Overview

The Commercial Payer Rates Data allows an analyst to uncover numerous insights into commercial payer rates across all 50 states. In sum, the data in the spreadsheet includes:

• Pricing from all major commercial insurers - this amounts to ~ 170 million lives, which represents 95% of commercial coverage
• More than ten thousand insurance plans
• Three-and-a-half million providers and organizations
• The ability to sort the data by:
  • 47,625 CPT codes
  • 76,315 HCPCS codes
  • 893 MS-DRG codes

Since this data is publicly available, why is this a Trella Health product?

Answer - The original data file is massive and requires careful analytics to organize the data into an easily accessible format for use.

Customers who have purchased the Payer Rates data will receive this data directly from Trella Health via Snowflake share or in a huge number of .csv files. (We strongly suggest using the Snowflake option.) The data will be sent quarterly with each data release. If you need assistance with getting the data, make contact with your Trella Health customer success manager.

In this article

• Understanding the metrics
• Use cases

Understanding the metrics

The data includes the following metrics. Definitions for each metric are on the right side of the table.

Use Cases

What to look for

This list of example strategies is not comprehensive. There is a lot of data and many ways to view it.

Since these examples depend on filtering and sorting, the metric names are identified in bold color.

• Compare rates by code for a selected payer across all providers - see where you rank
  • Select a specific Payer
  • Choose a specific billing code
• Identify new payers to partner with on favorable rates
  • Filter to your NPI State or County
  • Choose a specific billing code
  • Sort by Max Negotiated Rate - lowest to highest
• Identify which adjacent products have strong rates from a payer you are already contracted with
  • Select a specific Payer that you are contracted with
  • Choose a specific billing code or billing codes of interest
  • Sort by Max Negotiated Rate - highest to lowest
• Identify which markets have favorable rates by analyzing commercial payers.
  • Sort by Max Negotiated Rate - highest to lowest
  • The payers with the highest rates will be at the top. You can browse or sort further by payer or State/County
• And much more. 

Using Excel Filters - for users of the .csv files.

Familiarity with working in a spreadsheet is a prerequisite for examining the payer rates data. The files are enormous, and includes millions of records.

The most important setting for examining this spreadsheet is to make sure that the "Sort and Filter" filter is turned on for the spreadsheet. You can tell if the filters are on by looking at the top row of cells to see if each cell has the filter dropdown.

If you do not see the filter drop down, follow the steps below to turn them on.

Select all cells - Above the A1 cell and to the left is a button that has a triangle in it. Click that triangle to select every row and column in the spreadsheet.

Turn Filters On - In the Ribbon menu, toward the right side, find the section, "Editing."
Click on "Sort and Filter." A dropdown selector will open.
Click on "Filter."
As shown in the image, after selecting all cells, you can use the key combination Ctrl+Shift+L

Your filters should be on!

Using Excel Filters

Excel filters are powerful tools. You can filter and sort by multiple columns. When you click on the filter dropdown at the right side of any cell, a shortcut menu opens.
Sort - A single click will sort the table by the entries in the column
Select - You can easily select a single entry by which you want to filter all of the data in the spreadsheet. The example to the right is from the column of billing codes.
To select all entries or deselect all entries, click the (Select All) option. This option is always at the top of the list. Once you deselect all, you can choose a single or multiple billing codes.