2024 Payerset Price Transparency

This dataset contains sample data, in the same structure as it is delivered in Payerset's paid offerings, for Aetna, United Healthcare, Cigna, and Blue Cross Blue Shield of South Carolina.

Payerset offers complete datasets for over 60 payers that contain filtered, curated price transparency data that makes it simple to see rates for any service and any providers. Payerset also creates custom categorizations and subcategorizations of billing codes to make it easier to search and slice the data, which is provided alongside additional industry data such as NPPES and NUCC.

The data includes Payer Machine Readable files, sourced from their respective websites, that are parsed, flattened, filtered, and enriched with additional data.

Fields Include all CMS-mandated fields as well as optional fields as-available within the dataset. The primary fields include:
Billing Code (27447)
Billing Code Name (ARTHROSCOPIC KNEE SURGERY)
Billing Code Type (CPT/HCPCS)
Negotiation Arrangement (FFS)
Negotiated Rate ($15,000)
Billing Class (PROFESSIONAL/INSTITUTIONAL)
NPI (1184610297)
TIN Type (EIN/NPI)
TIN Number (89-3910301)

搜集汇总

背景与挑战

背景概述

该数据集以与付费产品相同的结构，提供了Aetna、联合健康、Cigna和南卡罗来纳州蓝十字蓝盾等支付方的样本价格透明度数据。它包含经过解析、扁平化、过滤和增强的支付方可机读文件，涵盖CMS强制字段和可选字段，如计费代码、协商费率和NPI等核心信息。