# PriceMedic Core Examples Source: https://docs.pricemedic.com/data/core/examples Example queries and use cases for PriceMedic Core ## Overview These examples demonstrate common analytical patterns using the February 2026 hospital release. All queries use the [`providers`](/data/core/tables/providers), [`rates`](/data/core/tables/rates), and `V_PROVIDER_RATES` view. ## Setup ```sql theme={null} USE DATABASE PRICEMEDIC_CORE_HOSPITAL_HS; USE SCHEMA SNAPSHOT_FEB_2026; ``` Don't have access yet? Follow the [Snowflake setup guide](/data/core/snowflake-setup) to receive the PriceMedic Core data share and create this database. ## Example Queries ### 1. Hospital System Footprint Analysis Identify the largest hospital systems by provider count and payer coverage. ```sql theme={null} SELECT imputed_ein_name, COUNT(DISTINCT npi_number) AS hospitals, COUNT(DISTINCT payer_slug) AS payers, COUNT(DISTINCT network_slug) AS networks, COUNT(DISTINCT schedule_id) AS schedules FROM providers GROUP BY imputed_ein_name ORDER BY hospitals DESC; ``` **Sample Output:** | IMPUTED\_EIN\_NAME | HOSPITALS | PAYERS | NETWORKS | SCHEDULES | | ----------------------------------------------------- | --------- | ------ | -------- | --------- | | PRISMA HEALTH-UPSTATE | 74 | 4 | 4 | 38 | | NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | 69 | 4 | 4 | 82 | | UNIVERSITY OF CALIFORNIA SAN FRANCISCO MEDICAL CENTER | 68 | 5 | 5 | 31 | | CATHOLIC HEALTH INITIATIVES COLORADO | 42 | 5 | 5 | 39 | **Use Case**: Market intelligence on which health systems have the widest footprint and payer relationships. ### 2. Payer Coverage Analysis Analyze provider footprint by payer to understand market coverage. ```sql theme={null} SELECT payer_slug, COUNT(DISTINCT npi_number) AS npis, COUNT(DISTINCT imputed_ein) AS hospital_systems, COUNT(DISTINCT schedule_id) AS schedules FROM providers GROUP BY payer_slug ORDER BY npis DESC; ``` **Sample Output:** | PAYER\_SLUG | NPIS | HOSPITAL\_SYSTEMS | SCHEDULES | | ---------------- | ------ | ----------------- | --------- | | uhc | 10,033 | 4,902 | 6,956 | | aetna | 8,142 | 5,300 | 9,070 | | cigna | 6,263 | 4,266 | 3,610 | | anthem\_bcbs\_in | 993 | 657 | 994 | | bcbs\_tx | 684 | 482 | 517 | **Use Case**: Identify which payers have the broadest provider networks and most comprehensive transparency data. ### 3. Procedure Rate Benchmarking Compare institutional rates for knee replacement (CPT 27447) across states. ```sql theme={null} SELECT npi_state, COUNT(DISTINCT imputed_ein) as n_eins, COUNT(*) AS n_observations, ROUND(APPROX_PERCENTILE(negotiated_rate, 0.25), 0) AS p25_rate, ROUND(APPROX_PERCENTILE(negotiated_rate, 0.50), 0) AS median_rate, ROUND(APPROX_PERCENTILE(negotiated_rate, 0.75), 0) AS p75_rate FROM V_PROVIDER_RATES WHERE billing_code = '27447' AND billing_class = 'institutional' AND negotiated_rate > 100 AND negotiated_type != 'percentage' AND npi_taxonomy_code LIKE '282N%' -- General Acute Care Hospitals GROUP BY npi_state HAVING COUNT(*) >= 5 ORDER BY npi_state DESC; ``` **Sample Output:** | NPI\_STATE | N\_EINS | N\_OBSERVATIONS | P25\_RATE | MEDIAN\_RATE | P75\_RATE | | ---------- | ------- | --------------- | --------- | ------------ | --------- | | WY | 16 | 224 | 9,104 | 11,187 | 28,493 | | WV | 41 | 1,724 | 10,005 | 20,326 | 27,729 | | WI | 83 | 2,648 | 13,200 | 17,239 | 22,764 | | WA | 55 | 1,818 | 8,618 | 21,959 | 52,252 | | VT | 5 | 10 | 14,228 | 16,640 | 17,148 | | VA | 62 | 3,230 | 8,420 | 17,009 | 26,911 | | UT | 23 | 1,216 | 6,795 | 23,998 | 32,594 | | TX | 331 | 11,624 | 4,480 | 8,674 | 14,522 | | TN | 87 | 2,776 | 4,739 | 7,660 | 12,857 | | SD | 20 | 676 | 10,020 | 13,194 | 18,147 | | SC | 41 | 8,602 | 9,584 | 18,429 | 29,224 | | RI | 10 | 186 | 4,505 | 6,768 | 15,150 | **Use Case**: Rate benchmarking - understand regional pricing variations and market positioning. ### 4. Fee Schedule Extraction Extract complete fee schedules for a specific provider-payer combination. ```sql theme={null} SELECT DISTINCT payer_slug, network_slug, billing_code, billing_code_modifier, negotiated_rate, negotiated_type FROM V_PROVIDER_RATES WHERE imputed_ein = '390813418' -- Mayo Clinic Arizona EIN AND payer_slug = 'uhc' ORDER BY billing_code ``` **Sample Output:** | PAYER\_SLUG | NETWORK\_SLUG | NEGOTIATED\_RATE | NEGOTIATED\_TYPE | BILLING\_CODE | BILLING\_CODE\_MODIFIER | | ----------- | --------------------------- | ---------------- | ---------------- | ------------- | ----------------------- | | aetna | aetna\_exchange\_aetna\_ppo | 0 | fee schedule | 99202 | \["55"] | | aetna | aetna\_exchange\_aetna\_ppo | 56 | fee schedule | 99202 | null | | aetna | aetna\_exchange\_aetna\_ppo | 0 | fee schedule | 99202 | \["52"] | | aetna | aetna\_exchange\_aetna\_ppo | 0 | fee schedule | 99202 | \["56"] | | aetna | aetna\_exchange\_aetna\_ppo | 43 | fee schedule | 99202 | null | | aetna | aetna\_exchange\_aetna\_ppo | 32 | fee schedule | 99202 | null | | aetna | aetna\_exchange\_aetna\_ppo | 37 | fee schedule | 99202 | null | | aetna | aetna\_exchange\_aetna\_ppo | 66 | fee schedule | 99202 | null | | aetna | aetna\_exchange\_aetna\_ppo | 50 | fee schedule | 99202 | null | | aetna | aetna\_exchange\_aetna\_ppo | 88 | fee schedule | 99203 | null | **Use Case**: Quickly pull complete fee schedules to verify negotiated rates. ## Tips for Working with PriceMedic Core * **Filter by `negotiated_type`**: Exclude `'percentage'` rates when calculating dollar amount statistics * **Use taxonomy codes**: Filter to specific facility types using `npi_taxonomy_code` (e.g., `282N%` for hospitals) * **Leverage the view**: Use `V_PROVIDER_RATES` to avoid manual joins between providers and rates * **Watch for outliers**: Apply reasonable min/max filters on `negotiated_rate` to exclude data errors # Overview Source: https://docs.pricemedic.com/data/core/overview Overview of PriceMedic Core data ## Introduction PriceMedic Core provides access to processed transparency in coverage (TIC) data from major health insurance payers. This dataset focuses on negotiated rates between payers and providers across the United States. Purchased PriceMedic Core? Follow the setup guide to receive your private Snowflake data share and run your first query in about 10 minutes. PriceMedic Core is also listed on the [Snowflake Marketplace](https://app.snowflake.com/marketplace/providers/GZT1Z36FBPY/PriceMedic). ## What's Included PriceMedic Core contains: * **Provider Information**: Detailed provider demographics, organizational relationships, and network associations * **Negotiated Rates**: Procedure-level pricing for billing codes (CPT, HCPCS, DRG, etc.) across institutional and professional settings * **Payer-Network Metadata**: Coverage information for each payer-network combination * **EIN Attribution**: Imputed hospital and health system groupings based on Employer Identification Numbers ## Releases PriceMedic Core is published in periodic releases, each containing a snapshot of data from specific payer transparency files. New releases are delivered automatically to your private data share. **6,533** hospital and health system EINs across **60** payers | **2.26 billion** negotiated rates | **407,975** provider records ## Use Cases Common analytical applications include: * Competitive rate benchmarking for hospitals and health systems * Network adequacy analysis and coverage mapping * Contract negotiation preparation and rate validation * Market intelligence and pricing strategy development # Feb 2026 - Hospitals and Health Systems Release Source: https://docs.pricemedic.com/data/core/releases/feb-2026-hospitals Details about the February 2026 release of PriceMedic Core data focusing on hospitals and health systems. ## Release Summary * **2.26 billion** negotiated rates * **407,975** provider records * **6,533** unique hospital and health system EINs * **60** payers and their widest networks [View the Snowflake Marketplace listing](https://app.snowflake.com/marketplace/providers/GZT1Z36FBPY/PriceMedic). ## Covered Hospital and Health Systems * Includes **6,533** unique hospital and health system EINs * Covers **12,602** total hospital NPIs * Represents acute care, psychiatric, rehabilitation, and military hospitals * Includes both single-facility hospitals and multi-facility health systems ## Covered Payors and Networks * Includes **60** payors and their widest networks | # | Payer Name | Network Name | Covered EINs | TIC v2 | | -- | ------------------------------------ | ----------------------------------------------------- | ------------ | ------ | | 1 | Aetna | Aetna Exchange - Aetna PPO | 5,874 | ✓ | | 2 | Anthem BC California | Blue Cross of California PAR providers | 552 | ✓ | | 3 | Anthem BCBS Central States | Blue Traditional | 856 | ✓ | | 4 | Anthem BCBS Colorado | BluePreferred PPO | 113 | ✓ | | 5 | Anthem BCBS Connecticut | Century Preferred | 76 | ✓ | | 6 | Anthem BCBS Georgia | BCBS Georgia PAR providers | 291 | ✓ | | 7 | Anthem BCBS Kentucky | Anthem BCBS Blue High Performance | 142 | ✓ | | 8 | Anthem BCBS Maine | Anthem Main Blue Choice | 71 | ✓ | | 9 | Anthem BCBS Missouri | Blue Access Choice | 192 | ✓ | | 10 | Anthem BCBS Nevada | Anthem Nevada BluePreferred | 66 | ✓ | | 11 | Anthem BCBS New Hampshire | Anthem BCBS - Preferred Blue | 89 | ✓ | | 12 | Anthem BCBS Ohio | Participating Providers | 140 | ✓ | | 13 | Anthem BCBS Virginia | Anthem KeyCare PPO | 178 | ✓ | | 14 | Anthem BCBS Wisconsin | Blue Preferred POS | 237 | ✓ | | 15 | Arkansas BCBS | True Blue PPO | 125 | ✓ | | 16 | BCBS of Mississippi | BCBS Mississippi - PAR Network | 128 | ✓ | | 17 | BCBS of Rhode Island | Classic Blue | 32 | ✓ | | 18 | BCBS Of Arizona | Blue Preferred | 114 | | | 19 | BCBS of Massachusetts | BCBS Massachusetts Blue Care Elect | 568 | ✓ | | 20 | BCBS of Michigan | TRUST | 452 | ✓ | | 21 | BCBS of Nebraska | Network BLUE | 120 | | | 22 | BCBS of North Dakota | Traditional | 70 | ✓ | | 23 | BCBS of Wyoming | BCBS Wyoming - PAR Network | 57 | ✓ | | 24 | BCBS of Alabama | BCBS Alabama - PAR Network | 138 | | | 25 | BCBS of Hawaii | Preferred Provider Network | 62 | ✓ | | 26 | BCBS of Illinois | BCBS Illinois - Participating Provider Option | 306 | ✓ | | 27 | BCBS of Kansas | BCBS Kansas Blue Choice | 154 | ✓ | | 28 | BCBS of Kansas City | Preferred Care PPO | 54 | ✓ | | 29 | BCBS of Louisiana | BCBS Louisiana Blue High Performance | 198 | ✓ | | 30 | BCBS of Minnesota | BCBS Minnesota Aware | 162 | | | 31 | BCBS of Montana | BCBS Montana - PAR Network | 76 | ✓ | | 32 | BCBS of New Mexico | New Mexico Par Network | 64 | ✓ | | 33 | BCBS of North Carolina | Preferred Provider Network (PPN) | 1,328 | ✓ | | 34 | BCBS of Oklahoma | Blue Traditional | 155 | ✓ | | 35 | BCBS of Texas | PAR Network (Preview) | 528 | ✓ | | 36 | BCBS of Vermont | BCBS Vermont - PAR providers | 32 | ✓ | | 37 | BC of Idaho | BC Idaho - Preferred Blue | 86 | ✓ | | 38 | BS of California | BS California - PPO Network | 304 | ✓ | | 39 | BCBS of Puerto Rico | Triple S - PAR Network | 63 | ✓ | | 40 | BCBS of South Carolina | PAR providers | 90 | ✓ | | 41 | Capital BC | Capital Blue Cross Traditional | 687 | | | 42 | CareFirst BCBS | CareFirst BCBS - PAR Network | 114 | ✓ | | 43 | Cigna | Localplus | 5,475 | | | 44 | Empire BCBS | Empire BCBS - PPO Network | 419 | ✓ | | 45 | Excellus BCBS | BlueShield Par | 99 | | | 46 | Florida Blue | BlueChoice | 243 | | | 47 | Highmark BCBS Delaware | BCBS Delaware Blue Choice | 27 | ✓ | | 48 | Highmark BCBS West Virginia | Super Blue Plus | 64 | ✓ | | 49 | Highmark BCBS of Western New York | HighMark BlueCross BlueShield of Western New York-PPO | 53 | ✓ | | 50 | Highmark BS Pennsylvania | Highmark BS Network | 232 | ✓ | | 51 | Highmark BS of Northeastern New York | PPO | 33 | ✓ | | 52 | Horizon BCBS of New Jersey | Select Hospitals/PAR Physicians | 215 | ✓ | | 53 | Independence BC | Independence BC - PAR Network | 181 | | | 54 | Premera BC | Traditional | 182 | ✓ | | 55 | Regence BCBS of Oregon | Regence BCBS Oregon - PAR Network | 94 | ✓ | | 56 | Regence BCBS of Utah | ValueCare | 47 | ✓ | | 57 | Regence BS of Idaho | Blue Shield Preferred Providers | 71 | ✓ | | 58 | Regence BS of Washington | Regence BS BlueCard PPO | 88 | ✓ | | 59 | UnitedHealthcare Insurance Company | Choice | 5,356 | ✓ | | 60 | Wellmark BCBS of Iowa | Wellmark BCBS Iowa Alliance Select | 163 | | ## Included Tables and Views ### Tables #### [`providers`](/data/core/tables/providers) Contains provider-level information from transparency in coverage files, including: * NPI and TIN identifiers * Business and provider names * Imputed EIN attribution for hospital and health system grouping * Network and payer associations * Provider taxonomy and location data #### [`rates`](/data/core/tables/rates) Contains negotiated rate information for billing codes: * Billing codes (CPT, HCPCS, DRG, etc.) with modifiers * Negotiated rates and arrangement types * Service settings and classifications * Bundled code relationships * Rate descriptions and metadata #### [`payer_network_manifest`](#payer-network-manifest) Metadata table containing: * Payer and network names and identifiers * Count of covered EINs per payer-network combination * TIC v2 format indicator ### Views #### `V_PROVIDER_RATES` A denormalized view that joins the [`providers`](/data/core/tables/providers) and [`rates`](/data/core/tables/rates) tables to provide complete provider and rate context in a single query. This view includes all provider attributes alongside their associated negotiated rates, enabling efficient analysis of provider-specific pricing without needing to manually join the tables. **Join Keys:** * `schedule_id` * `payer_slug` * `network_slug` * `date_key` ## Payer Network Manifest The `payer_network_manifest` table contains metadata about each payer-network combination in this release. ### Table Columns | # | Column Name | Type | Description | | - | --------------------------------------- | ------- | -------------------------------------------- | | 1 | [payer\_slug](#payer_slug) | string | Standardized payer identifier | | 2 | [payer\_name](#payer_name) | string | Full payer name | | 3 | [network\_slug](#network_slug) | string | Standardized network identifier | | 4 | [network\_name](#network_name) | string | Full network name | | 5 | [num\_covered\_eins](#num_covered_eins) | number | Count of covered hospital/health system EINs | | 6 | [is\_tic\_v2](#is_tic_v2) | boolean | Indicates TIC v2 format compliance | ### Column Descriptions #### payer\_slug **Type:** string Standardized payer identifier used for consistent referencing and filtering. **Example Values:** ``` bcbs_nc anthem_bcbs_co uhc cigna aetna ``` #### payer\_name **Type:** string Full legal or business name of the insurance payer organization. **Example Values:** ``` Blue Cross and Blue Shield of North Carolina Anthem Blue Cross and Blue Shield Colorado UnitedHealthcare Insurance Company ``` #### network\_slug **Type:** string Standardized network identifier, typically includes payer identifier and network name components. **Example Values:** ``` bcbs_nc_preferred_provider_network_ppn anthem_bcbs_co_bluepreferred_ppo uhc_choice ``` #### network\_name **Type:** string Full name of the insurance network or plan. **Example Values:** ``` Preferred Provider Network (PPN) BluePreferred PPO Choice ``` #### num\_covered\_eins **Type:** number Count of unique hospital and health system EINs with negotiated rates in this payer-network combination. **Example Values:** ``` 1328 113 5356 ``` #### is\_tic\_v2 **Type:** boolean Indicates TIC v2 (Transparency in Coverage version 2) format compliance. **Possible Values:** * `true` - Complies with TIC v2 format * `false` - Uses earlier TIC format version # Snowflake Setup Source: https://docs.pricemedic.com/data/core/snowflake-setup Connect to your private PriceMedic Core data share in Snowflake and run your first query ## Overview PriceMedic Core is delivered as a private [Snowflake Secure Data Share](https://docs.snowflake.com/en/user-guide/data-share-consumers) that PriceMedic provisions directly to your Snowflake account when you purchase. The share is exclusive to your account — no data is copied and there is nothing to install. Once the share is accepted, you query 2.26 billion negotiated rates in place, paying only for your own compute. Setup takes about 10 minutes of work on your side, plus PriceMedic's provisioning turnaround. Looking to sync your PriceMedic platform data (reports, fee schedules, benchmarks) into your own warehouse instead? See [Data Integrations](/data/sinks/overview). This page covers access to the PriceMedic Core national rates dataset. ## Prerequisites * **A Snowflake account** (any edition). To create a database from the share, you need the `ACCOUNTADMIN` role or a role with the `IMPORT SHARE` privilege. * **A virtual warehouse**. The share includes storage but not compute — queries run on your own warehouse. Step 6 shows how to create one if you don't have one yet. * **Same cloud and region as PriceMedic's provider account**. Direct shares require the provider and consumer accounts to be in the same cloud region. If your account is in a different region or cloud, flag this when you contact PriceMedic — we'll arrange delivery via replication or the Marketplace listing instead. Unsure of any of these values? Step 1 below shows how to look them all up with a single query. ## Setup Steps PriceMedic needs your organization name, account name, and cloud region to target the share. Run this in any Snowflake worksheet: ```sql theme={null} SELECT CURRENT_ORGANIZATION_NAME() AS organization_name, CURRENT_ACCOUNT_NAME() AS account_name, CURRENT_ACCOUNT() AS account_locator, CURRENT_REGION() AS region; ``` **Example output:** | ORGANIZATION\_NAME | ACCOUNT\_NAME | ACCOUNT\_LOCATOR | REGION | | ------------------ | ------------- | ---------------- | ---------------- | | MYORG | MY\_ACCOUNT1 | AB12345 | AWS\_US\_EAST\_1 | Email all four values to [team@pricemedic.com](mailto:team@pricemedic.com) or your PriceMedic account contact. The organization name and account name pair (`MYORG.MY_ACCOUNT1`) is the identifier PriceMedic uses to provision the share. If your region differs from PriceMedic's provider region, say so in your email. Cross-region delivery requires extra provisioning on PriceMedic's side, and flagging it up front avoids a round trip. PriceMedic provisions the share to your account and confirms by email, including the exact provider account identifier and share name you'll use in the next steps. Provisioning typically completes within one business day. Once you receive the confirmation email, verify the share is visible in your account. Run as `ACCOUNTADMIN` (or a role with `IMPORT SHARE`): ```sql theme={null} USE ROLE ACCOUNTADMIN; -- List shares available to your account; look for kind = INBOUND SHOW SHARES; -- Inspect the contents of the PriceMedic share DESC SHARE PRICEMEDIC.PM_PROD."PRICEMEDIC_CORE_HOSPITAL_HS"; ``` `PRICEMEDIC.PM_PROD` is a placeholder for the provider account identifier — use the exact `..