> For the complete documentation index, see [llms.txt](https://docs.payerset.com/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://docs.payerset.com/using-the-payerset-platform/data-dictionary/payer-transparency.md).

# Payer Transparency

### Provider

<table data-full-width="false"><thead><tr><th width="220.765380859375">Field</th><th width="333.3157958984375">Description</th><th>Original Source</th></tr></thead><tbody><tr><td><strong>Parent Organization</strong></td><td>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.</td><td>Payerset</td></tr><tr><td><strong>Organization</strong></td><td>Indicates the healthcare organization or facility where the service was provided. There can be multiple NPIs for a given organization.</td><td>Payerset (derived from NPPES)</td></tr><tr><td><strong>NPI</strong></td><td>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.</td><td>Payer MRF</td></tr><tr><td><strong>State</strong></td><td>Indicates the U.S. state where the NPI is registered in NPPES.</td><td>NPPES</td></tr><tr><td><strong>County</strong></td><td>Indicates the U.S. county where the NPI is registered in NPPES.</td><td>NPPES</td></tr><tr><td><strong>City</strong></td><td>Indicates the U.S. city where the NPI is registered in NPPES.</td><td>NPPES</td></tr><tr><td><strong>Taxonomy</strong></td><td>Represents the categorization of healthcare providers based on their specialties and services.</td><td>NUCC</td></tr><tr><td><strong>Primary Taxonomy Code</strong></td><td>The main code used to identify a provider’s specialty or service category.</td><td>NUCC</td></tr><tr><td><strong>Taxonomy Display Name</strong></td><td>User-friendly name to describe a provider’s specialty or service category. This is the display name of the Taxonomy Code.</td><td>NUCC</td></tr><tr><td><strong>Taxonomy Classification</strong></td><td>Offers a detailed categorization of the provider’s area of expertise.</td><td>NUCC</td></tr><tr><td><strong>Taxonomy Specialization</strong></td><td>Indicates a further level of specialization within a broader taxonomy classification.</td><td>NUCC</td></tr><tr><td><strong>TIN Type</strong></td><td>Specifies the type of Tax Identification Number (TIN) used, such as an individual provider or EIN.</td><td>Payer MRF</td></tr><tr><td><strong>TIN Value</strong></td><td>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 &#x26; organizations, respectively.</td><td>Payer MRF</td></tr><tr><td><strong>Trade Category</strong></td><td>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.</td><td>Payerset</td></tr><tr><td><strong>Trade Type</strong></td><td>Additional layer of specificity within a trade category by describing the general nature of the services delivered (for example, in-home nursing care services).</td><td>Payerset</td></tr><tr><td><strong>Trade Subtype</strong></td><td>The most granular classification within Trade Categories &#x26; Types, identifying the specific service focus within a trade type.</td><td>Payerset</td></tr></tbody></table>

### Health Plan

<table data-full-width="false"><thead><tr><th width="220.308837890625">Field</th><th width="329.8953857421875">Description</th><th>Original Source</th></tr></thead><tbody><tr><td><strong>Payer</strong></td><td>Identifies the insurance provider or entity responsible for reimbursement.</td><td>Payerset (derived from Payer MRF &#x26; enriched)</td></tr><tr><td><strong>Negotiated Type</strong></td><td>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.<br><br>There are five potential values:<br>1. Negotiated<br>2. Fee Schedule<br>3. Percentage<br>4. Per Diem<br>5. Derived</td><td>Payer MRF</td></tr><tr><td><strong>Negotiation Arrangement</strong></td><td>Describes the contractual terms for the negotiated rate. It is useful for understanding the structure and conditions of pricing agreements in your analysis.<br><br>The potential values are:<br>1. FFS (fee-for-service)<br>2. Bundle<br>3. Capitation</td><td>Payer MRF</td></tr><tr><td><strong>Plans</strong></td><td>Lists the specific insurance plans associated with the negotiated rate.</td><td>Payerset (derived from Payer MRF &#x26; enriched)</td></tr><tr><td><strong>Expiration Date</strong></td><td>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.</td><td>Payer MRF</td></tr></tbody></table>

### Service

<table><thead><tr><th width="242.42919921875">Field</th><th width="312.93896484375">Description</th><th>Original Source</th></tr></thead><tbody><tr><td><strong>Negotiated Rate</strong></td><td>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.</td><td>Payer MRF</td></tr><tr><td><strong>Billing Class</strong></td><td>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.</td><td>Payer MRF</td></tr><tr><td><strong>Billing Code Category</strong></td><td>Groups billing codes into broader categories based on service or procedure characteristics to more easily identify services for analysis.</td><td>Payerset</td></tr><tr><td><strong>Billing Code Subcategory</strong></td><td>Provides a more detailed classification within a broader billing code category to further identify specific services or sets of services.</td><td>Payerset</td></tr><tr><td><strong>Billing Code Modifier</strong></td><td>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.</td><td>Payer MRF</td></tr><tr><td><strong>Billing Code</strong></td><td>The standardized code representing a specific medical service or procedure.</td><td>Payer MRF</td></tr><tr><td><strong>Billing Code Name</strong></td><td>Provides a descriptive name associated with the billing code.</td><td>Payerset (derived from Payer MRF &#x26; enriched)</td></tr><tr><td><strong>Billing Code Type</strong></td><td>Defines the type of billing code, such as CPT, HCPCS, or ICD.</td><td>Payerset (derived from Payer MRF &#x26; enriched)</td></tr><tr><td><strong>MRF Billing Code Name</strong></td><td>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.</td><td>Payer MRF</td></tr><tr><td><strong>MRF Billing Code Type</strong></td><td>Defines the type of billing code, such as CPT, HCPCS, or ICD as it is written in the published MRF.</td><td>Payer MRF</td></tr><tr><td><strong>Billing Code Type Version</strong></td><td>Specifies the version of the billing code in use, ensuring that comparisons are made within consistent coding standards.</td><td>Payer MRF</td></tr><tr><td><strong>Place of Service Codes</strong></td><td>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.</td><td>Payer MRF</td></tr><tr><td><strong>Place of Service</strong></td><td>Provides the descriptive name(s) corresponding to the place of service code(s).</td><td>Payerset</td></tr><tr><td><strong>Facility vs. Non-Facility</strong></td><td>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.</td><td>Payerset</td></tr><tr><td><strong>Additional Information</strong></td><td>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.</td><td>Payer MRF</td></tr></tbody></table>


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