The home screen serves as your starting point for creating new analyses and revisiting any saved analyses you've previously created. If this is your first time logging in, you will be prompted to create a new analysis.

On the home screen, you will also find information about your saved analyses, including the Payers, NPIs, and Billing Codes you selected. Hover over any tag to view the complete list of your selections.

To open an existing analysis, simply click on it. This will allow you to explore the associated data. If you're looking for a specific analysis you’ve created in the past, you can also use the search function. (Tip: Remember to press Enter after typing your search terms.)

You can also modify your account settings, like changing your email address, display name, and password, by clicking the avatar in the top right corner and selecting "Account"

But enough of the intro, to get started, let's create our first analysis using the Rate Comparison Tool!

At Payerset, we aim to be the premier provider of curated provider and payer price transparency datasets. Our mission is to empower healthcare organizations, insurance carriers, researchers, consultants, and data-driven professionals with accurate and comprehensive data that enables them to make informed decisions, streamline operations, and uncover new opportunities. The datasets we offer are meticulously compiled, verified, and updated by our team of data experts, ensuring you have access to the most reliable and accurate information available in the industry.

This documentation is intended for our Payerset Data Lake™ and Payerset Rate Explorer™ customers to have an understanding of the data structures, payer compliance with the CMS mandates, and how to use the Rate Explorer portal.

Analysis Creation

Now onto the fun part, creating an analysis!

The Comparison Analysis tool allows you to select a series of billing codes, payers, and providers to compare rates across these dimensions.

You can create a Comparison Analysis in two ways:

1. Select "Create a Rate Comparison" from the main tile on the home page OR

2. in the top right-hand side of the screen, you will see a button called New analysis - click that to start choosing billing codes, payers, and providers for your dataset.

We'll select "Create a Rate Comparison from the homescreen.

Choose Date Snapshot

Payerset provides you with both current and historical views of rates. The system automatically populates data with the most recent available date. Additionally, you can select an alternative snapshot date from the dropdown menu to explore how rates have evolved over time, gaining valuable insights into trends and changes.

Choose your Services (Billing Codes)

You can select codes individually or click the "Select all" button at the bottom to select all of the codes you have in your current filtered view. We'll use the "Select all" option.

Choose your Payers

Similar to billing codes, on the "Choose your payers" screen you will be able to select up to 5 payers to compare. You are able to filter by Category and Region to make the list easier to navigate.

Select "Next, choose your Providers" to move to the next step.

Choose your Providers

Next, the Rate Comparison tool will crawl our data catalog using your selections of billing codes and payers to find which providers have negotiated rates posted in the payer price transparency data.

From here, you will be able to search for providers you want to analyze.

As with the previous screens, you can also search by name or NPI to find specific providers.

Generate Your Analysis

Finally, we're ready to create our analysis. It's best to give your analysis a descriptive name so it's easy to identify later. When you're ready, click "Generate Analysis" and Rate Explorer will crawl our data lake to pull all of the data you requested. This can take from a few seconds up to 10 minutes, depending on which payers and how many codes and providers you selected, but the progress bar will help you get a feel for how long the analysis will take to run.

Once the analysis completes, you will see some KPIs detailing how many rates were found, as well as a visualization showing the distribution of those rates by billing code for each payer.

In the next section of this guide, we'll go over how to create a fee schedule. If you'd like to skip ahead to learn how to analyze the comparison we just created, feel free to use the left-hand panel instead to skip to the "Analyzing your Data" section.

Welcome to the Payerset Rate Explorer™ Training and Onboarding section of our documentation! In this section, we highlight how the Rate Explorer portal works and will guide you through the initial steps to get started, helping you navigate the platform with ease. We also address common issues you might face using Price Transparency data, and we'll showcase how to create and analyze datasets.

Get started by clicking below or using the left-side panel.

Overview

Analyzing rate comparisons and fee schedules is the core function of Payerset, providing essential insights into healthcare pricing. Our platform offers three main analysis options: the Summary Page, Data Overview, and Explore screens. Each of these options provides unique perspectives and valuable insights into healthcare pricing data from high-level summaries to granular details.

Summary View

When your analysis is finished loading, you will land on the Summary screen, which shows you the total number of rates, providers, and services that apply to your selections and filters, as well as a distribution plot visualization of the data.