` string from your provisioning email. It also appears verbatim in the `SHOW SHARES` output. `DESC SHARE` should list the `SNAPSHOT_FEB_2026` schema containing the `PROVIDERS` and `RATES` tables and the `V_PROVIDER_RATES` view. ```sql theme={null} CREATE DATABASE PRICEMEDIC_CORE_HOSPITAL_HS FROM SHARE PRICEMEDIC.PM_PROD."PRICEMEDIC_CORE_HOSPITAL_HS"; ``` You can name this database anything, but we recommend `PRICEMEDIC_CORE_HOSPITAL_HS` — all example queries in this documentation assume that name. Shared databases work differently from regular databases: access is granted with a single `IMPORTED PRIVILEGES` grant per role. Object-level grants (per-schema or per-table) are not supported on shared databases. ```sql theme={null} -- Repeat for each role that should be able to query PriceMedic Core GRANT IMPORTED PRIVILEGES ON DATABASE PRICEMEDIC_CORE_HOSPITAL_HS TO ROLE ANALYST_ROLE; ``` Replace `ANALYST_ROLE` with your own role name. If you already have a warehouse you plan to use, grant your roles `USAGE` on it and skip to the next step. Otherwise, create a dedicated warehouse for querying PriceMedic Core: ```sql theme={null} CREATE WAREHOUSE IF NOT EXISTS PRICEMEDIC_WH WAREHOUSE_SIZE = 'MEDIUM' AUTO_SUSPEND = 60 -- suspend after 60 seconds idle AUTO_RESUME = TRUE INITIALLY_SUSPENDED = TRUE; -- Repeat for each role that will query PriceMedic Core GRANT USAGE ON WAREHOUSE PRICEMEDIC_WH TO ROLE ANALYST_ROLE; ``` **Sizing guidance** — the `rates` table holds 2.26 billion rows, so warehouse size matters more than for typical datasets: | Warehouse Size | Best For | | -------------- | ------------------------------------------------------------------------------------------- | | X-Small | Exploring `providers` (\~408K rows), metadata queries, small filtered lookups | | Small – Medium | Filtered `rates` and `V_PROVIDER_RATES` queries (specific billing codes, payers, or states) | | Large+ | Full-table aggregations across `rates`, nationwide benchmarking, large extracts | Start with Medium and adjust. `AUTO_SUSPEND = 60` with `AUTO_RESUME` keeps costs low — the warehouse only bills while queries are running, and you can resize at any time with `ALTER WAREHOUSE PRICEMEDIC_WH SET WAREHOUSE_SIZE = 'LARGE';`. Queries against shared data run on your own warehouse, so make sure one is active: ```sql theme={null} USE WAREHOUSE PRICEMEDIC_WH; -- or your existing warehouse USE DATABASE PRICEMEDIC_CORE_HOSPITAL_HS; USE SCHEMA SNAPSHOT_FEB_2026; -- Confirm the objects are visible SHOW TABLES; SHOW VIEWS; -- Verify row counts SELECT (SELECT COUNT(*) FROM providers) AS provider_records, (SELECT COUNT(*) FROM rates) AS negotiated_rates; ``` For the February 2026 release you should see approximately **407,975** provider records and **2.26 billion** negotiated rates. Now run your first analytical query — the largest health systems by hospital count and payer coverage: ```sql theme={null} SELECT imputed_ein_name, COUNT(DISTINCT npi_number) AS hospitals, COUNT(DISTINCT payer_slug) AS payers, COUNT(DISTINCT network_slug) AS networks, COUNT(DISTINCT schedule_id) AS schedules FROM providers GROUP BY imputed_ein_name ORDER BY hospitals DESC; ``` If this returns results, your setup is complete. ## Working with Shared Data A few properties of Snowflake data shares worth knowing as you build on PriceMedic Core: * **Read-only**: You can query shared objects but not modify them. To derive your own datasets, create tables in your own databases — `CREATE TABLE my_db.my_schema.t AS SELECT ...` works as expected. * **Bring your own compute**: The share includes storage, not compute. Every query runs on one of your warehouses and bills to your account. * **No cloning or Time Travel**: Shared databases and their objects cannot be cloned, and Time Travel is not available on shared data. * **Updates arrive automatically**: When PriceMedic publishes a new release to the share (for example, a new snapshot schema), it appears in your database with no action on your side. Watch the [release notes](/data/core/releases/feb-2026-hospitals) for what's new. ## Troubleshooting **Symptom**: `SHOW SHARES` returns no inbound share from PriceMedic. **Common causes and solutions**: * **Provisioning not complete**: The share only appears after PriceMedic confirms provisioning by email. * **Wrong account**: If your organization has multiple Snowflake accounts, make sure you're logged into the account whose details you sent. Re-run the query from Step 1 and compare. * **Role visibility**: Run `SHOW SHARES` as `ACCOUNTADMIN` — other roles may not see inbound shares. If it's been more than a business day since confirmation, contact [team@pricemedic.com](mailto:team@pricemedic.com) with the output of the Step 1 query. **Symptom**: PriceMedic reports the share can't be provisioned directly, or you know your account runs in a different cloud region. **Cause**: Direct shares only work between accounts in the same cloud and region. **Solution**: PriceMedic handles cross-region delivery via replication or the Snowflake Marketplace listing. Email [team@pricemedic.com](mailto:team@pricemedic.com) with your `CURRENT_REGION()` output and we'll set up the right delivery path. **Symptom**: `CREATE DATABASE ... FROM SHARE` fails with a privilege error. **Cause**: Creating a database from a share requires the `ACCOUNTADMIN` role or the `IMPORT SHARE` privilege. **Solution**: Switch to `ACCOUNTADMIN`, or have an admin grant the privilege to your role: ```sql theme={null} GRANT IMPORT SHARE ON ACCOUNT TO ROLE YOUR_ROLE; ``` **Symptom**: Granting schema- or table-level privileges on the shared database errors out, or users with grants still can't query. **Cause**: Shared databases only support the database-level `IMPORTED PRIVILEGES` grant — object-level grants are rejected. Users also need `USAGE` on a warehouse to run queries. **Solution**: ```sql theme={null} GRANT IMPORTED PRIVILEGES ON DATABASE PRICEMEDIC_CORE_HOSPITAL_HS TO ROLE ANALYST_ROLE; GRANT USAGE ON WAREHOUSE PRICEMEDIC_WH TO ROLE ANALYST_ROLE; ``` **Symptom**: Queries against the shared database fail with a no-active-warehouse error. **Cause**: Shared data doesn't come with compute — a warehouse from your account must be active in the session. **Solution**: Run `USE WAREHOUSE ;` in your session, or set a default warehouse for the user: ```sql theme={null} ALTER USER my_user SET DEFAULT_WAREHOUSE = PRICEMEDIC_WH; ``` ## Next Steps Common analytical patterns — footprint analysis, rate benchmarking, and fee schedule extraction. Schema reference for provider demographics, relationships, and network associations. Schema reference for procedure-level negotiated rates. Coverage details for the current hospitals and health systems release. ## Getting Support For provisioning status, region questions, or access issues: * Email: [team@pricemedic.com](mailto:team@pricemedic.com) * Include the output of the Step 1 query when reporting access problems For general reference on consuming Snowflake data shares, see the [Snowflake consumer documentation](https://docs.snowflake.com/en/user-guide/data-share-consumers). # Providers Table Source: https://docs.pricemedic.com/data/core/tables/providers Provider organization and demographic data ## Overview The Providers table contains information about healthcare provider organizations, including demographic and organizational details. ## Table Columns Each column in the Providers table is described below with examples of the data it contains. | # | Column Name | Type | Description | | -- | ------------------------------------------------- | ------ | --------------------------------------------------------- | | 1 | [schedule\_id](#schedule_id) | string | Unique identifier for each fee schedule | | 2 | [npi\_number](#npi_number) | string | National Provider Identifier | | 3 | [tin\_value](#tin_value) | string | Tax Identification Number | | 4 | [tin\_type](#tin_type) | string | Type of TIN (EIN or NPI) | | 5 | [business\_name](#business_name) | string | Provider or organization business name | | 6 | [network\_name](#network_name) | string | Insurance network name | | 7 | [imputed\_ein](#imputed_ein) | string | Inferred organization EIN | | 8 | [imputed\_ein\_name](#imputed_ein_name) | string | Organization name for imputed EIN | | 9 | [imputed\_ein\_source](#imputed_ein_source) | string | Method used to determine imputed EIN | | 10 | [npi\_last\_or\_org\_name](#npi_last_or_org_name) | string | Provider last name or organization name from NPI registry | | 11 | [npi\_first\_name](#npi_first_name) | string | Provider first name from NPI registry | | 12 | [npi\_taxonomy\_code](#npi_taxonomy_code) | string | Healthcare provider taxonomy classification | | 13 | [npi\_state](#npi_state) | string | Provider location state | | 14 | [date\_key](#date_key) | string | Data snapshot date (Partition key) | | 15 | [network\_slug](#network_slug) | string | Standardized network identifier (Partition key) | | 16 | [payer\_slug](#payer_slug) | string | Standardized payer identifier (Partition key) | ## Column Descriptions Detailed descriptions and examples for each column will be provided below. ### schedule\_id **Type:** string Unique identifier for each fee schedule in the system. Each schedule\_id represents a specific payer's fee schedule file. **Example Values:** ``` PM_SCHEDULE_8ZGF24A36MAU PM_SCHEDULE_1Q16VXEQ5WFC0 PM_SCHEDULE_5QVDLSIRIS3N PM_SCHEDULE_1UDVIGC0B7TGT PM_SCHEDULE_BZ7EOT7V0QMA ``` ### npi\_number **Type:** string National Provider Identifier (NPI), a unique 10-digit identification number issued to healthcare providers in the United States. **Example Values:** ``` 1225216054 1033484175 1013917525 1497192785 1174733620 ``` ### tin\_value **Type:** string Tax Identification Number (TIN) associated with the provider or provider organization. This is typically an Employer Identification Number (EIN) used for billing purposes. **Example Values:** ``` 1629168505 1558863415 1003977976 1790397008 1215527809 ``` ### tin\_type **Type:** string Indicates the type of Tax Identification Number provided in the tin\_value field. This field has only two possible values representing the source of the tax identification. **Possible Values:** * `ein` - Employer Identification Number * `npi` - National Provider Identifier **Example Values:** ``` ein npi ``` ### business\_name **Type:** string The business or legal name of the provider or provider organization as reported