How does the price transparency data differ from claims data?
Unlike claims data, the price transparency data comes from providers’ contracted fee schedules. To be as comprehensive as possible, payers often include all the codes included in a provider’s contract even if they may not ever utilize them. For example, a dentist may have orthopedic surgery codes in their fee schedule even though they may never perform a knee surgery. In the price transparency industry, we refer to these as “ghost rates” or “zombie rates.”
To address these “ghost rates” and “zombie rates,” Serif reviews utilization data at a NUCC taxonomy level to understand what codes different specialties have billed to claims. This is how we generate the column “is_billable” in the data to indicate where we have seen a taxonomy actually bill a given code.
For each NPI in the npi_list field, we consider two pieces of information to make the "is_billable" determination: (1) the npi's primary-taxonomy, (2) the npi's secondary-taxonomies.
You can see examples of an npi's primary and secondary taxonomies here:
The primary taxonomy is 'Critical Access Hospital' and the secondary taxonomies are 'General Acute Care Hospital', 'Skilled Nursing Facility', 'Ambulance', etc...
By default, Signal only returns results using 'balanced filtering' where Is_billable primary taxonomy is either 'TRUE' or 'UNDEFINED.' Per our data dictionary, this means each row returned has at least 1 npi in the npi_list that has a valid primary_taxonomy which has billed a given code.
However, you can adjust these filters to be more or less strict by toggling the following on / off inside the filters panel:
- Changing is_billable filter to 'maximum filtering' excludes results where there is no npi-taxonomy detail available to make a determination (i.e., excludes is_billable_primary_taxonomy = 'NULL')
- Changing is_billable filter to 'minimum filtering' includes results where an npi's seondary taxonomy is allowed to bill a code, even if there primary-taxonomy cannot (i.e., adds is_billable_secondary_taxonomy = 'TRUE')