There are a few key features you can use on this screen to quickly compare rates across payers and providers.

Analysis Details & Metadata

You can see which payers, NPIs, and billing codes you have selected by hovering over the blue/green/purple chips at the top right of the page. If you have selected any data that does not contain rates (in the example below, you can see QualChoice does not have any data for the selected NPIs and billing codes), you will see an indicator that the data is Not Found.

Distribution Plot

The distribution plot shows how rates are distributed by payer across providers and billing codes, which enables you to get a quick idea of how disparate rates are across those payers for the same codes.

Rates can have different types, such as negotiated, fee schedule, per diem, or percentage. In the chart, you can toggle between dollars and percentages. As you can see below, VIVA Health provides both dollars and percentage rates, while the other payers show dollar values only.

Hover over a point on the chart to see the payer and provider details.

Filters

The filter options allow you to filter the data you are viewing by different dimensions so you can better compare apples-to-apples when looking at rates across codes, payers, and providers.

To create a filter, select any combination of filters from either option.

To remove a filter, click the ⓧ in the box of the filter you want to remove.

Data View

The data view is a comprehensive table of all the data available at the rate level.

Sorting & Filtering

To sort the table, click on the column you want to sort by. You can also search each column using the search boxes underneath the field name.

To add more columns, click the "More columns" button on the top right of the screen and you will be able to get a broader view of the data.

Explore View

The explore view is a pivot table that enables you to aggregate the data by various different dimensions, as well as view multiple different metrics.

To start, choose a column and a measure.

You can also pivot the data horizontally by Payer, NPI, Organization Name, or Billing Code to get a better view of how data compares across dimensions.

Note that you may have to use the filters to get a good comparison of the data, and ensure that you're adding the proper columns so your comparisons are valid.

You are now ready to start digging in to all of the price transparency data within Payerset!

Standard Charges Overview (Hospital Data)

The Standard Charges rate analysis a powerful new feature of Payerset that enables users to gain comprehensive insights into the pricing structures of specific hospital systems. This tool is designed to provide a detailed view of rates for all services offered by a selected hospital, allowing for in-depth analysis and comparison.

Users can easily select a hospital system from an interactive map interface, making it simple to focus on specific geographic areas or institutions of interest.

Rate Explorer Overview

Payerset Rate Explorer is a tool designed to enhance health plan price transparency, offering access to comprehensive payer Machine Readable Files (MRF) data for analysis and comparison. Created to address the complexities and opacity of healthcare pricing, the portal enables users to easily navigate, understand, and benchmark healthcare pricing data across different payers and organizations. By providing clear, accessible, and actionable pricing insights, Rate Explorer supports informed decision-making in healthcare pricing and strategy.

Logging In

First things first, let's get you logged in! You will need to have a user account provisioned for you - if you haven't received one yet, please reach out to support@payerset.com and we will set you up with one.

To change your password, you can click on the circle avatar in the top right corner, navigate to Account, and then set a new password.

Additional Information

If you don't see this screen or see an error, your VPN or company firewall may be blocking traffic to our site. If this is the case, please reach out to support@payerset.com so we can address the issue and get you logged in as soon as possible.

Change Your Password

To change your password if you are able to log into the platform, please do the following:

1. Click the avatar circle in the top right corner of the page

2. Click "Account"

3. Enter a new password

4. Click "Update password"

You can also change your email address and name here.

Password Reset

To reset your password, enter the email address you use to log into the portal and click "Forgot password?"

Within a few minutes, you should receive an email from support@payerset.com with a link to reset your password. Be sure to check your spam mail just in case, as sometimes companies block these types of reset emails. If you don't receive your reset email within 15 minutes, please reach out to support@payerset.com and we will troubleshoot the issue with you.

Additional Information

If you experience any issues you are unable to troubleshoot, or if you have any feedback, please email support@payerset.com and we will get you sorted right away.

TIN Rollup File

Please see below for a screenshot example of this dataset.

The National Uniform Claim Committee (NUCC) is an organization that focuses on standardizing data sets for non-institutional health care claims in the U.S. It was established in 1995, replacing the Uniform Claim Form Task Force, and plays a key role in the administrative simplification section of HIPAA. The NUCC, chaired by the American Medical Association, collaborates with a diverse group of health care stakeholders, including providers, payers, and vendors.

