Question 1

What is healthcare price transparency data?

Accepted Answer

Healthcare price transparency data is the set of negotiated rates between health insurers and healthcare providers, made public under federal regulation. These are contractually agreed prices — not chargemaster list prices — though actual payments can vary with plan terms and billing circumstances. DeductibleData extracts and delivers this data in clean, structured form.

Question 2

What is the Transparency-in-Coverage Rule?

Accepted Answer

The Transparency-in-Coverage (TiC) Rule is a federal regulation from HHS, Treasury and Labor (26 CFR Part 54, 29 CFR Part 2590, 45 CFR Part 147) requiring health insurers to publish their negotiated rates with providers. Since July 2022 insurers must publish Machine Readable Files (MRFs) covering in-network rates and out-of-network allowed amounts. A separate prescription drug file is required but enforcement is deferred and the specification is unfinished; some drug pricing does appear inside the in-network files via NDC codes.

Question 3

What are Machine Readable Files (MRFs)?

Accepted Answer

Machine Readable Files are the standardized data files that health insurers publish to comply with the TiC Rule. They contain negotiated rates in JSON format. Individual files can exceed 100GB, with a single payer's complete dataset reaching terabytes. The nested JSON structure, thousands of files per payer, and sheer scale make them impractical to process without specialized cloud infrastructure and engineering. DeductibleData handles this complexity and delivers only the data you need.

Question 4

What is Schema 2.0 and how does it affect the data?

Accepted Answer

Schema 2.0 is the current data format for Machine Readable Files, enforced since February 2, 2026. It requires a business_name alongside every EIN, consolidates billing code types, adds APR-DRG severity levels, and moves provider groups to inline-only format. Extractions from Schema 2.0 files carry richer and more consistent provider identification than earlier vintages.

Question 5

Is healthcare price transparency data HIPAA protected?

Accepted Answer

No. MRF data contains zero patient information. The TiC Rule specifically requires disclosure of negotiated rates, which are contractual prices between insurers and providers. The data includes provider business identifiers (NPI, TIN) that are already public information. There is no Protected Health Information (PHI) in any of our deliverables.

Question 6

What is the difference between in-network and out-of-network rates?

Accepted Answer

In-network rates are the negotiated prices that insurers have agreed to pay contracted providers — typically lower than list prices. Out-of-network allowed amounts reflect historical payments insurers have made for services from non-contracted providers during a rolling 90-day period, often based on Medicare rates, usual and customary charges, or plan-specific methodologies. DeductibleData primarily provides in-network negotiated rate data from MRF files.

Question 7

How does price transparency data compare to claims data?

Accepted Answer

Price transparency data shows the rates an insurer has agreed to pay. Claims data shows what was actually billed and paid for specific encounters. TiC data is public and covers every contracted rate; claims data is proprietary and limited to actual utilization. They answer different questions — TiC is broader, claims captures real-world volume.

Question 8

Who uses healthcare price transparency data?

Accepted Answer

Healthcare consultants, hospital systems, health tech companies, researchers, employers, benefits advisors, and litigators — anyone who needs to know what a payer pays for a service and cannot get it from claims data.

Question 9

What makes DeductibleData different from downloading MRFs myself?

Accepted Answer

Scale. A single payer's MRF data can span thousands of files and terabytes of nested JSON, and processing it takes cloud infrastructure, specialized parsing, cross-file joins, and normalization. That pipeline already exists here. You specify payers, providers and billing codes; we deliver structured data ready for analysis, with no infrastructure on your end.

Question 10

Can DeductibleData serve as the data backend for my product or platform?

Accepted Answer

Yes. If you are building a cost estimator, a plan comparison tool, or anything that needs payer negotiated rate data, we can provide ongoing feeds scoped to your specification, delivered as CSV or Parquet on your update cadence. Contact us to discuss integration.

Question 11

Is this data useful for small or independent group practices?

Accepted Answer

Yes, and you do not need a data team. Configure a targeted pull — your payers, your billing codes, your geography — and check out with a credit card. Small practices usually have focused needs, and a targeted pull costs far less than a broad extraction and can complete in hours.