in the payer's fee schedule file. This can be an individual provider's name or an organization name. **Example Values:** ``` SUPRABHA BHAT THE BURNLEY CLINIC LLC MEADOWS OUTPATIENT CENTER ``` ### network\_name **Type:** string The name of the insurance network or plan under which the provider participates. This identifies the specific network tier or plan type within a payer's offerings. Each network name represents a distinct plan configuration or tier offered by the payers. **Example Values:** ``` Blue Next PCP Copay IU Health Narrow Network Tier 1 Kentucky Exchange PPO HIX BlueCard PPO Basic Green Network ``` ### imputed\_ein **Type:** string Employer Identification Number (EIN) that has been imputed or inferred for the provider organization. This is used to group providers that belong to the same organization when direct EIN information may not be available in the source data. **Example Values:** ``` 592852900 840622660 562222382 844658454 271511893 ``` ### imputed\_ein\_name **Type:** string The organization name associated with the imputed\_ein. This represents the business name of the organization that has been matched or inferred through the imputation process. **Example Values:** ``` NEW YORK DOWNTOWN HOSPITAL SEAFIELD CENTER, INC. HILLA STEINBERG, M.D., PLLC ALLERGY AND ASTHMA ASSOCIATES OF WESTCHESTER PLLC ARDSLEY RADIOLOGY PC ``` ### imputed\_ein\_source **Type:** string Indicates the method or source used to determine the imputed\_ein value. This field has three possible values, each representing a different data matching methodology. **Possible Values:** * `direct` - EIN was directly available in the source data * `npi1_crosswalk` - EIN was matched using NPI Type 1 (individual provider) crosswalk * `npi2_crosswalk` - EIN was matched using NPI Type 2 (organization) crosswalk **Example Values:** ``` direct npi1_crosswalk npi2_crosswalk ``` ### npi\_last\_or\_org\_name **Type:** string The last name of an individual provider or the organization name, as registered in the National Provider Identifier (NPI) registry. For individual providers, this is typically the last name; for organizational providers, this is the organization's legal name. **Example Values:** ``` FERNANDEZ MONROE TRYON BEVERSDORF JAAFAR ``` ### npi\_first\_name **Type:** string The first name of an individual provider, as registered in the National Provider Identifier (NPI) registry. This field is only populated when the NPI represents an individual provider (Type 1 NPI), and will be null for organizational providers (Type 2 NPI). **Example Values:** ``` ELIZABETH MARIAM AARON SHANE NICOLE ``` ### npi\_taxonomy\_code **Type:** string The Healthcare Provider Taxonomy Code associated with the provider's NPI. This is a unique 10-character alphanumeric code that classifies the provider's type, classification, and area of specialization. Each taxonomy code represents a specific healthcare provider specialty or service type. **Example Values:** ``` 363LP0200X 207XS0114X 103K00000X 103G00000X 208VP0014X ``` ### npi\_state **Type:** string The state or location where the provider is registered in the NPI registry. This can include US states (both abbreviations and full names), US territories, Canadian provinces, and international locations. **Example Values:** ``` WA CALIFORNIA FLORIDA KANSAS NOVA SCOTIA ``` ### date\_key **Type:** string The date representing when the data was processed or loaded into the system. This field is used as a partition key for data organization and querying efficiency. Currently represents a single snapshot date for the available data set. **Example Values:** ``` 2026-02-01 ``` ### network\_slug **Type:** string A standardized identifier for the insurance network. This slug is used for consistent referencing and filtering of network data across the system. The slug typically includes the payer identifier and network name. Each network slug represents a unique network configuration within the available payers. **Example Values:** ``` 132_high_performance_36R0 132_blue_high_performance_06X0 132_blue_choice_59H0 132_select_hospitals_par_physicians_36B0 132_empire_blue_access_ppo_39W0 ``` ### payer\_slug **Type:** string A standardized identifier for the insurance payer. This slug is used for consistent referencing and filtering of payer data across the system. Each slug represents one of the major insurance payers currently available in PriceMedic's data set. **Example Values:** ``` bcbs_nc horizon_bcbs_nj bcbs_tx uhc anthem_bcbs_co ``` # Rates Table Source: https://docs.pricemedic.com/data/core/tables/rates Negotiated rate data from transparency in coverage ## Overview The Rates table contains negotiated rate information extracted from payer transparency in coverage files. ## Table Columns Each column in the Rates table is described below with examples of the data it contains. | # | Column Name | Type | Description | | -- | --------------------------------------------------------------- | ------ | -------------------------------------------------- | | 1 | [schedule\_id](#schedule_id) | string | Unique identifier for each fee schedule | | 2 | [schedule\_line\_id](#schedule_line_id) | string | Unique identifier for each rate line | | 3 | [billing\_code](#billing_code) | string | Procedure or service code | | 4 | [billing\_code\_type](#billing_code_type) | string | Code classification system (CPT, HCPCS, DRG, etc.) | | 5 | [billing\_code\_modifier](#billing_code_modifier) | array | Additional procedure modifier codes | | 6 | [billing\_class](#billing_class) | string | Professional or institutional billing | | 7 | [negotiated\_type](#negotiated_type) | string | Rate determination methodology | | 8 | [negotiation\_arrangement](#negotiation_arrangement) | string | Payment structure (FFS, capitation, bundle) | | 9 | [setting](#setting) | string | Care setting (inpatient, outpatient, both) | | 10 | [service\_code](#service_code) | array | Additional service classification codes | | 11 | [additional\_information](#additional_information) | string | Supplementary rate information | | 12 | [severity\_of\_illness](#severity_of_illness) | string | Severity or risk adjustment indicators | | 13 | [expiration\_date](#expiration_date) | string | Rate expiration date | | 14 | [name](#name) | string | Procedure or service name | | 15 | [description](#description) | string | Detailed procedure description | | 16 | [bundled\_code\_with\_type\_list](#bundled_code_with_type_list) | array | Codes bundled with primary billing code | | 17 | [negotiated\_rate](#negotiated_rate) | float | Negotiated dollar amount | | 18 | [source\_file\_ids](#source_file_ids) | array | Source transparency file identifiers | | 19 | [date\_key](#date_key) | string | Data snapshot date (Partition key) | | 20 | [network\_slug](#network_slug) | string | Standardized network identifier (Partition key) | ## Column Descriptions Detailed descriptions and examples for each column will be provided below. ### schedule\_id **Type:** string Unique identifier for each fee schedule in the system. This links the rate to a specific payer's fee schedule file and corresponds to the schedule\_id in the providers table. **Example Values:** ``` PM_SCHEDULE_10044RA3EFYLZ ``` ### schedule\_line\_id **Type:** string Unique identifier for each individual rate line within a schedule. This identifies a specific negotiated rate entry and allows for precise referencing of individual rate records. **Example Values:** ``` PM_SLINE_0001F_11UU6GW4KGZF2 PM_SLINE_0005F_ONXSK6YL4EM PM_SLINE_0012F_134PBWWI8WH0Q PM_SLINE_0014F_4IGB4FCC2D6 PM_SLINE_0015F_1VYCMDG17KX0V ``` ### billing\_code **Type:** string The procedure or service code for which the rate is negotiated. This is typically a CPT (Current Procedural Terminology) code, HCPCS code, or other standardized medical billing code. **Example Values:** ``` 0001F 0005F 0012F 0014F 0015F ``` ### billing\_code\_type **Type:** string The classification system or type of the billing code. Each value represents a specific medical coding standard used in healthcare billing. **Possible Values:** * `CPT` - Current Procedural Terminology * `HCPCS` - Healthcare Common Procedure Coding System * `ICD` - International Classification of Diseases * `MS-DRG` - Medicare Severity Diagnosis Related Group * `APR-DRG` - All Patient Refined Diagnosis Related Group * `APC` - Ambulatory Payment Classification * `CDT` - Current Dental Terminology * `NDC` - National Drug Code * `HIPPS` - Health Insurance Prospective Payment System * `RC` - Revenue Code * `LOCAL` - Local or payer-specific code * `CSTM-ALL` - Custom or all-inclusive code **Example Values:** ``` CPT HCPCS MS-DRG ICD NDC ``` ### billing\_code\_modifier **Type:** array An array of modifier codes that provide additional information about how a service or procedure was performed. Modifiers can affect reimbursement rates and indicate special circumstances such as bilateral procedures, multiple surgeons, assistants, or equipment rentals. Multiple modifiers can be applied to a single billing code. **Example Values:** ``` [50, 62] [50, 80, AS] [26] [TC] [NU, RR, UE] [GP] [GN] [26, TC] [AU, AV, AW] [RR] ``` ### billing\_class **Type:** string Indicates whether the rate applies to professional or institutional services. This field has only two possible values, each representing a distinct billing category. **Possible Values:** * `professional` - Services billed by individual physicians or practitioners (typically uses CMS-1500 form) * `institutional` - Services billed by hospitals or facilities (typically uses UB-04 form) **Example Values:** ``` professional institutional ``` ### negotiated\_type **Type:** string Specifies the methodology used to determine the negotiated rate. This field has a limited set of values, each representing a distinct rate calculation method. **Possible