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Version: 2.1

First Party Data

Outpatient Procedure Grouper​

We pull fee schedules from first party data and combine them with MRF data to infer contract provisions. For example, we can use OP surgery groupers and MRF rates to infer OP grouper case rates. Then, these case rates can be used to impute rates to fill gaps in MRF data.

We currently use OPG Grouper-Code crosswalks for the following payers:

  • United Healthcare (actually publically available)
  • Aetna
  • Cigna
  • BS of CA
  • Anthem CA
  • Carefirst BCBS MD
  • Florida Blue
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