-digit National Provider Identifier. e.g. 1043270564 or No NPI Found
carrier_number	Carrier Number	Payer’s internal carrier code. e.g. 110107
Rndrng_Prvdr_Org_Name	Provider Organization Name	Name of the rendering provider’s organization. e.g. Atrium Health Navicent
Rndrng_Prvdr_City	Provider City	City where the provider is located. e.g. Macon
Rndrng_Prvdr_St	Provider Street Address	Street address of the provider. e.g. 777 Hemlock Street
Rndrng_Prvdr_State_FIPS	State FIPS Code	U.S. Census state FIPS code. e.g. 13
Rndrng_Prvdr_Zip5	Provider ZIP Code	5-digit postal ZIP code. e.g. 31201
Rndrng_Prvdr_State_Abbrvtn	State Abbreviation	USPS state abbreviation. e.g. GA
cbsa	CBSA Code	Core-Based Statistical Area code. e.g. 12060
drg_code	DRG Code	Diagnosis-Related Group code. e.g. 470
fee_schedule_dollar_amount	Fee Schedule Amount	CMS fee schedule amount in dollars. e.g. 125.00
Total_Discharges	Total Discharges	Total number of discharges reported. e.g. 250 (may be blank/null)
Avg_Submitted_Covered_Charges	Avg Covered Charges	Average submitted covered charges. e.g. 3250.50
Avg_Total_Payment_Amount	Avg Total Payment	Average total payment amount. e.g. 2900.75
Avg_Medicare_Payment_Amount	Avg Medicare Payment	Average amount paid by Medicare. e.g. 1800.25
Avg_Medicare_Payment_Percent	Medicare Payment %	Medicare payment as percentage of covered charges. e.g. 55.33
latitude	Latitude	Geographic latitude of the provider. e.g. 32.8095
longitude	Longitude	Geographic longitude of the provider. e.g. -83.6168

Outpatient Data

Field Name	Friendly Name	Description / Sample Value
HCPCS Code	HCPCS Procedure Code	Healthcare Common Procedure Coding System code. e.g. 0275T
Modifier	HCPCS Modifier	Optional two-character modifier. e.g. "" (empty if none)
Short Description	Service Short Description	Brief description of the procedure. e.g. Perq lamot/lam lumbar
Mac Locality	MAC Locality Code	Medicare Administrative Contractor locality code. e.g. 111205
Locality County	County	County that corresponds with Mac Locality
Locality State	State	State that corresponds with Mac Locality
Non-Facility Price	Non-Facility Price	Allowed charge in a non-facility setting. e.g. "$0.00"
Facility Price	Facility Price	Allowed charge in a facility setting. e.g. "$0.00"
Non-Facility Limiting Charge	Non-Facility Limiting Charge	Payment limit for non-facility. e.g. "$0.00"
Facility Limiting Charge	Facility Limiting Charge	Payment limit for facility. e.g. "$0.00"
GPCI Work	Work GPCI Factor	Geographic practice cost index for work. e.g. 1.088
GPCI PE	Practice Exp. GPCI Factor	Geographic practice cost index for practice expense. e.g. 1.419
GPCI MP	Malpractice GPCI Factor	Geographic malpractice cost index. e.g. 0.445
Proc Stat	Procedure Status	Status indicator (e.g. R=revised). e.g. "R"
Work RVU	Work RVU	Relative value unit for physician work. e.g. 0.00
NA Flag for Trans Non-FAC PE RVU	Flag: Transitional Non-Facility PE RVU Missing	"NA" if no transitional practice-expense RVU available
Transitioned Non-FAC PE RVU	Transitional Non-Facility PE RVU	Transitional practice-expense RVU, non-facility. e.g. 0.00
NA Flag for Fully IMP Non-FAC PE RVU	Flag: Fully Implemented Non-FAC PE RVU Missing	"NA" if no fully implemented practice-expense RVU available
Fully Implemented Non-FAC PE RVU	Fully Impl. Non-Facility PE RVU	Final practice-expense RVU, non-facility. e.g. 0.00
NA Flag for Trans Facility PE RVU	Flag: Transitional Facility PE RVU Missing	"NA" if no transitional practice-expense RVU for facility available
Transitioned Facility PE RVU	Transitional Facility PE RVU	Transitional practice-expense RVU, facility. e.g. 0.00
NA Flag for Fully IMP FAC PE RVU	Flag: Fully Implemented Facility PE RVU Missing	"NA" if no fully implemented practice-expense RVU for facility available
Fully Implemented Facility PE RVU	Fully Impl. Facility PE RVU	Final practice-expense RVU, facility. e.g. 0.00
MP RVU	Malpractice RVU	Relative value unit for malpractice. e.g. 0.00
Transitioned Non-FAC Total	Transitional Non-Facility Total RVU	Sum of work + PE + MP RVUs (transitional)(non-facility). e.g. 0.00
Transitioned Facility Total	Transitional Facility Total RVU	Sum of work + PE + MP RVUs (transitional)(facility). e.g. 0.00
Fully Implemented Non-Fac Total	Fully Impl. Non-Facility Total RVU	Sum of RVUs (work+PE+MP) final, non-facility. e.g. 0.00
Fully Implemented Facility Total	Fully Impl. Facility Total RVU	Sum of RVUs (work+PE+MP) final, facility. e.g. 0.00
PCTC	Multiple-Procedure Indicator	Indicator for multiple-procedure payment reduction. e.g. "YYY"
Global	Global Surgical Indicator	Global surgery period indicator (0=no global). e.g. 0
Pre Op	Pre-Operative RVU	RVU for pre-operative period. e.g. 0.00
Intra Op	Intra-Operative RVU	RVU for intra-operative period. e.g. 0.00
Post Op	Post-Operative RVU	RVU for post-operative period. e.g. 0.00
Mult Surg	Multiple Surgery RVU	RVU adjustment for multiple surgeries. e.g. 0.00
Bilt Surg	Bilateral Surgery RVU	RVU adjustment for bilateral procedures. e.g. 0.00
Asst Surg	Assistant Surgeon RVU	RVU for assistant surgeon. e.g. 0.00
Co Surg	Co-Surgeon RVU	RVU for co-surgeon. e.g. 0.00
Team Surg	Team Surgery RVU	RVU for team surgery. e.g. 0.00
Phys Supv	Physician Supervision RVU	RVU for physician supervision. e.g. 0.00
Endobase	Endoscopic Base RVU Indicator	Indicator if code is endoscopic base. e.g. ""
Conv Fact	Conversion Factor	Dollar-to-RVU conversion factor. e.g. 32.3465
Not Used for Medicare	Excluded from Medicare	Flag if code is not payable by Medicare. e.g. ""
Diag Imaging Family Ind	Diagnostic Imaging Family Indicator	Family group code. e.g. 99
Opps Non-Facility Payment Amount	OPPS Non-Facility Payment	Payment amount under OPPS non-facility. e.g. "NA"
Opps Facility Payment Amount	OPPS Facility Payment	Payment amount under OPPS facility. e.g. "NA"
Non-Fac PE Used For Opps PMT AMT	Non-Facility PE Weight for OPPS Payment	Practice-expense index used in OPPS non-facility calculation. e.g. 0.0
Facility PE Used For Opps PMT AMT	Facility PE Weight for OPPS Payment	Practice-expense index used in OPPS facility calculation. e.g. 0.0
Malpractice Used For Opps PMT AMT	Malpractice PE Weight for OPPS Payment	Malpractice index used in OPPS payment calculation. e.g. 0.0