Values:** * `negotiated` - A directly negotiated fixed rate * `fee schedule` - Rate based on a predetermined fee schedule * `percentage` - Rate calculated as a percentage of a reference amount (e.g., percentage of Medicare) * `per diem` - Daily rate for services * `derived` - Rate derived or calculated from other rates **Example Values:** ``` negotiated fee schedule percentage per diem derived ``` ### negotiation\_arrangement **Type:** string Defines the payment arrangement structure between the payer and provider. This field has only three possible values, each representing a fundamental payment model. **Possible Values:** * `ffs` - Fee-for-service, payment for each individual service rendered * `capitation` - Fixed payment per patient or member, regardless of services provided * `bundle` - Bundled payment covering a group of related services **Example Values:** ``` ffs capitation bundle ``` ### setting **Type:** string Indicates the care setting where the service is provided. This field has three possible values representing different service delivery contexts. **Possible Values:** * `outpatient` - Services provided without an overnight hospital stay * `inpatient` - Services provided with an overnight hospital stay or admission * `both` - Rate applies to both inpatient and outpatient settings **Example Values:** ``` outpatient inpatient both ``` ### service\_code **Type:** array An array of service codes that may provide additional classification or categorization for the billing code. These codes can supplement the primary billing code with extra context about the service being provided. **Example Values:** ``` [CSTM-00] ``` ### additional\_information **Type:** string Optional field for any supplementary information about the negotiated rate. This field is typically null but may contain notes, clarifications, or special conditions related to the rate when provided by the payer. ### severity\_of\_illness **Type:** string Field intended to capture severity of illness indicators or risk adjustment factors. This field is currently null across all records but may be populated in future data sets to reflect patient acuity or complexity levels. ### expiration\_date **Type:** string The date when the negotiated rate expires or is no longer valid. A value of `9999-12-31` indicates that the rate has no expiration date and remains valid indefinitely or until updated. **Example Values:** ``` 9999-12-31 ``` ### name **Type:** string The name or description of the procedure, service, or billing code. This provides a human-readable label for the billing code to help identify what service the rate applies to. **Example Values:** ``` HEART FAILURE ASSESSED OSTEOARTHRITIS ASSESSED Community-aquired bacterial pn Comprehensive preoperative ass Melanoma follow up completed ( ``` ### description **Type:** string A more detailed description of the procedure or service. This typically provides additional context or a fuller explanation compared to the name field, though it may sometimes contain the same information. **Example Values:** ``` HEART FAILURE ASSESSED OSTEOARTHRITIS ASSESSED Community-aquired bacterial pneumonia assessed Comprehensive preoperative assessment performed fo r cataract surgery with intra Melanoma follow up completed (includes assessment of all of the following compon ``` ### bundled\_code\_with\_type\_list **Type:** array An array of billing codes that are bundled together with the primary billing code. Each entry is formatted as `code|type` where the code is the billing code value and the type indicates the code system (e.g., RC for Revenue Code). This identifies all component services included in a bundled rate. **Example Values:** ``` [0300|RC, 0301|RC, 0302|RC, 0303|RC, 0304|RC, 0305|RC, 0306|RC] [0300|RC, 0301|RC, 0303|RC, 0305|RC, 0306|RC, 0307|RC, 0309|RC] ``` ### negotiated\_rate **Type:** float The actual dollar amount of the negotiated rate for the service or procedure. This represents the reimbursement amount agreed upon between the payer and provider. A value of 0.0 may indicate rates that are not disclosed or are calculated using alternative methods. **Example Values:** ``` 75.0 100.0 0.0 ``` ### source\_file\_ids **Type:** array An array of identifiers referencing the original transparency in coverage files from which this rate data was extracted. This enables traceability back to the source payer files. **Example Values:** ``` [765] ``` ### date\_key **Type:** string\ **Partition:** 0 The date representing when the data was processed or loaded into the system. This field is used as a partition key for data organization and querying efficiency. Currently represents a single snapshot date for the available data set. **Example Values:** ``` 2026-02-01 ``` ### network\_slug **Type:** string\ **Partition:** 1 A standardized identifier for the insurance network. This slug is used for consistent referencing and filtering of network data across the system. The slug typically includes the payer identifier and network name. This field corresponds to the network\_slug in the providers table and links rates to specific networks. **Example Values:** ``` 132_comprehensive_major_medical_network_cmmn_32R0 ``` # Data Dictionary Source: https://docs.pricemedic.com/data/data-dictionary Comprehensive reference for all data fields and attributes in PriceMedic's reports database 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 Source: https://docs.pricemedic.com/data/enrichments/benchmark-rates Documentation for the benchmark rates enrichment process that adds Medicare and other benchmark pricing data ## Overview This enrichment takes the base rate data and adds corresponding Medicare benchmark rates from two primary sources: * **Medicare RBRVS (Resource-Based Relative Value Scale)** rates by locality * **Medicare ASP (Average Sales Price)** rates for applicable codes The process creates locality-specific and national benchmark comparisons to enable comprehensive rate analysis. ## Data Sources **Source**: CMS Medicare Physician Fee Schedule\ **Coverage**: Professional services with RVU components\ **Locality**: Geographic adjustment factors applied\ **Currency**: 2025 fee schedule rates **Source**: CMS Average Sales Price files\ **Coverage**: Drug and biologics pricing\ **Update**: January 2025 pricing\ **Scope**: National rates (no locality adjustment) ## Output Schema The enrichment produces 8 additional columns that are joined to the base rate data: | Field | Description | Example | | ------------------------- | -------------------------------------------------- | ----------------------------------------- | | `billing_code` | Procedure or service code for benchmark matching | "99213", "J0696" | | `benchmark_name` | Human-readable benchmark source identifier | "2025 Dallas MCR (CARRIER 0112026)" | | `benchmark_type` | Medicare benchmark methodology used | "MCR\_RBRVS", "MCR\_ASP" | | `benchmark_rate` | Locality-adjusted Medicare benchmark rate | 98.75 | | `national_benchmark_name` | National benchmark source identifier | "2025 \[National] MCR (CARRIER 00000:00)" | | `national_benchmark_type` | National benchmark methodology | "MCR\_RBRVS", "MCR\_ASP" | | `national_benchmark_rate` | National Medicare rate without locality adjustment | 95.50 | ## Processing Logic This enrichment helps put commercial insurance rates in context by comparing them to what Medicare would pay for the same services. **Smart Benchmark Selection**\ For doctor visits and medical procedures, the system uses Medicare's physician fee schedule, adjusting the rates based on local practice costs (since medical expenses vary by geographic region). For prescription drugs and biologics, it uses Medicare's drug pricing methodology. **Apples-to-Apples Comparisons**\ The system carefully matches billing codes between commercial rates and Medicare fee schedules to ensure fair comparisons. It focuses on standard procedures without special modifiers to create the cleanest possible benchmark relationships, using the most current Medicare rates available. # Billing Attributes Enrichment Source: https://docs.pricemedic.com/data/enrichments/billing-attributes Enhanced billing code information and service classification data ## Overview This enrichment enhances rate data by adding hierarchical classification information from PriceMedic's billing code group reference data. It provides both broad categories and specific subgroups for better organization and analysis of healthcare services. ## Data Sources The enrichment uses PriceMedic's comprehensive billing code classification system with hierarchical groupings and subgroups for healthcare services analysis. ## Output Schema The enrichment produces 4 columns that provide billing code classification: | Field | Description | Example | | ----------------------- | ----------------------------------------------------- | --------------------------------------------------- | | `billing_code` | Procedure or service code for classification matching | "99213", "70553" | | `billing_code_group` | High-level service category classification | "Evaluation and Management", "Surgery", "Radiology" | | `billing_code_subgroup` | Detailed service classification within broader group | "Office/Outpatient Visits", "Cardiovascular System" | ## Processing Logic This enrichment makes medical billing codes more understandable by organizing them into logical categories. **Creating Meaningful Groups**\ Medical procedures are identified by cryptic codes like "99213" or "70553" that don't tell you much at first glance. This process looks up each code in a comprehensive reference guide to assign clear category names like "Office Visits" or "MRI Scans." **Two Levels of Organization**\ Each code gets classified at two levels: a broad category (like "Surgery" or "Radiology") and a more