Payerset Notes

Table of Contents

Aetna has multiple tables of contents:

Compliance Scorecard

Overall Rating: 3/5 - Needs Improvement

Schema: AETNA

Rates Records: 2,494,235,787,461

Provider Records: 18,288,687,914

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.

• File Download Barriers: ✔️ No, there are no barriers to downloading the files.

• File Accessibility Percentage: 99.7% of the files are accessible.

• Data Assessment: Aetna duplicates their rate data for every related NPI under each TIN and for each Reporting Plan, even if rates are the same, making the data volumes very large. It is debatable whether this interpretation of the rules is acceptable, but it does at least give very good coverage of their rates across the country.

Overall Assessment: Aetna publishes many thousands of duplicated data and much of the data is their base fee schedules. This is especially true for Professional rates for non-hospitals, which makes the data integrity questionable as it cannot be verified via Hospital MRFs. This is an ongoing issue that must be addressed and as such Aetna has been downgraded from "Good" to "Acceptable".

As of May 2024 there are new rate limits on Aetna's Table of Contents API - this causes the process to download all of the ToC files to take a little longer, but is not unreasonable.

There is an additional PLAN_MAP table that contains details about the Plans and Plan Types.

There are ~300 fields in this dataset, but the primary fields with their descriptions are listed below. All fields are available when you purchase any payer data.

Schema: ENRICHMENT_DATA

Table Name: NPPES

• NPI Number: Enter the NPI Number to search for a specific NPI. When entered, no other search criteria is needed.

• NPI Type: The search can be refined to search for only Individual (Type 1) NPIs or only Organization (Type 2) NPIs; or the search can include all NPIs (both Individual and Organization) by selecting Any. Select the desired value from the drop-down list. The NPI Type cannot be the only search criterion entered. Searching by NPI Type and Country is acceptable as long as the Country selected is not United States. When searching by NPI Type and the Country United States, at least one other search criterion field besides State must be entered.

• Taxonomy Description: Search for providers by their taxonomy by entering the taxonomy description.

• Provider First Name: This field only applies to Individual Providers. This field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon.

• Provider Last Name: This field only applies to Individual Providers. This field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon.

• Organization Name: This field only applies to Organizational Providers. This field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. NPPES searches both the Organization Name and Other Organization Names associated with the NPI, such as the Doing Business As or Former Legal Business Name; therefore, results displayed on the NPI Registry Search Results page might contain an organization name different from the one entered in the Organization Name search criterion.

• Authorized Official First Name: This field only applies to Authorized Officials. This field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon.

• Authorized Official Last Name: This field only applies to Authorized Officials. This field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon.

• City: The City associated with the provider's practice location address. To search for a Military Address enter either APO or FPO into the City field. This field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon.

• State: The State associated with the provider's practice location address. This field cannot be used as the only search criterion. If this field is used, at least one other field, besides the NPI type and Country, must be populated. Select the desired state from the drop down list.

• Country: The Country associated with the provider's practice location address. This field can be used as the only search criterion as long as the value selected is neither United States nor Any. When selecting United States as a search criterion, at least one other search criterion field besides the NPI Type and State must be entered. Select the desired Country from the drop down list.

• Postal Code: The Postal Code associated with the provider's practice location address.

• Address Type: Primary and Secondary Address associated with the provider's practice location address. Must be used with City, State, Country, and/or Postal Code.

This is a sample of the categories and subcategories:

Payerset Notes

Table of Contents

Compliance Scorecard

Overall Rating: 5/5 - Excellent

Schema: AMERIHEALTH

Rates Records: 2,325,318

Provider Records: 2,401,531

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 easily accessible.

• Table of Contents Formatting: ✔️ Yes, the Table of Contents is properly formatted.

• File Download Barriers: ✔️ No barriers to download

• File Accessibility Percentage: ✔️ All files available.

Overall Assessment: AmeriHealth has cleaned up their Table of Contents and removed irrelevant files, so they apparently were previously compliant, but had many bad links so it was difficult to tell. Kudos AmeriHealth!

Payerset Notes

Table of Contents

Compliance Scorecard

Overall Rating: 4/5 - Good

Schema: AMBETTER

Rates Records: 28,736,135

Provider Records: 121,392,257

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 easily accessible.