Question 12

How do I check whether the rates a payer is offering me match what they pay comparable providers?

Accepted Answer

This is one of the most common reasons providers purchase TiC data. Negotiated rate data gives you the factual record of what a payer is actually paying other providers in your area for the same billing codes — published by that payer under federal requirement. It tells you where you sit relative to that record. It does not tell you what you should be paid, and we take no position on what any rate ought to be: we are not a party to your contract and we are not anyone's advocate. What the data does is let you enter a negotiation with documented benchmarks instead of a characterization of the market.

Question 13

Can I use negotiated rate data to push back on what my insurance company is telling me?

Accepted Answer

This is one of the most common reasons providers purchase TiC data. Negotiated rate data gives you the factual record of what a payer is actually paying other providers in your area for the same billing codes — published by that payer under federal requirement. It tells you where you sit relative to that record. It does not tell you what you should be paid, and we take no position on what any rate ought to be: we are not a party to your contract and we are not anyone's advocate. What the data does is let you enter a negotiation with documented benchmarks instead of a characterization of the market.

Question 14

Is this data useful for behavioral health practices?

Accepted Answer

Yes. Behavioral health has some of the widest gaps between what payers describe as market rates and what they pay comparable providers, and parity law requires commercial insurers to cover behavioral health comparably to medical and surgical services — negotiated rate data is one of the few independent ways to check that. Therapy codes (90832, 90834, 90837, 90847), psychiatric evaluation (90791) and medication management (99213–99215) are all well represented in commercial MRF data.

Question 15

What payers do you have data for?

Accepted Answer

More than thirty commercial payers, national and regional, including Blue Cross Blue Shield plans, UnitedHealthcare, Aetna and Anthem. The list changes as we process new sources and as publishers change what they publish, so the current list is the one the site resolves at quote time rather than a roster on this page. Availability and vintage differ by payer; a quote tells you the asOf date and whether that payer is deliverable today.

Question 16

Do you have Medicare or Medicaid rates?

Accepted Answer

DeductibleData focuses on commercial payer negotiated rates published under the Transparency-in-Coverage Rule. Medicare and Medicaid rates are set by CMS and published through separate channels (Medicare Physician Fee Schedule, OPPS, IPPS). Our data captures what commercial insurers like UnitedHealthcare, BCBS, and Aetna pay providers — which is often significantly different from government rates and is the data most consultants and hospital systems need for contract benchmarking.

Question 17

Do you have historical pricing data?

Accepted Answer

Yes. We retain data from previous MRF publications, allowing you to analyze rate trends over time. Since insurers have been publishing MRFs since July 2022, we can provide data going back to the earliest available publications for payers we've processed. Contact us with your specific time range requirements.

Question 18

How current is the data?

Accepted Answer

Insurers are required to publish MRF data monthly under federal regulation, but publication schedules differ by payer, and the vintage we hold for a payer can lag its publisher. Rather than promise a refresh window, we make the vintage checkable. Every price quote returns an asOf date — the published file set that quote was computed against — and a validUntil date, after which we stop treating the quote as good. Where a payer publishes unsigned files and makes no expiry claim, validUntil is null and we say so rather than implying an open-ended price. If a payer’s published files cannot currently be fetched, the quote is marked not deliverable and we block checkout: we do not sell a corpus our own freshness check says we cannot retrieve. The same contract, including a worked example of a payer we currently cannot deliver, is published for machine callers at deductibledata.com/llms.txt.

Question 19

What happens if a payer's files can't be fetched?

Accepted Answer

The quote still computes, but it is marked not deliverable and checkout is blocked. Payer files sit behind signed URLs that expire, and a publisher’s batch label can read current while its signed access has lapsed — so a fresh-looking date is not proof the data can be retrieved. We test retrievability, not the label, and we do not sell a corpus our own freshness check says we cannot retrieve. A payer can come back: when the publisher re-signs and we re-walk the file set, it becomes deliverable again.

Question 20

What format is the data delivered in?

