Data Dictionary - PriceMedic Resources

Payer and Network Information
Provider and Organization Information
Rate and Contract Information
Provider Classification and Credentials
Geographic and Location Data
Benchmarking and Reference Data
Billing Eligibility and Service Classification
Data Quality and Lineage
Rate Resolution and Ranking

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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