• Table of Contents Formatting: ✔️ Yes, the Table of Contents is properly formatted.

• File Download Barriers: ✔️ No download barriers

• File Accessibility Percentage: ✔️ 100% of the files are accessible.

Overall Assessment: These files are posted by Centene and are generally pretty good, however we have received feedback that they are missing data for which there is definitely a contracted rate, specifically for Imaging and ED codes for a few hospitals in Arkansas. We are looking into this issue and will make Ambetter aware of any findings.

Payerset Notes

Table of Contents

Compliance Scorecard

Overall Rating: 4/5 - Good

Schema: ALLWAYS_HEALTH_PARTNERS

Rates Records: 8,325,318

Provider Records: 2,401,531

Additional Observations

Machine-Readable Price Transparency Files Review

• MRFs Up-to-Date: ❌ No, the MRFs are not kept up to date each month and there have been delays in the past of getting them updated.

• Table of Contents Accessibility: ✔️ The Table of Contents link is easily accessible.

• Table of Contents Formatting: ✔️ Yes, the Table of Contents is properly formatted.

• File Download Barriers: ✔️ No barriers to download

• File Accessibility Percentage: ✔️ All files available.

Overall Assessment: Aways Health Partners has had some issues with delays in updating MRFs in a timely manner. Other than delays, the quality is fair and consistent amongst peers.

Payerset Notes

Table of Contents

Compliance Scorecard

Overall Rating: 5/5 - Excellent

Schema: ALLIANT_HEALTH_PLANS

Rates Records: 2,325,318

Provider Records: 2,401,531

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 easily accessible.

• Table of Contents Formatting: ✔️ Yes, the Table of Contents is properly formatted.

• File Download Barriers: ✔️ No barriers to download

• File Accessibility Percentage: ✔️ All files available.

Overall Assessment: Alliant Health Plans does a good job of complying and updating their files in a timely manner. There are some complications but could be due to the way the CMS regulations are interpreted.

Payerset Notes

Table of Contents

Compliance Scorecard

Overall Rating: 4/5 - Good

Schema: BC_IDAHO

Rates Records: 17,280,082,609

Provider Records: 163,610,247,812

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 easily accessible.

• Table of Contents Formatting: ✔️ Yes, the Table of Contents is properly formatted.

• File Download Barriers: ✔️ MRF Links in the TOC expire before new links are posted, making it important to download/parse the data by the 20th of each month.

• File Accessibility Percentage: ❌ 95% of the files are accessible.

Payerset Notes

Table of Contents

Compliance Scorecard

Overall Rating: 4/5 - Good

Schema: BAYLOR_SCOTT_WHITE

Rates Records: 3,842,867

Provider Records: 26,290,436

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: ❌ There is no formal Table of Contents, the files are just linked on their main page.

• Table of Contents Formatting: ❌ There is no Table of Contents.

• File Download Barriers: ✔️ There are no barriers to downloading the MRFs.

• File Accessibility Percentage: ✔️ 100% of the files are accessible.

Overall Assessment: BSW is a health system that has their own network and posts these files monthly. They do a great job with the files, though a Table of Contents must be created in order to fit them into our standardized parsing process.

Payerset Notes

Table of Contents

Compliance Scorecard

Overall Rating: 5/5 - Excellent

Schema: BCBS_ALABAMA

Rates Records: 17,507,735,993

Provider Records: 182,619,335,096

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 easily accessible.

• Table of Contents Formatting: ✔️ Yes, the Table of Contents is properly formatted.

• File Download Barriers: ✔️ No barriers to downloading the MRFs.

• File Accessibility Percentage: ✔️ 100% of the files are accessible.

Overall Assessment: BCBS Alabama does a great job of posting these files each month. They duplicate provider data substantially, but that can be a result of interpretation of the CMS rules.

If you have additional links to share, please send them to info@payerset.com and we are happy to add them to this published list so we can ensure everyone has access to the latest data.

The record count indicates the number of records contained in each hospital file based on the way that Payerset flattens and normalizes the dataset - it is intended to be a guide for how much data is present in each file should you try to download and use the file yourself.

Additional information about what data is contained in these files can be found in our Hospital MRF - Standard Charges [BETA] onboarding documentation.

Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

Florida

Georgia

Illinois

Indiana

Kansas