specific subcategory (like "Cardiovascular Surgery" or "Diagnostic Imaging"). This hierarchical approach makes it easy to analyze rates at whatever level of detail you need. **Complete Data Preservation**\ If a billing code doesn't have an established classification, it's kept in the data but marked as unclassified. This ensures no rate information is lost while still providing organized groupings for the codes that can be categorized. # Organization Info Enrichment Source: https://docs.pricemedic.com/data/enrichments/organization-info Enhanced provider organization data and intelligence from multiple healthcare data sources ## Overview This enrichment transforms basic TIN identifiers into rich organizational profiles by: * **TIN Type Classification**: Determining if TINs are EINs, NPI Type 1, or NPI Type 2 * **Entity Name Resolution**: Finding official organization names through multiple data sources * **Organizational Attributes**: Adding size, location, and specialty information * **Billing Capability Analysis**: Determining if organizations can bill for specific services ## Data Sources The enrichment uses multiple reference data sources: * **NPI Registry**: National Provider Identifier database for TIN classification and provider information * **Healthcare Provider Taxonomy**: Standard taxonomy codes and specialty classifications * **Historical CMS Claims Data**: For determining service-specific billing capabilities ## Output Schema The enrichment produces 15 columns providing comprehensive organizational context: | Field | Description | Example | | -------------------- | ---------------------------------------------------------- | ---------------------------------------- | | `entity_name` | Primary display name for the healthcare entity | "ABC Medical Group" | | `tin` | Original Tax Identification Number from rate data | "12-3456789", "1234567890" | | `tin_type` | Type of tax identifier (ein, npi1, npi2, unknown) | "ein", "npi2" | | `org_match_type` | Method used to match organizational information | "direct\_match", "npi2\_imputed" | | `org_name` | Official organization name from authoritative sources | "ABC Healthcare System" | | `org_ein` | Employer Identification Number of the organization | "12-3456789" | | `org_states` | States where the organization operates | \["TX", "OK", "AR"] | | `org_taxonomies` | Healthcare specialty codes for the organization | \["207Q00000X", "208D00000X"] | | `org_taxonomy_names` | Human-readable specialty names for organization | \["Family Medicine", "General Practice"] | | `org_est_count_md` | Estimated count of physicians in organization | 45 | | `org_est_count_app` | Estimated count of advanced practice providers | 12 | | `org_est_count_npi1` | Total estimated individual provider count | 67 | | `taxonomy_names` | Human-readable specialty names for rate-specific providers | \["Family Medicine"] | | `can_bill` | Organization can legitimately bill for this service | true, false | ## Processing Logic This enrichment answers key questions about the healthcare organizations behind each rate: "Who are they?" and "What do they actually do?" **Identifying the Organization**\ The system examines provider identifiers to determine if they represent individual doctors, group practices, or large healthcare systems. When multiple identifiers point to the same organization (like different departments in a hospital), they're grouped together to create a complete organizational profile. **Understanding Their Business**\ For each organization, the system gathers important details like how many providers they have, what medical specialties they offer, and where they operate. This helps explain why their rates might be higher or lower than others. **Determining Service Capabilities**\ The system also figures out what services each organization can realistically provide by looking at their specialties and past billing patterns. If an organization's doctors have frequently performed a procedure, it's marked as a service they can legitimately offer. # Payer Metadata Enrichment Source: https://docs.pricemedic.com/data/enrichments/payer-metadata Enhanced payer and network identification with human-readable names and standardized identifiers ## Overview This enrichment enhances rate data by: * **Payer Name Resolution**: Converting payer IDs to official payer names * **Network Name Resolution**: Converting network keys to network names * **Standardized Identifiers**: Providing consistent payer and network slugs * **Hierarchical Relationships**: Creating composite payer-network identifiers The process ensures that every rate record has clear, readable payer and network identification for analysis and reporting. ## Data Sources The enrichment uses PriceMedic's payer and network registry data for official names and standardized identifiers. ## Output Schema The enrichment produces 6 columns providing comprehensive payer and network metadata: | Field | Description | Example | | ------------------ | ----------------------------------------------- | ------------------------------------------ | | `payer_name` | Official name of the insurance payer | "Aetna Better Health", "Anthem Blue Cross" | | `payer_id` | Standardized payer identifier slug | "aetna-better-health" | | `network_name` | Human-readable network name | "Choice Plus", "PPO Network" | | `network_id` | Original network identifier from source data | "choice-plus-network" | | `payer_network_id` | Composite identifier linking payer with network | "aetna-better-health/choice-plus" | ## Processing Logic The enrichment performs straightforward lookups against comprehensive payer and network registries to convert cryptic identifiers into user-friendly names. The system matches payer IDs from rate data against the payer registry to retrieve official insurance company names and standardized identifier slugs. Similarly, it matches network keys against the network registry to obtain readable network names. The process creates composite payer-network identifiers by concatenating standardized slugs, enabling granular identification of specific payer-network combinations. All original identifiers are preserved alongside the enhanced metadata to maintain data lineage and support validation workflows. # Resolution Attributes Enrichment Source: https://docs.pricemedic.com/data/enrichments/resolution-attributes Data resolution, ranking, and quality indicators for healthcare pricing data analysis ## Overview This enrichment addresses the challenge of multiple rates for the same service by providing: * **TIN Resolution**: Standardizing organizational identifiers for consistent grouping * **Payer-Specific Ranking**: Applying payer-defined policies for rate selection * **Multi-Dimensional Rankings**: Ranking by provider count, rate amount, and care setting * **Quality Indicators**: Flagging best rates for different analytical scenarios The process ensures that analysts can confidently select the most appropriate rates based on their specific use cases and payer requirements. ## Data Sources **Source**: National Provider Identifier database\ **Usage**: TIN type classification for resolution logic\ **Coverage**: Individual and organizational provider information ## Output Schema The enrichment produces 14 columns providing comprehensive resolution and ranking information: | Field | Description | Example | | ---------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ---------------- | | `tin` | Original Tax Identification Number from the source rate data for traceability and audit purposes. | `"123456789"` | | `resolution_tin` | Standardized organizational identifier - either the original TIN (if EIN) or the mapped EIN (if NPI), with fallback to original TIN for unknown types. Used for consistent organizational rate grouping and deduplication. | `"987654321"` | | `billing_code` | Procedure or service code used in ranking partitions for code-specific rate resolution. | `"99213"` | | `npis_hash` | Unique identifier for the specific set of providers associated with the rate, used for exact provider group rate resolution and validation. | `"abc123def456"` | | `npis_length_rank` | Ranking based on the number of NPIs associated with each rate, with rank 1 having the most providers within each partition group. Identifies rates with the broadest provider coverage. | `1` | | `negotiated_rate_rank` | Ranking based on negotiated rate amount, with rank 1 having the highest rate within each partition group. Identifies the highest-priced rates for each service and provider combination. | `2` | | `is_best_rate` | Primary rate selection flag based on payer-specific preferences. True for rates that rank #1 according to the payer's preferred methodology (either most NPIs or maximum rate). | `true` | | `is_best_non_fac_rate` | Best rate selection specifically for office-based healthcare services. True for rates that rank #1 for non-facility services according to the payer's resolution policy. | `false` | | `is_best_fac_rate` | Best rate selection specifically for hospital and facility-based services. True for rates that rank #1 for facility-based services according to the payer's resolution policy. | `true` | | `has_most_npis` | Identifies rates with maximum provider network coverage. True for rates with the highest number of associated NPIs within each partition group, regardless of payer policy. | `true` | | `has_max_rate` | Identifies the highest-priced rates for benchmarking and analysis. True for rates with the highest negotiated amount within each partition group, regardless of payer policy. | `false` | ## Processing Logic This enrichment helps solve a common problem: when multiple rates exist for the same medical service, which one should you use? The process works in three simple steps: **Step 1: Group Similar Organizations**\ The system recognizes that different provider numbers might actually represent the same healthcare organization (like a hospital system), so it groups all rates from the same organization together. **Step 2: Rank the Options**\ Within each group, rates are ranked by two factors: how many doctors accept them (more is usually better for patients) and how much they pay (higher rates may indicate premium networks). The system creates separate rankings for hospital-based and office-based care. **Step 3: Apply Insurance Company Preferences**\ Each insurance company has its own strategy - some prefer rates accepted by the most doctors (broader coverage), while others prefer the highest-paying rates (premium positioning). The system applies these preferences to identify the "best" rate for each scenario. # Data Sinks Source: https://docs.pricemedic.com/data/sinks/overview Flexible data delivery solutions for seamless integration with your data infrastructure. ## Overview PriceMedic's data sinks provide flexible, scalable solutions for delivering healthcare pricing data directly into your preferred data platforms and environments. Our comprehensive suite of data delivery options ensures seamless integration with your existing data infrastructure, enabling you to access PriceMedic's enriched healthcare pricing intelligence where you need it most. Data sinks require configuration and setup. Contact your PriceMedic team member to enable and configure data delivery to your preferred platforms. ### Detailed Platform Support | Platform | Description | Data Format | Integration Method | Use Cases | | ------------------------ | ------------------------------------- | ------------- | ------------------------------- | ------------------------------------------------- | | **Amazon S3** | Industry-leading cloud object storage | Parquet | S3 API with secure credentials | Data lakes, ETL pipelines, cost-effective storage | | **Azure Blob Storage** | Microsoft's cloud storage solution | Parquet | Azure SDK with managed identity | Azure-native environments, hybrid cloud | | **Google Cloud Storage** | Google's unified object storage | Parquet | GCS API with service accounts | GCP ecosystems, multi-cloud strategies | | **Snowflake** | Cloud-native data platform | Native tables | Snowflake Connector | Data warehousing, analytics, BI tools | | **Databricks** | Unified analytics and ML platform | Delta tables | Databricks Connector | Data science, ML workflows, advanced analytics | | **SFTP** | Your own SFTP server | Parquet | Outbound key-based transfer | On-premise intake, no cloud storage required | ## Key Benefits Data is automatically delivered to your configured sinks on your preferred schedule, eliminating manual data transfer processes and ensuring consistent, up-to-date information. Data is delivered in platform-optimized formats (Parquet for storage, native tables for analytics platforms) to ensure maximum performance and compatibility. All data transfers use enterprise-grade security with encrypted connections, credential management, and audit logging to meet healthcare data compliance requirements. Our data sink infrastructure scales automatically to handle datasets of any size, from small specialty reports to comprehensive national pricing databases. ## Getting Started ### For Existing Customers If you're already a PriceMedic customer and would like to set up data delivery to your platforms **contact your PriceMedic team member** to discuss your data delivery requirements. ### New Data Sink Requests Don't see your preferred platform listed? We're continuously expanding our data sink capabilities. Contact your PriceMedic team member to discuss: * Custom integration requirements * New platform support requests * Specialized delivery formats * Advanced configuration options For the fastest setup, have your platform storage locations, and delivery preferences ready when you contact your PriceMedic team member. # Upload a Contract Source: https://docs.pricemedic.com/guides/contracts/01-upload-contract Learn how to upload contract documents to PriceMedic PriceMedic Contract Upload Process ## Basics Upload your payer contracts to begin analyzing their terms and provisions. PriceMedic supports various document formats and uses intelligent processing to extract key contract information automatically. Click **Upload Documents** to begin the upload process. You can upload multiple contracts at once for batch processing. Supported file formats include PDF, DOCX, DOC, TXT, and image files (PNG, JPG). Maximum file size is 50MB per document. ## Upload Process ### Step 1: Select Files * Click **Upload Documents** or drag and drop files into the upload area * Select one or multiple contract files from your computer * Supported formats: PDF, DOCX, DOC, TXT, PNG, JPG * Maximum file size: 50MB per document ### Step 2: Processing Once uploaded, PriceMedic will: * **Extract text** from the document using OCR if needed * **Identify key provisions and dates** using AI-powered analysis * **Structure the data** for easy review and editing Processing time varies based on document size and complexity. Large contracts may take several minutes to process completely. ## Upload Best Practices * **Use clear, high-quality scans** for image-based documents * **Ensure text is readable** and not heavily redacted * **Organize files** with descriptive names before upload Establish consistent naming patterns for easy organization: * `[Payer]_[EffectiveDate]_[ContractType].pdf` * Example: `Aetna_2024-01-01_Professional.pdf` When uploading multiple contracts: * **Group by payer** for easier data entry * **Compress files** into a ZIP archive if needed, allowing for a single upload action ## Supported Contract Types ### Professional Contracts * Physician services and professional fees * Outpatient procedures and consultations * Professional component of split billing ### Institutional Contracts * Hospital and facility services * Inpatient care and room charges * Technical component of procedures ### Comprehensive Contracts * Combined professional and institutional services * Bundled payment arrangements * Capitation agreements ## Common Upload Issues **Problem**: File won't upload or shows format error **Solutions**: * Convert to supported format (PDF recommended) * Reduce file size if over 25MB limit * Save scanned documents as PDF rather than image files **Problem**: Text extraction is incomplete or inaccurate **Solutions**: * Use higher resolution scans (300 DPI minimum) * Ensure document is right-side up and properly aligned * Consider re-scanning poor quality documents **Problem**: Document is taking too long to process **Solutions**: * Check document size and complexity * Wait for processing to complete before uploading additional files * Contact support if processing exceeds 10 minutes ## Security and Privacy PriceMedic maintains strict security standards for contract documents: * **Encryption**: All uploads are encrypted in transit and at rest * **Access Control**: Only authorized users can view your contracts * **Compliance**: HIPAA-compliant storage and processing * **Retention**: Documents stored according to your organization's policies ## Next Steps After uploading your contracts, proceed to [Update and View Provisions](/guides/contracts/02-update-view-provisions) to review and organize the extracted contract information. Start with your most important or recent contracts to get familiar with the system before uploading your entire contract portfolio. # View and Update Provisions Source: https://docs.pricemedic.com/guides/contracts/02-update-view-provisions How to review, edit, and manage provisions in PriceMedic PriceMedic Provisions Management Interface ## Viewing Provisions The interface displays provisions by category. You can expand each provision to see details, references, and source excerpts. ## Editing Provisions ### Add New 1. Click **Add Provision** 2. Enter title, description, category, effective date, and page reference 3. Save ### Edit Existing 1. Expand the provision 2. Click **Edit** 3. Update fields as needed 4. Save Always verify extracted provisions against the original contract document. ## Management Tools * **Search and filter** across provisions * **Custom tagging** (priority, status, custom labels) * **Version control** with full audit history ## Quality Assurance Use checklists to confirm: * Payment rates match schedules * Administrative requirements are complete * Clinical requirements align with contract Watch for common issues such as incomplete tables, formatting errors, or missing context. ## Advanced Features * Bulk edits, imports, and exports * Link provisions to billing codes * Summaries and compliance tracking * Performance metrics on adherence to terms ## Collaboration * Share contracts with team members * Role-based permissions for edits ## Next Steps With provisions updated you can: * Compare contracts across payers * Analyze terms against market data * Track compliance * Prepare for negotiations with structured insights Schedule regular reviews to keep provisions and reimbursements current. # Contracts Overview Source: https://docs.pricemedic.com/guides/contracts/overview Learn how to upload, manage, and analyze contracts in PriceMedic ## What is Contract Management? PriceMedic's Contract Management system allows healthcare providers to upload, organize, and analyze their payer contracts. This powerful tool helps you: * **Centralize contract storage** for easy access and organization * **Extract key provisions** automatically from uploaded documents * **Compare contract terms** across different payers and time periods * **Track contract performance** against actual reimbursement data * **Identify optimization opportunities** for future negotiations ## Getting Started The