Streamlined Workflow for Transparency in Coverage (TiC) Data Analysis
Installation
You can install the development version of defogger from GitHub with:
# install.packages("devtools")
devtools::install_github("andrewallenbruce/defogger")
# install.packages("remotes")
remotes::install_github("andrewallenbruce/defogger")Defogging Transparency in Coverage Files
The Transparency in Coverage Final Rule[^2] requires most group health plans and issuers of group or individual health insurance to disclose pricing information in the form of machine-readable files containing the following sets of costs for items and services:
- In-Network Rate File: Rates for all covered items and services between the plan or issuer and in-network providers.
- Allowed Amount File: Allowed amounts for, and billed charges from, out-of-network providers.
Usage
res <- httr2::request("https://transparency-in-coverage.uhc.com/api/v1/uhc/blobs/") |>
httr2::req_perform() |>
httr2::resp_body_json(check_type = FALSE,
simplifyVector = TRUE)
res$blobs |>
tibble::tibble() |>
dplyr::slice_tail() |>
dplyr::glimpse()
#> Rows: 1
#> Columns: 2
#> $ name <chr> "2023-01-01_totes-Isotoner_index.json"
#> $ downloadUrl <chr> "https://uhc-tic-mrf.azureedge.net/public-mrf/2023-01-01/2…
dl <- res$blobs |> tibble::tibble() |> dplyr::slice_tail()
dll <- httr2::request(dl$downloadUrl) |>
httr2::req_perform() |>
httr2::resp_body_json(check_type = FALSE, simplifyVector = TRUE)
dll$reporting_structure |>
tidyr::unnest(cols = c(reporting_plans, in_network_files)) |>
dplyr::glimpse()
#> Rows: 2
#> Columns: 6
#> $ plan_name <chr> "POS CHOICE PLUS", "POS CHOICE PLUS"
#> $ plan_id <chr> "310405270", "310405270"
#> $ plan_id_type <chr> "EIN", "EIN"
#> $ plan_market_type <chr> "group", "group"
#> $ description <chr> "in-network files", "in-network files"
#> $ location <chr> "https://uhc-tic-mrf.azureedge.net/public-mrf/2023-01…
dll$reporting_structure |>
tidyr::unnest(cols = c(reporting_plans, in_network_files)) |>
purrr::pluck("location", 1)
#> [1] "https://uhc-tic-mrf.azureedge.net/public-mrf/2023-01-01/2023-01-01_United-HealthCare-Services--Inc-_Third-Party-Administrator_PPO---NDC_PPO-NDC_in-network-rates.json.gz"
dll$reporting_structure |>
tidyr::unnest(cols = c(reporting_plans, in_network_files)) |>
purrr::pluck("location", 2)
#> [1] "https://uhc-tic-mrf.azureedge.net/public-mrf/2023-01-01/2023-01-01_United-HealthCare-Services--Inc-_Third-Party-Administrator_PS1-50_C2_in-network-rates.json.gz"
centene_toc_jun <- "https://www.centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-06-29_ambetter_index.json"
centene_toc_sep <- "https://www.centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-09-30_ambetter_index.json"
centene_toc_dec <- "https://www.centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_ambetter_index.json"
defog_toc(centene_toc_dec) |>
dplyr::select(!c(id,
plan_id_type,
plan_market_type,
entity)) |>
dplyr::slice_head() |>
dplyr::glimpse()
#> Rows: 1
#> Columns: 5
#> $ plan_name <chr> "Silver 87 Ambetter HMO "
#> $ plan_id <chr> "67138CA052"
#> $ rate_type <chr> "in_network"
#> $ location <chr> "http://centene.com/content/dam/centene/Centene%20Corporate/…
#> $ origin <chr> "https://www.centene.com/content/dam/centene/Centene%20Corpo…Out-of-Network Files
defog_toc(centene_toc_dec) |>
dplyr::filter(rate_type == "out_of_network") |>
dplyr::select(location) |>
dplyr::distinct() |>
tibble::deframe()
#> [1] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-ca_allowed-amounts.json"
#> [2] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-la_allowed-amounts.json"
#> [3] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-ky_allowed-amounts.json"
#> [4] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-ms_allowed-amounts.json"
#> [5] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-pa_allowed-amounts.json"
#> [6] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-wa_allowed-amounts.json"
#> [7] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-tn_allowed-amounts.json"
#> [8] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-mo_allowed-amounts.json"
#> [9] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-az_allowed-amounts.json"
#> [10] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-ok_allowed-amounts.json"
#> [11] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-nc_allowed-amounts.json"
#> [12] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-nh_allowed-amounts.json"
#> [13] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-sc_allowed-amounts.json"
#> [14] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-ne_allowed-amounts.json"
#> [15] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-nv_allowed-amounts.json"
#> [16] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-nj_allowed-amounts.json"
#> [17] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-nm_allowed-amounts.json"
#> [18] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-in_allowed-amounts.json"
#> [19] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-ga_allowed-amounts.json"
#> [20] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-il_allowed-amounts.json"
#> [21] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-ar_allowed-amounts.json"
#> [22] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-fl_allowed-amounts.json"
#> [23] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-ks_allowed-amounts.json"
#> [24] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-tx_allowed-amounts.json"
#> [25] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-oh_allowed-amounts.json"
#> [26] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-mi_allowed-amounts.json"
centene_oon <- defog_toc(centene_toc_dec) |>
dplyr::filter(rate_type == "out_of_network") |>
dplyr::select(location) |>
dplyr::distinct()
defog_oon(tibble::deframe(centene_oon[10, ])) |>
dplyr::select(npi, billing_code, name, allowed_amount, billed_charge) |>
knitr::kable()| npi | billing_code | name | allowed_amount | billed_charge |