Accepted Answer

CSV for most requests — compatible with Excel, Google Sheets, Python, R and SQL tools. Parquet via cloud storage for extractions beyond Excel's ~1 million row limit. Both ship with documentation for every field.

Question 21

How large will my data deliverable be?

Accepted Answer

It depends on your filters. A targeted pull for specific NPIs and codes from one payer is often under 1GB; one payer with all providers and all codes can produce terabytes. The calculator shows the estimated size alongside the price before you buy.

Question 22

How long does delivery take?

Accepted Answer

Delivery takes hours to 7 business days depending on data volume, with targeted requests completing fastest. Small, targeted requests (under 10GB) typically complete within hours. Medium requests take 1-3 business days. Very large extractions covering all providers and all codes for a major payer can take 3-7 business days due to the scale of processing. You'll receive email notifications with progress updates throughout.

Question 23

Can I filter by provider type or geographic area?

Accepted Answer

Yes, you can filter by provider type (hospitals, physician groups, individual practitioners) and geographic area, in addition to NPI and billing code filters. You can also provide specific facility names or NPI lists for targeted extractions. Contact us with your requirements for a custom quote.

Question 24

Do you offer claims volume data alongside negotiated rates?

Accepted Answer

Our product is TiC negotiated rate data — what insurers have agreed to pay. Volume and utilization come from 835/837 claims data, which is proprietary and sold by specialist resellers, not published under the TiC rule. If you need both, contact us and we will scope what is possible.

Question 25

What happens if my data processing job fails?

Accepted Answer

We monitor every job and are notified immediately if an issue occurs. In most cases, we can resume processing from where it left off. You won't be charged for incomplete deliveries, and we'll keep you informed via email until your data is ready for download.

Question 26

How do I access my data after the job is complete?

Accepted Answer

Once your job is complete, you'll receive an email notification. Log in to your account dashboard, find the completed job, and click Download. The file is delivered as a CSV (or Parquet for large extractions) that you can open in Excel, Google Sheets, Python, R, or any data tool. Download the file to your local storage promptly — download links expire after a limited window.

Question 27

Can I share the data file with colleagues or my billing team?

Accepted Answer

Yes. The downloaded CSV or Parquet file is yours to use and share internally. There are no restrictions on sharing it within your organization — including with billing staff, practice managers, or consultants you've engaged. Our Terms of Service prohibit reselling or redistributing the raw data to third parties, but internal use is unrestricted.

Question 28

How is DeductibleData pricing calculated?

Accepted Answer

Price is driven mainly by how much published data your selection has to be computed against — the payer's file footprint is the dominant factor, and it differs by an order of magnitude between a regional plan and a national one. Narrower provider and billing-code filters reduce cost, and a flat per-pull platform fee applies. Because the payer you pick matters more than the number of codes you pick, the price can change a lot between two selections that look similar. The calculator on our custom data pull page shows your exact price as you configure, before checkout and before any account. There are no hidden fees — everyone gets the same pricing regardless of company size.

Question 29

What billing codes can I filter by?

Accepted Answer

Fifteen billing code types, including CPT, HCPCS, MS-DRG, NDC, revenue codes, CDT, APC, AP-DRG, APR-DRG and ICD.

Question 30

What is an NPI number and how do I use it to filter data?

Accepted Answer

An NPI (National Provider Identifier) is a unique 10-digit number assigned to every healthcare provider in the United States. Type 1 NPIs identify individual practitioners (doctors, nurses, therapists). Type 2 NPIs identify organizations (hospitals, clinics, group practices). You can search by name or NPI number on our custom data pull page to filter your extraction to specific providers.

Question 31

Can I get a subscription for recurring data updates?

Accepted Answer

Yes. Subscriptions are available monthly, quarterly, or bi-annually, delivering data refreshes on your chosen schedule — each computed against the payer’s then-current published file set. This is ideal for ongoing market monitoring, competitive analysis, or maintaining current pricing databases.

Question 32

Can DeductibleData host my data for team access?

Accepted Answer

Yes. For large datasets, we can provide hosted query access where your team can search and extract specific slices without downloading the entire file. This is ideal for organizations that need collaborative access or don't have the infrastructure to store terabytes locally. Contact us to set up hosted access.

