"Payer Price Transparency" data refers to the information that health insurance companies (payers) are required to disclose about the prices they have negotiated with healthcare providers for various medical services. This data includes detailed records of the rates for medical procedures, services, and items, as negotiated between payers and providers. It is mandated by regulations such as the Hospital Price Transparency Rule and the Transparency in Coverage Rule. The purpose of this transparency is to empower patients, employers, and other stakeholders to compare prices across different providers and payers, facilitating more informed decision-making and fostering competition in healthcare. Payerset leverages this data to offer comprehensive datasets and self-service data exploration, enabling organizations to use the information for cost management, competitive pricing, and strategic planning​​​​​​. See the CMS "Transparency in Coverage Overview" here: https://www.cms.gov/files/document/transparency-coverage-webinar-naic-06-27-22-508.pdf

While both datasets aim to promote transparency in healthcare costs, hospital price transparency focuses on the charges for services directly from hospitals, and health plan (payer) price transparency focuses on the rates negotiated between insurers and all care delivery organizations (including hospitals) and individuals.​​

Payerset retains all detail posted by the insurance companies within their machine readable files (MRFs) and further enriches and cleanses that data for analytics and insights. Here is an overview of what Payerset data includes and its level of detail: Negotiated Rates: Content: The data includes negotiated rates for medical procedures, services, and items between payers (insurance companies) and healthcare providers. These rates are the actual amounts that insurers agree to pay providers. Detail: The rates are broken down by service, provider, and location, allowing for granular analysis of healthcare costs across different regions and providers. Billing Codes and Descriptions: Content: Detailed billing codes (such as CPT, HCPCS) and descriptions for various medical services and procedures. Detail: Includes comprehensive coding information which is essential for understanding specific healthcare services and their associated costs. Plans and Providers: Content: We provide all commercial plans and networks for a full picture of the payer's reimbursement rates by NPI (National Provider Identifier) Detail: Covers all providers and plans, offering a complete view of the U.S. healthcare market. For more details, please see our Data Dictionary here: https://docs.payerset.com/rate-explorer/data-dictionary

Payerset refreshes its data quarterly. This means that every three months, Payerset updates and audits its entire data set to incorporate the latest changes in payer data structures, negotiated rates, and any new regulatory requirements. These regular updates ensure that users have access to the most current and accurate information available. In addition, Payerset always keeps the historical payer data. Please see our latest payer compliance audit results here: https://docs.payerset.com/payers/aetna-price-transparency

Rate Explorer sources its data from the Payerset Data Lake. The data is refreshed quarterly, in the months of February, May, August, and November.

We will work with you and your technology organization. Every organization is different depending on your environment, platforms, and processes. We support all major clouds and can provide the data in various formats. Snowflake customers can easily access and purchase our data via the Snowflake Marketplace.

Yes. There can be regular schema changes based on payer updates in price transparency compliance. There can also be changes based on updated CMS rules. We normalize the data before you receive it, so we handle these changes for you. We will never remove fields, as that would affect your downstream processes, but we may add fields based on new requirements.