|---|---|---|---|---|
| 1649794157 | 250 | PHARMACY | 713.41 | 43.25 |
| 1043260482 | 300 | LABORATORY | 256.32 | 651.00 |
| 1578704938 | 301 | LAB/CHEMISTRY | 707.77 | 1905.00 |
| 1649794157 | 301 | LAB/CHEMISTRY | 6312.15 | 10520.25 |
| 1649794157 | 301 | LAB/CHEMISTRY | 693.83 | 4166.00 |
| 1649794157 | 301 | LAB/CHEMISTRY | 6312.15 | 10520.25 |
| 1649794157 | 301 | LAB/CHEMISTRY | 693.83 | 4166.00 |
| 1144228487 | 301 | LAB/CHEMISTRY | 2070.71 | 4547.94 |
| 1164494027 | 301 | LAB/CHEMISTRY | 311.40 | 865.00 |
| 1164494027 | 301 | LAB/CHEMISTRY | 147.35 | 1320.00 |
| 1164494027 | 301 | LAB/CHEMISTRY | 311.40 | 865.00 |
| 1164494027 | 301 | LAB/CHEMISTRY | 147.35 | 1320.00 |
| 1376561944 | 301 | LAB/CHEMISTRY | 254.40 | 634.10 |
| 1144228487 | 636 | DRUG/DETAIL CODE | 114.97 | 732.38 |
| 1689337503 | 98940 | CHIROPRACT MANJ 1-2 REGIONS | 371.84 | 910.00 |
| 1659667798 | 98940 | CHIROPRACT MANJ 1-2 REGIONS | 1832.40 | 3900.00 |
| 1740207646 | A0425 | GRND MLGE PER STATUTE MILE | 123.69 | 361.00 |
| 1234567893 | E2402 | NEG PRSS WND TX PUMP STATN | 664.95 | 2407.90 |
| 1234567893 | S9502 | HIT ABX ANTIVIRL/ANTIFUNGAL; | 240.00 | 3696.18 |
In-Network Files
defog_toc(centene_toc_dec) |>
dplyr::filter(rate_type == "in_network") |>
dplyr::select(location) |>
dplyr::distinct() |>
tibble::deframe()
#> [1] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-ca_in-network.json"
#> [2] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-la_in-network.json"
#> [3] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-ky_in-network.json"
#> [4] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-ms_in-network.json"
#> [5] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-pa_in-network.json"
#> [6] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-wa_in-network.json"
#> [7] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-tn_in-network.json"
#> [8] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-mo_in-network.json"
#> [9] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-az_in-network.json"
#> [10] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-ok_in-network.json"
#> [11] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-nc_in-network.json"
#> [12] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-nh_in-network.json"
#> [13] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-sc_in-network.json"
#> [14] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-ne_in-network.json"
#> [15] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-nv_in-network.json"
#> [16] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-nj_in-network.json"
#> [17] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-nm_in-network.json"
#> [18] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-in_in-network.json"
#> [19] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-ga_in-network.json"
#> [20] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-il_in-network.json"
#> [21] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-ar_in-network.json"
#> [22] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-fl_in-network.json"
#> [23] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-ks_in-network.json"
#> [24] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-tx_in-network.json"
#> [25] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-oh_in-network.json"
#> [26] "http://centene.com/content/dam/centene/Centene%20Corporate/json/DOCUMENT/2022-12-29_centene-management-company-llc_ambetter-mi_in-network.json"
centene_inn <- defog_toc(centene_toc_dec) |>
dplyr::filter(rate_type == "in_network") |>
dplyr::select(location) |>
dplyr::distinct()
defog_inn(tibble::deframe(centene_inn[10, ])) |>
dplyr::slice_head(n = 30) |>
dplyr::select(npi,
billing_code,
billing_code_modifier,
name,
negotiated_rate) |>
knitr::kable()| npi | billing_code | billing_code_modifier | name | negotiated_rate |
|---|---|---|---|---|
| 1518136126 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1407266083 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1538684428 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1669910949 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1912080888 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1730327446 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1073696043 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1740427178 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1265437909 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1861540858 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1265702062 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1053646802 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1518136126 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1407266083 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1457350142 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1841607264 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1538684428 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1669910949 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1861961112 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1124048772 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1699127050 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1477573020 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1326044603 | 00142 | QZ | ANESTH, LENS SURGERY | 130.31 |
| 1518136126 | 00145 | QZ | ANESTH, VITREORETINAL SURG | 208.50 |
| 1407266083 | 00145 | QZ | ANESTH, VITREORETINAL SURG | 208.50 |
| 1538684428 | 00145 | QZ | ANESTH, VITREORETINAL SURG | 208.50 |
| 1669910949 | 00145 | QZ | ANESTH, VITREORETINAL SURG | 208.50 |
| 1912080888 | 00145 | QZ | ANESTH, VITREORETINAL SURG | 208.50 |
| 1730327446 | 00145 | QZ | ANESTH, VITREORETINAL SURG | 208.50 |
| 1073696043 | 00145 | QZ | ANESTH, VITREORETINAL SURG | 208.50 |
Code of Conduct
Please note that the defogger project is released with a Contributor Code of Conduct. By contributing to this project, you agree to abide by its terms.