Question 33

How do I know which billing codes to include in my data pull?

Accepted Answer

Start with the CPT or HCPCS codes you bill most often.

Question 34

How do I know which payers to include in my data pull?

Accepted Answer

Start with the insurers that carry the largest share of your patient volume or contract portfolio — for most practices and consultants that is a handful of commercial payers plus whichever Blues plan is dominant in your geography. You can add multiple payers to one pull, and the picker will tell you if a payer cannot currently be delivered. Medicaid managed care plans publish under different names by state; contact us if you need help matching them.

Question 35

Can I see the price before committing to a purchase?

Accepted Answer

Yes, and if the number surprises you, narrow it. The calculator on our custom data pull page shows your exact cost before checkout with no account required — and filtering to specific NPIs instead of a whole geography or taxonomy usually drops the price by an order of magnitude. Configure your payers, providers and billing codes and the price updates in real time. There is no minimum commitment, no sales call and no waiting for a quote.

Question 36

What if a payer is not paying me what their published negotiated rate says they should?

Accepted Answer

Published MRF rates are the contractually negotiated prices payers are required to disclose and, in principle, honor. If you are receiving payments below the published rate for a billing code, the gap is documentable.

The data alone does not establish underpayment — actual payment amounts come from your practice management system or EOBs, not the MRF — and we do not adjudicate the question or appear on either side of it. What the combination gives you is a factual basis your counsel or auditor can work from.

Contact us if you need data scoped for a payment audit or litigation support.

Question 37

How does DeductibleData pricing compare to other TiC data vendors?

Accepted Answer

DeductibleData starts at $75 for a one-time data pull — one payer, one provider, one billing code — with self-serve credit card checkout and no contract required, and you see your exact price before creating an account. Serif Health publishes no pricing page; Turquoise Health lists plan tiers with no prices and a demo request on every tier. Most other vendors in this space do not disclose pricing and require sales calls and annual commitments. Among the vendors compared here, DeductibleData is the only one with transparent, self-serve pricing for MRF negotiated rate data.

Question 38

Why doesn't DeductibleData require a demo or sales call?

Accepted Answer

Our product is self-explanatory and our pricing is transparent. You configure exactly what you need — payers, providers, billing codes — on our custom data pull page, see the price in real time, and check out with a credit card.

No scoping call, no contract negotiation, no waiting for a quote. Most vendors in this space require demos because their pricing is opaque and varies by customer. We believe if you can't show your price, you're not confident in it.

Question 39

What is the difference between pay-per-pull and an annual contract?

Accepted Answer

Pay-per-pull means you pay only when you need data, with no minimum commitment and no lock-in. Annual contracts, which most vendors in this space require, lock you into a fixed payment regardless of how much data you actually use. DeductibleData offers both one-time purchases and optional subscriptions (monthly, quarterly, or bi-annual), but subscriptions are opt-in — you're never required to commit upfront.

Question 40

How does DeductibleData differ from platforms like Turquoise Health or Serif Health?

Accepted Answer

Three key differences: price, access model, and focus. Price: DeductibleData starts at $75 for a one-time pull (one payer, one provider, one billing code), with no contract, and the price is published before you buy. Serif Health publishes no pricing page; Turquoise Health lists plan tiers with no prices. Access: among the vendors compared here, DeductibleData is the only one with self-serve credit card checkout — no demo, no sales call, no contract. Focus: we deliver clean, filtered negotiated rate data scoped to your exact specifications, rather than bundling it into a broad compliance or analytics platform. If you need specific MRF rate data without the overhead of an enterprise platform, we're built for that.

Question 41

What is the difference between MRF pricing data and claims data?

Accepted Answer

MRF data contains contracted negotiated rates — the prices insurers have agreed to pay providers, published under the Transparency-in-Coverage Rule. This is what DeductibleData provides. Claims data (835/837 transactions) shows what was actually billed and paid per patient encounter, including procedure volume and utilization patterns. Claims data is proprietary and not publicly available. The two are complementary: MRF data tells you the price, claims data tells you the volume. If you need both pricing and volume, contact us and we'll scope what's possible for your request.

