Peer Service Lines Export
Data Dictionary
Service-line benchmarks comparing your rates against a defined peer set.
Column added or derived by Serif Health
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Rollup, Entity & Network
- The level in which the underlying data is being aggregatedMethodology: For each provider, the aggregation summary is defined as follows:
- provider_level_rollup_report: Aggregation across all codes, service categories / subcategories, and payer networks selected
- provider_code_level_rollup_report: Code-level aggregation across all payer networks selected
- provider_serviceCategory_level_rollup_report: Service Category-level aggregation across all payer networks selected
- provider_serviceCategory_subcategory_level_rollup_report: Service Subcategory-level aggregation across all payer networks selected
- provider_network_level_rollup_report: Payer network-level aggregation across all codes and service categories / subcategories selected
- provider_network_code_level_rollup_report: Payer-network level aggregation for each code selected
- provider_network_serviceCategory_level_rollup_report: Payer-network level aggregation for each service category selected
- provider_network_serviceCategory_subcategory_level_rollup_report: Payer-network level aggregation for each service subcategory selected
- Will be a 9 digit un-hyphenated EIN or a 10 digit NPI number, each payer may use either format. EINs can be zero-led so this must be a text field
- The name (EIN name or Provider Group name) of the organization, practice group, or provider that was resolvedMethodology: EIN names come from NPPES as well as proprietary and public sources like EDGAR filings, IRS notices, legal filings, etc.Provider Group names are named by users within the platform
- Full payer name, e.g. “Blue Cross Blue Shield of Alabama”
- Full network name where delineated by payer MRF index, e.g. “Blue Choice Platinum for Business - PPO”Methodology: We keep the plan_name indicated in the table of contents file if fully defined; if not or ambiguous we may use web searches or other sources to identify the plan name
Code & Service Line
- The specific service being pricedMethodology: Normalized billing code to be zero-led and hyphens removed. MS-DRG will always be three characters, RC 4 characters, APR DRG 4 characters.Note: If a custom code has been crosswalked to another code by Serif Health (e.g., EMR3 —> 99283), the crosswalked code will show up in this field
- Grouping of codes created by Serif Health to allow users to review pricing trends across service linesMethodology: Code groupings were created based on review of claims records, published literature, customer feedback, and other relevant sources
- Sub-grouping of codes created by Serif Health to allow users to review pricing trends across service linesMethodology: Code groupings were created based on review of claims records, published literature, customer feedback, and other relevant sources
- Number of codes being aggregated for a given row
- Number of records being aggregated for a given row
Maximum Rate
- Maximum rate across records being evaluated in the row
- Maximum baseline rate across records being evaluated in the rowMethodology: We update our baseline rate tables annually or quarterly by pulling the tables directly from CMS
- Maximum percent of baseline across records being evaluated in the rowMethodology: Percent of baseline is the ratio of the rate divided by the baseline. When the baseline is a CMS-dictated dollar payment amount, this column represents "percent of CMS" for the relevant baseline schedule. When the baseline is a weight, this column represents a "base rate" commonly used for negotiating inpatient or anesthesia pricing
- Result when selecting "Select Rates By" = Maximum Rate and "See Results By" = AverageMethodology: "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology.
- Result when selecting "Select Rates By" = Maximum Rate and "See Results By" = ModeMethodology: "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology.
- Result when selecting "Select Rates By" = Maximum Rate and "See Results By" = MedianMethodology: "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology.
- Result when selecting "Select Rates By" = Maximum Rate and "See Results By" = Weighted AverageMethodology: "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology.
Minimum Rate
- Minimum rate across records being evaluated in the row
- Minimum baseline rate across records being evaluated in the rowMethodology: We update our baseline rate tables annually or quarterly by pulling the tables directly from CMS
- Minimum percent of baseline across records being evaluated in the rowMethodology: Percent of baseline is the ratio of the rate divided by the baseline. When the baseline is a CMS-dictated dollar payment amount, this column represents "percent of CMS" for the relevant baseline schedule. When the baseline is a weight, this column represents a "base rate" commonly used for negotiating inpatient or anesthesia pricing
- Result when selecting "Select Rates By" = Minimum Rate and "See Results By" = AverageMethodology: "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology.
- Result when selecting "Select Rates By" = Minimum Rate and "See Results By" = ModeMethodology: "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology.
- Result when selecting "Select Rates By" = Minimum Rate and "See Results By" = MedianMethodology: "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology.
- Result when selecting "Select Rates By" = Minimum Rate and "See Results By" = Weighted AverageMethodology: "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology.
Most NPIs
- Rate associated with largest npi_list_length across records in the rowMethodology: See our payer data dictionary for more details on npi_list_length
- Baseline associated with largest npi_list_length across records in the rowMethodology: We update our baseline rate tables annually or quarterly by pulling the tables directly from CMS
- Percent of baseline associated with largest npi_list_length across records in the rowMethodology: Percent of baseline is the ratio of the rate divided by the baseline. When the baseline is a CMS-dictated dollar payment amount, this column represents "percent of CMS" for the relevant baseline schedule. When the baseline is a weight, this column represents a "base rate" commonly used for negotiating inpatient or anesthesia pricing
- Result when selecting "Select Rates By" = Most NPIs and "See Results By" = AverageMethodology: "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology.
- Result when selecting "Select Rates By" = Most NPIs and "See Results By" = ModeMethodology: "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology.
- Result when selecting "Select Rates By" = Most NPIs and "See Results By" = MedianMethodology: "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology.
