OpenCare Data User Guide
Welcome to OpenCare Data. This guide will provide a high level overview of the functionality found within as well as provide more information about how we obtain our data and present it to you.
Transparency in Coverage Data
As of July 1st, 2022 all insurance carriers are required to publish all of their contracted rate data down to the individual billing code and NPI. This data is massive and requires specialized software to both extract, store, and search. Enter OpenCareData.com. Through our system you will be able to search through all machine readable files for a specified set of filters discussed below.
You can read more about the Transparency in Coverage final rule mandating the publication of this data here: https://www.cms.gov/healthplan-price-transparency/public-data
Data is published in a json format and is commonly referred to as a machine readable file. These files can range in size from a few kilobytes to a few terabytes. Insurance carriers can have any number of individual files (from a few hundred to tens of thousands). Here's a few example insurance carrier MRF download pages:
- BCBS of Texas: https://www.bcbstx.com/member/policy-forms/machine-readable-file
- BCBS of Louisiana: https://bcbsla.sapphiremrfhub.com/
- BCBS of Florida: https://www.floridablue.com/members/tools-resources/transparency/machine-readable-files
- BCBS of Arkansas: https://www.arkansasbluecross.com/interoperability/machine-readable-files
United Healthcare: https://transparency-in-coverage.uhc.com/
You'll notice quickly no single payer does it the same way. Some make it harder than others.
The MRF (machine readable files) are refreshed monthly. Our system automatically obtains and refreshes data as we see it released by the insurance carriers.
Performing Searches in OpenCare Data
In this guide we will walk you through searching for a specific billing code for a payer within OpenCareData. When you first logon you will be presented with a blank search dashboard.
Data Source: Select the payer you would like to search. Currently, as of 5/11/2023, we have the following payers:
Billing Code: A billing code is the five digit procedure code assigned to a specific service in the US Healthcare system.
Enter 99284 into the Code box
The code we will be using for our guide is 99284 which is for a Emergency Department Visit Level 4 (Moderate mdm)
Search: There are two "area" searching methods. Select the method you wish to search with
Geozip: An area defined by the first 3 digits of your zipcode. Rates will be displayed for all zipcodes starting with the specified 3 digits.
MSA (Metropolitan Statistical Area): A great description of this along with a tool you can use to lookup which MSA's you would like to search in by inputting a zipcode can be found on our main webpage here: https://opencaredata.com/MSALookup.aspx
An MSA typically consists of 3 or more Geozips and correlates to a specific high population-denisty geographic area as defined by the U.S. Office of Management & Budget. CMS relies upon MSA's in order to calculate QPAs (qualifying payment amounts) related to the new No Surprise Act regulations.
Group by NPI: Grouping by NPI is turned on by default and it is the way of aggregating your results data. When turned on all of the results value will group by the physician NPI and summarize the rate count, display high/low/average rate values, and show the median price broken out by the payer plan type (HMO/PPO/EPO/Etc)
Alternatively, if the grouping by NPI is turned off, this will show values groups be the payer type.
NPI Number: Select a specific provide NPI to search
Plan Name: Select a specific plan name to search. This search will assist your search by attempting to auto-complete from your input values
State: Select a specific state to search
Class: Specify the Class of rate you are wanting to search. This is the rate as defined by the insurance carriers in their respective machine readable files. Institutional rates tend to be more for healthcare facilities whereas professional rates are more for physicians and other providers.
Arrangement: Specify an Arrangement type. Many of our drop downs will provide a description of the values within as shown below (more coming soon!) FFS - Fee For Service is the most common arrangement type we have found within the MRFs.
Negotiation Type: Pick a Negotiation Type filter per the descriptions below. Note, combining negotiation types is not recommended as they do not follow the same payment methodologies. Negotiated is the most common filter type found in the MRF files.
Network Type: Pick a Network Type.
Taxonomy Code: Pick a Taxonomy Code. When you input a taxonomy code our system will attempt to filter rates down to only entities who have the specified taxonomy listed on their national provider identifier registration. This can be useful to limit your results to only providers in your specified specialty. The taxonomy code box allows for search by code or description
Exclude Taxonomies: This comma separated listing will allow you to enter in all of the taxonomies codes you do not want in your search results.
Finally, you are ready to search. You can do this by clicking the Search magnifying glass
Searches can take anywhere between 1 second and 45 seconds depending on the number of rates available for the insurance carrier and filters applied.
The top pane of the search results provides a quick statistical analysis of the returned rates. Note, Median, percentile, and Average rates are all based on the raw MRF data per the filters you have applied and may not accurately reflect the actual statistics. You may need to further refine your search.
Median = The value of the middle most rate within the result set. For the example result set below this would be the average of the 209th and 210th rate (rates sorted lowest to highest)
Average = The sum of all rates in the result set divided by the number of rates.
Percentile = The rate for which the specified percentage of rates fall.
The top two highest rates are also shown
The results data grid groups rates together and is presented in collapsed mode by default. Click the + next to each rate to see the providers who have the specified contracted rate. A providers NPI, Name, Phone number (per their NPI registration), and address is listed as shown below. You can use the Filter Results box to filter by any of these values.
Click the Excel or CSV button to export a complete listing of the results within the data grid
Contact OpenCare Data
We are always open to feedback! If you have any questions or suggestions please feel free to message the OpenCare Data Team via email at firstname.lastname@example.org.
Note: Most inquiries will be responded to within 48 hours.