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price transparency health plan payer MRF

Free access to all payer-sourced

price transparency data through our Rate Explorer portal for academic research.

price transparency health plan payer MRF

Payerset
for Academic Research

Mission to Democratization

At Payerset, our mission is to democratize price transparency in healthcare. However, continually parsing, cleaning, and serving trillions of rows of data is extremely costly.

When the Transparency in Coverage (TiC) law was passed, this was not the intent.

Through diligent work with our partners, policymakers, and the publication of our payer compliance audit, we are working to make the data more accessible.​

For this reason, we are also democratizing this data for research, ensuring it can be used for the benefit of all.

Research Criteria

  • This program is intended for independent researchers with grants focused on improving the U.S. healthcare system.

  • Payerset will determine the duration of access.

  • Data accessed through Payerset’s Rate Explorer must be used solely for non-commercial academic research.

  • Selling any data, derivative products, insights, consulting, or information derived from this data is strictly prohibited.

  • Payerset must be cited as the source in all research publications.

Apply for Access

Help democratize price transparency data TODAY.

Please submit your information below for review.

Upon interview and approval, you will receive free access to our self-service

Rate Explorer portal under our research terms and conditions.

Desired Access Duration
  • What is "Payer Price Transparency" Data?
    "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
  • What’s the Difference Between Hospital and Health Plan (Payer) Price Transparency Data?
    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.​​
  • What Does the Payerset Price Transparency Data Include and How Detailed Is It?
    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
  • How Often Is the Data Refreshed?
    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
  • How Does Data Synchronization Work?
    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.
  • Does Payerset Handle Schema Drift as Upstream Data Structures Change?
    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.
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