Data Dictionary - PriceMedic Resources

Fields marked with an asterisk (*) are enhancements added by PriceMedic and do not appear in the original Transparency in Coverage (TiC) publications.

Payer and Network Information

Field	Description	Example	Enhanced
`payer_name`	The name of the insurance payer that negotiated this rate	”Aetna Better Health”, “Anthem Blue Cross”	No
`payer_slug`*	Standardized payer identifier slug	”aetna-better-health”	Yes
`network_name`*	The specific insurance network or product name for this rate	”Aetna Better Health - Commercial”	Yes
`network_id`*	Original network identifier from source data	”choice-plus-network”	Yes
`payer_network_id`*	Combined identifier string linking payer with network	”aetna-better-health-commercial”	Yes

Provider and Organization Information

Field	Description	Example	Enhanced
`tin`	Tax Identification Number as published in TiC files	”12-3456789”, “1234567890”	No
`tin_type`*	Type of tax identifier (ein, npi1, npi2)	“ein”, “npi2”	Yes
`entity_name`*	Name of the entity corresponding to the Tax ID	”ABC Medical Group”	Yes
`org_match_type`*	Method used to match entity to organization	”direct_match”, “npi2_imputed”	Yes
`org_name`*	Official name of the matched organization	”ABC Healthcare System”	Yes
`org_ein`*	Employer Identification Number of the organization	”12-3456789”	Yes
`org_states`*	States where the organization has presence	[“TX”, “OK”, “AR”]	Yes
`org_taxonomies`*	Healthcare specialty codes for the organization	[“207Q00000X”, “208D00000X”]	Yes
`org_taxonomy_names`*	Human-readable specialty names	[“Family Medicine”, “General Practice”]	Yes
`org_est_count_md`*	Estimated count of physicians in organization	45	Yes
`org_est_count_app`*	Estimated count of advanced practice providers	12	Yes
`org_est_count_npi1`*	Total estimated individual provider count	67	Yes

Rate and Contract Information

Field	Description	Example	Enhanced
`negotiated_rate`	Contracted rate amount between payer and provider	125.50	No
`negotiation_arrangement`	Payment methodology (ffs, capitation, bundled)	“ffs”	No
`negotiated_type`	Method used to determine the rate	”negotiated”, “fee_schedule”	No
`derived_negotiated_type`*	Standardized negotiation type	”negotiated”, “fee_schedule”	Yes
`billing_class`	Type of billing entity (professional, institutional)	“professional”	No
`expiration_date`	Contract expiration date when available	”2024-12-31”	No
`additional_information`	Payer-specific rate context and conditions	”Covers codes 0120-0126”	No
`description`*	Human-readable service description	”Office visit, established patient”	Yes
`billing_code`	Procedure or service code	”99213”, “70553”	No
`billing_code_type`	Category type of billing code	”CPT”, “HCPCS”	No
`billing_code_modifier`	List of modifiers applied to billing code	[“26”], [“TC”]	No
`service_code`	CMS Place of Service codes	[“11”], [“22”]	No
`iop`*	Care setting (i=inpatient, o=outpatient, b=both)	“o”, “i”, “b”	Yes
`is_fac_eligible`*	Rate applies to facility-based services	true, false	Yes
`is_non_fac_eligible`*	Rate applies to office-based services	true, false	Yes

Provider Classification and Credentials

Field	Description	Example	Enhanced
`npis`*	Array of provider NPIs associated with rate	[“1234567890”, “0987654321”]	Yes
`cred_type`*	Primary credential type for rate-specific providers	”phys”, “app”	Yes
`taxonomies`*	Healthcare provider taxonomy codes	[“207Q00000X”, “208D00000X”]	Yes
`taxonomy_names`*	Human-readable specialty names	[“Family Medicine”, “General Practice”]	Yes
`classifications`*	High-level provider type classifications	[“Physicians”, “Behavioral Health”]	Yes
`can_bill`*	Organization can bill for this service	true, false	Yes

Geographic and Location Data

Field	Description	Example	Enhanced
`address_line_1`*	Primary street address	”123 Main Street”	Yes
`city`*	Provider entity city	”Dallas”	Yes
`state`*	Provider entity state	”TX”	Yes
`zip_code`*	Provider entity ZIP code	”75201”	Yes
`locality`*	Medicare Administrative Contractor locality	”01120:26”	Yes

Benchmarking and Reference Data

Field	Description	Example	Enhanced
`benchmark_name`*	Human-readable benchmark source name	”2025 Dallas MCR (CARRIER 0112026)“	Yes
`benchmark_type`*	Benchmark calculation methodology	”MCR_RBRVS”, “MCR_ASP”	Yes
`benchmark_rate`*	Medicare benchmark rate for comparison	98.75	Yes
`national_benchmark_name`*	Human-readable national benchmark source name	”2025 National MCR”	Yes
`national_benchmark_type`*	National benchmark calculation methodology	”MCR_RBRVS”, “MCR_ASP”	Yes
`national_benchmark_rate`*	National Medicare rate without locality	95.50	Yes

Billing Eligibility and Service Classification

Field	Description	Example	Enhanced
`billing_code_group`*	High-level service category	”Evaluation and Management”, “Surgery”	Yes
`billing_code_subgroup`*	Detailed service classification	”Office/Outpatient Visits”	Yes

Data Quality and Lineage

Field	Description	Example	Enhanced
`source_file`*	Original TiC filename	”2024-01-01_aetna_index.json”	Yes
`source_file_ids`*	Array of source file identifiers	[“file_001”, “file_002”]	Yes

Rate Resolution and Ranking

Field	Description	Example	Enhanced
`resolution_tin`*	Standardized organizational identifier (EIN when possible)	“12-3456789”	Yes
`is_best_rate`*	Primary rate per payer’s resolution policy	true, false	Yes
`is_best_non_fac_rate`*	Best rate for office-based services	true, false	Yes
`is_best_fac_rate`*	Best rate for facility-based services	true, false	Yes
`has_most_npis`*	Rate with most providers in group	true, false	Yes
`has_max_rate`*	Rate with highest amount in group	true, false	Yes

Benchmark Rates Enrichment

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