Utilities

UnitedHealthcare CSTM-ALL

Field Name	Friendly Name	Description / Sample Value
NPI	Provider NPI	National Provider Identifier. e.g. 1417993361
TIN_TYPE	Tax ID Type	Type of tax identifier (e.g., ein, ssn).
TIN_VALUE	Tax ID Value	Taxpayer Identification Number. e.g. 390286215
BILLING_CODE	Payer Billing Code	Code used by payer for billing. e.g. MISC, THR1
BILLING_CLASS	Billing Class	Class of billing (e.g., institutional, professional).
EXPIRATION_DATE	Agreement Expiration Date	Date the agreement expires. e.g. 1999-12-31 (from 12/31/99)
NEGOTIATED_RATE	Negotiated Rate	Agreed-upon rate. e.g. 75, 200, 28, 210, 90
NEGOTIATED_TYPE	Rate Type	Type of negotiated rate. e.g. percentage, per diem
SERVICE_CODES	Applicable Service Codes	Comma-separated list of service codes. (empty if none)
FACILITY_FLAG	Facility Flag	Indicator if facility setting. e.g. Y/N or blank
PLACE_OF_SERVICE	Place of Service	Payer’s place-of-service code/name. e.g. No Service Code
NEGOTIATION_ARRANGEMENT	Negotiation Arrangement	Arrangement type. e.g. ffs
ADDITIONAL_INFORMATION	Additional Information	Extra qualifiers. e.g. age[18-64]
BILLING_CODE_MODIFIER	Billing Code Modifier	Modifier for billing code. e.g. (empty)
BILLING_CODE_TYPE	Billing Code Type	Code system used. e.g. CSTM-ALL
BILLING_CODE_TYPE_VERSION	Billing Code Version	Version/year of the code system. e.g. 2025
BILLING_CODE_NAME	Billing Code Description	Human-readable description of billing code. e.g. OUTPATIENT MISCELLANEOUS (DEFAULT)
PAYER	Payer Name	Name of the insurance payer. e.g. UNITED_HEALTHCARE
NPPES_PRIMARY_TAXONOMY_CODE	Primary Taxonomy Code	NPPES taxonomy code. e.g. 101Y00000X
NPPES_STATE	Provider State	USPS state abbreviation. e.g. WI, AZ, CA
NPPES_CITY	Provider City	City of provider. e.g. FORT ATKINSON, PHOENIX
NPPES_COUNTY	Provider County	County of provider. e.g. JEFFERSON, MARICOPA
NPPES_ORGFRIENDLYNAME	Provider Organization Name	Official organization name. e.g. FORT HEALTHCARE INC - FORT ATKINSON MEMORIAL HEALTH SERVICES
NUCC_TAXONOMY_GROUPING	NUCC Taxonomy Grouping	Broad taxonomy grouping. e.g. Behavioral Health & Social Service Providers
NUCC_TAXONOMY_CLASSIFICATION	NUCC Taxonomy Classification	Taxonomy classification. e.g. Counselor
NUCC_TAXONOMY_SPECIALIZATION	NUCC Taxonomy Specialization	Taxonomy specialization. e.g. Addiction (Substance Use Disorder) or None
NUCC_TAXONOMY_DISPLAYNAME	NUCC Display Name	Display name for taxonomy. e.g. Counselor
PAYERSET_BILLING_CODE_NAME	Payerset Billing Code Name	Internal billing code name in Payerset. e.g. OUTPATIENT MISCELLANEOUS (DEFAULT)
PAYERSET_BILLING_CODE_TYPE	Payerset Billing Code Type	Internal billing code type in Payerset. e.g. CSTM-ALL