Ingest
Process payer-published in-network rate files, including the different structures used across payers and plan instances.
The analytical foundation
How we use payer price transparency files.
We process payer-published Transparency-in-Coverage (TiC) files to examine negotiated rates across providers, procedures, and markets. The pipeline supports our advisory work and ongoing analytical research.
Source data
What’s in a rate record?
In-network rate files contain negotiated rates associated with providers and procedure codes. They are published as machine-readable files, typically in JSON, and can be large enough to require dedicated processing infrastructure.
The structure varies across payers and plans. Provider references, plan instances, rate types, and duplicated records all affect how the data can be interpreted. Processing a file is the first step; deciding whether a rate is a useful comparison is part of the analysis.
A published negotiated rate is not a record of what a specific claim actually paid. We keep that distinction visible in the findings.
Payer coverage
National and regional files.
- UnitedHealthcare and Cigna — national commercial networks
- Optum Behavioral Health — national
- Blue Cross plans — Arizona, Florida, Massachusetts, and Michigan
- Regional payers including Mass General Brigham Health Plan, Oscar, and Point32Health
Coverage varies by payer, geography, and setting. We confirm the files and publication dates relevant to your project when scoping the work. Additional payer coverage is prioritized by client need.
Percent-of-Medicare comparisons are available for outpatient/OPPS, ASC, and professional settings. Inpatient normalization remains in progress.
From source to analysis
The processing work.
Normalize
Bring provider identifiers, procedure codes, and rate records into a common structure for analysis across sources.
Compare
Select relevant providers and rates for the question at hand. Document the source context and the limits of the comparison.
Bring us a reimbursement question.
Tell us the payer, market, and procedures you’re interested in. We can discuss whether the available data fits the question.