Question 42

Is DeductibleData's lower price because the data quality is lower?

Accepted Answer

No. Every vendor in this space pulls from the same source: the Machine Readable Files that health insurers are federally required to publish under the TiC Rule. The provider IDs, billing codes, negotiated rates, and payer metadata are identical regardless of who processes them. DeductibleData's lower price reflects our business model — automated pipeline, no enterprise sales team, no venture capital overhead — not a difference in data quality.

Question 43

What is Explore?

Accepted Answer

Explore is an AI research interface included with every completed job. Ask questions about your extracted dataset in plain English — no SQL, no download — and it runs the query and answers with the supporting numbers.

Question 44

What can I query with Explore?

Accepted Answer

Explore queries your delivered dataset in plain English, whatever its size — a completed job can run from a few hundred rows to billions, and Explore works the same way at both ends. Common queries include: comparing negotiated rates across payers for the same billing code, finding the highest and lowest paying insurers for a specific procedure, benchmarking rates at a target hospital against regional peers, identifying billing codes where rates are outliers, and summarizing rate distributions by provider type or geography. Explore is designed for the kinds of questions healthcare consultants, analysts, and litigators ask when evaluating payer contracts.

Question 45

Who can access Explore?

Accepted Answer

Explore is available to all users — no additional subscription required. It is accessible directly from any completed job in your account dashboard. There is no paywall or demo requirement to use it.

Question 46

Is there a limit on how many questions I can ask?

Accepted Answer

Yes. Each job includes up to 20 Explore queries. This limit is enforced server-side and resets per job — not per account. Most analyses are completable within 20 focused questions. If you need to run an extended research session, you can initiate a new data pull job to reset your query count.

Question 47

Does Explore require me to know SQL or programming?

Accepted Answer

No. Explore accepts plain English questions. The underlying system generates and executes the necessary database queries on your behalf. You describe what you want to know; Explore figures out how to retrieve it.

Question 48

Can I analyze my data without downloading the file?

Accepted Answer

Yes. Every completed job includes access to Explore, our AI-powered research interface. You can ask natural language questions directly against your dataset — 'What's the average negotiated rate for CPT 90837 across my payers?' or 'Which payer pays the most for family therapy?' — and get answers without downloading or opening the file. This is particularly useful for quick lookups, sharing findings verbally, or when you want to explore the data before deciding whether a full download is needed.

Question 49

What data source does DeductibleData use to build its NPI index?

Accepted Answer

DeductibleData builds its provider index from the NPPES (National Plan and Provider Enumeration System) registry, maintained by CMS. NPPES is the authoritative federal database of all healthcare providers assigned National Provider Identifiers. CMS publishes a full monthly replacement file and a separate monthly deactivation file. As of March 2026, CMS has migrated to Version 2 of the downloadable files; we use Version 2 as the current standard.

Question 50

How does DeductibleData determine whether an NPI is active?

Accepted Answer

An NPI is treated as active if it exists in the current NPPES registry and does not appear in the CMS monthly deactivation file. The four official deactivation reason codes we screen against are:

DT — Death
DB — Disbandment (organization dissolved)
FR — Fraud
OT — Other (retirement, no longer practicing, etc.)

NPIs flagged with any of these codes are excluded from our provider index.

Question 51

Does DeductibleData cross-reference NPIs against federal exclusion lists?

Accepted Answer

Yes. Our NPI index is cross-referenced against two federal exclusion databases:

OIG LEIE (List of Excluded Individuals/Entities, HHS) — individuals and entities excluded from participating in Medicare, Medicaid, and federal healthcare programs due to fraud, patient abuse, or program-related crimes. Updated monthly.
SAM.gov exclusions (GSA) — government-wide debarments including procurement fraud, tax delinquency, and national security violations. Broader than healthcare-specific exclusions. Note: SAM.gov does not use NPI records, so provider matching relies on name and EIN.