- Result when selecting "Select Rates By" = Most NPIs and "See Results By" = Weighted AverageMethodology: "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology.
| Column | Description | Methodology |
|---|---|---|
| Rollup, Entity & Network | ||
| rollup_level | The level in which the underlying data is being aggregated | For each provider, the aggregation summary is defined as follows:
|
| ein | Will be a 9 digit un-hyphenated EIN or a 10 digit NPI number, each payer may use either format. EINs can be zero-led so this must be a text field | — |
| name | The name (EIN name or Provider Group name) of the organization, practice group, or provider that was resolved | EIN names come from NPPES as well as proprietary and public sources like EDGAR filings, IRS notices, legal filings, etc.Provider Group names are named by users within the platform |
| payor_name | Full payer name, e.g. “Blue Cross Blue Shield of Alabama” | — |
| network_name | Full network name where delineated by payer MRF index, e.g. “Blue Choice Platinum for Business - PPO” | We keep the plan_name indicated in the table of contents file if fully defined; if not or ambiguous we may use web searches or other sources to identify the plan name |
| Code & Service Line | ||
| code | The specific service being priced | Normalized billing code to be zero-led and hyphens removed. MS-DRG will always be three characters, RC 4 characters, APR DRG 4 characters.Note: If a custom code has been crosswalked to another code by Serif Health (e.g., EMR3 —> 99283), the crosswalked code will show up in this field |
| code_service_category | Grouping of codes created by Serif Health to allow users to review pricing trends across service lines | Code groupings were created based on review of claims records, published literature, customer feedback, and other relevant sources |
| code_service_subcategory | Sub-grouping of codes created by Serif Health to allow users to review pricing trends across service lines | Code groupings were created based on review of claims records, published literature, customer feedback, and other relevant sources |
| code_count | Number of codes being aggregated for a given row | — |
| number_of_records | Number of records being aggregated for a given row | — |
| Maximum Rate | ||
| rate_max | Maximum rate across records being evaluated in the row | — |
| rate_max_baseline | Maximum baseline rate across records being evaluated in the row | We update our baseline rate tables annually or quarterly by pulling the tables directly from CMS |
| rate_max_percent_of_baseline | Maximum percent of baseline across records being evaluated in the row | Percent of baseline is the ratio of the rate divided by the baseline. When the baseline is a CMS-dictated dollar payment amount, this column represents "percent of CMS" for the relevant baseline schedule. When the baseline is a weight, this column represents a "base rate" commonly used for negotiating inpatient or anesthesia pricing |
| rate_max_mean | Result when selecting "Select Rates By" = Maximum Rate and "See Results By" = Average | "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology. |
| rate_max_mode | Result when selecting "Select Rates By" = Maximum Rate and "See Results By" = Mode | "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology. |
| rate_max_median | Result when selecting "Select Rates By" = Maximum Rate and "See Results By" = Median | "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology. |
| rate_max_mean_weighted | Result when selecting "Select Rates By" = Maximum Rate and "See Results By" = Weighted Average | "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology. |
| Minimum Rate | ||
| rate_min | Minimum rate across records being evaluated in the row | — |
| rate_min_baseline | Minimum baseline rate across records being evaluated in the row | We update our baseline rate tables annually or quarterly by pulling the tables directly from CMS |
| rate_min_percent_of_baseline | Minimum percent of baseline across records being evaluated in the row | Percent of baseline is the ratio of the rate divided by the baseline. When the baseline is a CMS-dictated dollar payment amount, this column represents "percent of CMS" for the relevant baseline schedule. When the baseline is a weight, this column represents a "base rate" commonly used for negotiating inpatient or anesthesia pricing |
| rate_min_mean | Result when selecting "Select Rates By" = Minimum Rate and "See Results By" = Average | "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology. |
| rate_min_mode | Result when selecting "Select Rates By" = Minimum Rate and "See Results By" = Mode | "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology. |
| rate_min_median | Result when selecting "Select Rates By" = Minimum Rate and "See Results By" = Median | "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology. |
| rate_min_mean_weighted | Result when selecting "Select Rates By" = Minimum Rate and "See Results By" = Weighted Average | "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology. |
| Most NPIs | ||
| rate_largest_npi | Rate associated with largest npi_list_length across records in the row | See our payer data dictionary for more details on npi_list_length |
| rate_largest_npi_baseline | Baseline associated with largest npi_list_length across records in the row | We update our baseline rate tables annually or quarterly by pulling the tables directly from CMS |
| rate_largest_npi_percent_of_baseline | Percent of baseline associated with largest npi_list_length across records in the row | Percent of baseline is the ratio of the rate divided by the baseline. When the baseline is a CMS-dictated dollar payment amount, this column represents "percent of CMS" for the relevant baseline schedule. When the baseline is a weight, this column represents a "base rate" commonly used for negotiating inpatient or anesthesia pricing |
| rate_largest_npi_mean | Result when selecting "Select Rates By" = Most NPIs and "See Results By" = Average | "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology. |
| rate_largest_npi_mode | Result when selecting "Select Rates By" = Most NPIs and "See Results By" = Mode | "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology. |
| rate_largest_npi_median | Result when selecting "Select Rates By" = Most NPIs and "See Results By" = Median | "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology. |
| rate_largest_npi_mean_weighted | Result when selecting "Select Rates By" = Most NPIs and "See Results By" = Weighted Average | "Select rates by" — the methodology the system uses to select a rate for a given EIN / code combination"See results by" — the methodology the system uses to display percent of baseline resultsSee HERE for more details on our methodology. |
See the data for yourself
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