Contract Management workflow consists of two main steps: Upload contract documents in various formats (PDF, Word, etc.) and let PriceMedic's intelligent parsing extract key information automatically. Review, edit, and organize the extracted contract provisions to ensure accuracy and completeness for your analysis. ## Key Features ### Intelligent Document Processing * **Automated extraction** of key contract terms and provisions * **Support for multiple formats** including PDF, DOCX, and scanned documents * **OCR capabilities** for processing image-based documents ### Provision Management * **Structured data organization** for easy analysis and comparison * **Custom tagging and categorization** options * **Version tracking** for contract amendments and updates ### Integration with Rate Analysis * **Cross-reference contract terms** with actual reimbursement data * **Identify discrepancies** between contracted and paid rates * **Performance tracking** against contract benchmarks ## Use Cases Use historical contract data and current market rates to prepare for upcoming negotiations with stronger data-driven insights. Track actual payments against contracted terms to ensure payers are meeting their obligations and identify potential underpayments. Compare contract terms across your entire payer portfolio to identify best and worst performing agreements. Analyze contract performance trends to inform strategic decisions about payer relationships and service line development. ## Before You Begin ### Prerequisites * Active PriceMedic account with Contract Management access * Contract documents in supported formats (PDF, DOCX, etc.) * Provider information and NPI details ### Best Practices * **Organize documents** before upload with clear naming conventions * **Prepare key information** such as effective dates and payer details * **Review extracted data** carefully to ensure accuracy * **Maintain version control** for contract amendments ## Getting Help Need assistance with Contract Management? Our support team is available to help: * **Email**: [support@pricemedic.com](mailto:support@pricemedic.com) * **Documentation**: Comprehensive guides for each feature * **Training**: Available through your Account Executive ## Next Steps Ready to get started? Begin with [uploading your first contract](/guides/contracts/01-upload-contract) to start building your contract management system. # What are Provisions? Source: https://docs.pricemedic.com/guides/contracts/provisions-overview Understand the types of provisions tracked in contracts ## What Are Provisions? Provisions are specific rules or requirements written into healthcare contracts. PriceMedic extracts these from the uploaded contract, organizes them, and makes them editable. Each provision includes: * **What it says**: Plain text requirement * **Where it came from**: Page and paragraph reference * **Who it applies to**: Provider, payer, or both * **Specific values**: Dates, amounts, notice periods * **Priority**: Which requirement takes precedence * **Source verification**: Clear link back to the contract ## Categories of Provisions ### Key Dates and Terms * Effective date * Estimated effective date * Term duration * Renewal notice periods * Auto renewal ### Payment Terms * Timely filing deadlines * Processing and clean claim processing terms * Reimbursement methodologies * Fee schedules and timelines ### Termination * Termination for cause process and notice period * Termination without cause process and notice period ### Overpayment Recovery * Recovery process * Notification process and term * Payment term ### Underpayment Recovery * Recovery process * Notification process and term * Payment term ### Change of Control * Notice period * Notification process ### Administrative Provisions * Prior authorization requirements * Claims submission and appeals * Credentialing requirements ### Clinical Requirements * Quality measures * Care management protocols * Utilization review * Documentation standards ### Financial Terms * Risk sharing and bonuses * Penalty clauses * Reconciliation * Audit and compliance These categories provide structure for organizing all extracted provisions and ensure consistency across contracts. # How do Reimbursements Work? Source: https://docs.pricemedic.com/guides/contracts/reimbursements-overview How contract reimbursement terms are classified and materialized ## What Is Reimbursement Classification? Reimbursement classification breaks down payment arrangements in contracts into structured, comparable formats. It ensures consistency across payers and networks. ## Fee Schedules Each schedule includes: * **Title** (Specialist Rates, Primary Care Schedule) * **Primary Methodology** (current year Medicare, fixed year Medicare, custom, payer-controlled, unknown) * **Scope Summary** (services, providers, networks covered) * **Effective Dates** ## Payment Methodologies * **Current Year Medicare**: Rates tied to the current year’s schedule * **Fixed Year Medicare**: Based on a specified past Medicare schedule * **Custom**: Explicit dollar amounts or custom tables * **Payer Controlled**: Determined by the payer’s internal fee schedule * **Unknown**: Not clearly defined ## Reimbursement Sections * Individual payment rules * Network applicability (commercial, Medicare Advantage, Medicaid, Tricare) * Billing codes associated with each rule ## Materialization Process 1. **Rate Calculation** * Medicare-based: Uses PriceMedic’s schedule builder * Custom: Extracted from attachments or tables * Payer-controlled: Linked from payer’s internal schedules 2. **Output Format**\ Standardized tables with: * Billing code * Modifier * Setting (facility or non-facility) * Allowable amount 3. **Source Documentation** * Page references * Contract excerpts * Cross-references to exhibits or appendices Materialized schedules create a consistent dataset for analysis, comparison, and negotiation. # Dashboards Overview Source: https://docs.pricemedic.com/guides/dashboards/overview Learn about the dashboards available in PriceMedic ## Introduction PriceMedic dashboards provide comprehensive insights into your pricing data and analytics. ## Available Dashboards Compare your pricing data against peer organizations Compare selected competitor groups and geographic coverage ## Getting Started Navigate to the specific dashboard guides to learn more about each feature and how to use them effectively. # Competitor View Source: https://docs.pricemedic.com/guides/dashboards/provider-analysis-dashboard/competitor-view Compare selected competitor groups and geographic coverage ## Overview The Competitor View in the Provider Analysis dashboard helps you select competitor organizations, review selected groups, and understand geographic distribution. ## Competitor Selection Use the left panel to build and refine your competitor set. * **Select by Entity Name**: Search and add competitors directly by organization name. * **Select by Entity Attributes**: Filter competitor candidates by attributes such as CBSA and practice size. Use these controls together to create a peer set that matches your market, scale, and competitive context. Provider Analysis Dashboard Filter Bar ## Selected Groups View The Selected Groups table displays the organizations currently included in your competitor set. Each row represents one competitor group and includes key comparison fields, such as: * **EIN** * **Name** * **Nearest Location (Mi)** * **Practice Size** Use this table to review who is currently included, confirm proximity and size alignment, and adjust your selection before deeper pricing analysis. Provider Analysis Dashboard Filter Bar ## Map The map visualizes selected competitor groups by location. * Each marker represents a selected competitor group. * The legend on the right matches marker colors to competitor names. * Use the map with the Selected Groups table to validate geographic coverage and spot clusters or gaps in your peer set. This view helps ensure your comparison group is both strategically relevant and geographically appropriate for your analysis. Provider Analysis Dashboard Filter Bar ## Selected Groups Fee Schedules Below the competitor selection and map, the dashboard includes a detailed table that shows fee schedule values for all selected groups. This section helps you compare reimbursement rates side by side across competitors and your target group. ### Billing Code Selection Use the Billing Code Selector panel to choose the code groups and individual billing codes you want to analyze. * **Billing Code Group** narrows the analysis to a category of services. * **Billing Code** lets you focus on specific procedures within the selected group. These selections control which rows appear in the fee schedule table and the related distribution view. ### Fee Schedule View The fee schedule table displays selected groups as columns and billing codes as rows so you can compare contracted rates directly. For each selected group, this view can include details such as: * **Payer Name** * **EIN** * **Competitor Name** * **Org # of Providers** * **Billing Class** * **Setting** * **Display Rate** Use this view to identify pricing gaps and spot where your rates are above or below competitor benchmarks for the same services. ### Percent of Medicare View The Percent of Medicare view summarizes negotiated rates as a percentage of current CMS values. * The distribution plot highlights how selected competitors are positioned by billing code. * The ranking table provides a quick list of competitor performance using **% of CMS**. Together, these views help you evaluate relative contract strength and prioritize opportunities for rate improvement. ## Configuring a Comparison Run a side-by-side comparison of a competitor against your provider to see how your rates stack up.