Providers appearing on either list are flagged in our dataset. A clean record on one list does not guarantee a clean record on the other — both are checked independently.

Question 52

What types of providers are included in or excluded from the NPI index?

Accepted Answer

Our index includes all Type 1 (individual) and Type 2 (organizational) NPIs that are active in NPPES, not flagged for deactivation, and not listed on OIG LEIE or SAM.gov. We do not limit by provider taxonomy — the index spans physicians, hospitals, ambulatory surgery centers, group practices, therapy providers, and all other NPI-holding entities. Deactivated, excluded, or fraudulently registered NPIs are excluded.

Question 53

How often is the NPI index updated?

Accepted Answer

We do not promise a refresh window for the NPI index. CMS publishes the NPPES replacement and deactivation files monthly and HHS updates the OIG LEIE monthly, but the cadence of a federal publisher is not a promise about ours — a rebuild can fail or lag. Provider status — active, deactivated, or excluded — reflects the last successful rebuild of our NPI index, not today’s federal data. If provider status has to be current as of a particular date for your use, contact us before you purchase.

Question 54

What compliance checks does DeductibleData perform on its data?

Accepted Answer

DeductibleData cross-references its NPI index against three public federal databases:

NPPES active NPI file (CMS) — provider deactivation status
OIG LEIE (HHS) — exclusion from federal healthcare programs
SAM.gov (GSA) — government-wide federal debarment

These cross-references are applied when the NPI index is rebuilt, not at the moment you order. The result reflects the last successful rebuild of the index rather than a live federal lookup, and we do not promise a rebuild cadence.

We do not independently verify the accuracy of the underlying negotiated rates. Those are published directly by payers under the Transparency-in-Coverage Rule and delivered as reported. Payer-reported rates are contractually negotiated prices and may not reflect actual payment amounts in every case.

Question 55

Can TiC negotiated rate data be used in litigation?

Accepted Answer

TiC negotiated rate data has been used as evidence in healthcare billing disputes, underpayment cases, and payer contract litigation. The data is payer-reported under federal regulatory mandate — a primary source for establishing contracted rates.

Important caveats:

Published negotiated rates are contracted amounts, not guaranteed payment amounts — actual payments may vary based on plan terms and billing circumstances
Rates in MRF files are payer-reported and have not been independently audited
The legal weight of TiC data in any specific case depends on jurisdiction, claim type, and how the data is introduced as evidence

Use of this data in litigation or compliance proceedings should involve qualified legal counsel.

Question 56

Does using TiC rate data for benchmarking raise antitrust concerns?

Accepted Answer

No — analyzing publicly mandated TiC data for benchmarking and contract negotiation is not an antitrust violation. The TiC Rule specifically requires payers to publish these rates; using them is the intended purpose of the regulation.

Antitrust risk in healthcare pricing data applies to payers coordinating rates using shared algorithms or intermediaries — not to analysts, consultants, or providers consuming publicly available rate data. The DOJ has specifically addressed algorithmic price coordination among insurers (see ongoing MultiPlan litigation), but that concern is about payer behavior, not data consumers.

If you have specific antitrust questions about your use case, consult qualified legal counsel.

Question 57

Does DeductibleData check providers against state Medicaid exclusion lists?

Accepted Answer

Not currently. Every U.S. state maintains its own Medicaid exclusion list, separate from both the federal OIG LEIE and SAM.gov. A provider can be excluded from a state Medicaid program without appearing on either federal list. Our current compliance checks cover the two federal exclusion databases (OIG LEIE and SAM.gov) and the NPPES deactivation file. If your use case requires state-level Medicaid exclusion screening, we recommend supplementing our data with a specialized exclusion monitoring service.

	DeductibleData	Serif Health	Turquoise Health
Published price	Yes — $75 one-time, shown before you buy	No pricing page	Plan tiers listed, no prices
Buy online without talking to sales	Yes — credit card checkout	No	No
See your exact price before signing up	Yes — quote any scope, no account needed	Sample data after sign-up	Free Out-of-Network Pricer

Frequently Asked Questions

About Healthcare Price Transparency