Version: Canary - 2.3 🚧

Posted Rates

One-liner: Rates that reflect fixed dollar amounts where no encounter-level variablity is expected, and are sourced directly from reported data.

These rates are the typical fee-for-service rates that say code X is paid rate $Y. Customers should think of these rates as "complete", and they should take them to the bank.

However, underneath the surface this does not mean that Turquoise has done no additional work. The following categories of work may be expected in order to arrive at a Posted Rate:

Outlier Filtering
Choosing between the payer posted rate or the hospital posted rate
Inferring missing rates, such as when it's extremely evident that a contract is structured around Surgical Groupers, but the posted MRF doesn't list every code in the Grouper

Rate Types

untransformed rates are those whose billing_code_type was not crosswalked (e.g. APR-DRG -> MS-DRG)

Raw Posted Rates

These are unprocessed rates directly from source data (payer MRF files or hospital chargemasters) that represent fixed dollar amounts.

Payer Raw Rates

Rate Type	Source	Contract Methodology*	Description
`raw: payer_negotiated_rate`	payer	negotiated	Direct negotiated rates from payer MRF files
`raw: payer_derived_rate`	payer	derived	Derived rates from payer MRF files
`raw: payer_fee_schedule_rate`	payer	fee schedule	Fee schedule rates from payer MRF files
`raw: payer_negotiated_untransformed_rate`	payer	negotiated	Untransformed negotiated rates from payer data
`raw: payer_derived_untransformed_rate`	payer	derived	Untransformed derived rates from payer data
`raw: payer_fee_schedule_untransformed_rate`	payer	fee schedule	Untransformed fee schedule rates from payer data

Hospital Raw Rates

Rate Type	Source	Contract Methodology*	Description
`raw: hospital_case_rate_dollar`	hospital	case rate	Hospital case rates in dollar amounts
`raw: hospital_fee_schedule_dollar`	hospital	fee schedule	Hospital fee schedule rates in dollars
`raw: hospital_null_methodology_dollar`	hospital	null	Hospital rates with null methodology in dollars
`raw: hospital_other_dollar`	hospital	other	Hospital other methodology rates in dollars
`raw: hospital_percent_of_total_billed_charges_dollar`	hospital	percent of charge	Hospital percentage-based rates converted to dollars
`raw: hospital_case_rate_untransformed_dollar`	hospital	case rate	Untransformed hospital case rates
`raw: hospital_fee_schedule_untransformed_dollar`	hospital	fee schedule	Untransformed hospital fee schedule rates
`raw: hospital_null_methodology_untransformed_dollar`	hospital	null	Untransformed hospital null methodology rates
`raw: hospital_other_untransformed_dollar`	hospital	other	Untransformed hospital other methodology rates
`raw: hospital_percent_of_total_billed_charges_untransformed_dollar`	hospital	percent of charge	Untransformed hospital percentage-based rates
`raw: hospital_case_rate_allowed_amount`	hospital	case rate	Hospital case rates from allowed amounts
`raw: hospital_fee_schedule_allowed_amount`	hospital	fee schedule	Hospital fee schedule from allowed amounts
`raw: hospital_null_methodology_allowed_amount`	hospital	null	Hospital null methodology from allowed amounts
`raw: hospital_other_allowed_amount`	hospital	other	Hospital other methodology from allowed amounts
`raw: hospital_percent_of_total_billed_charges_allowed_amount`	hospital	percent of charge	Hospital percentage rates from allowed amounts
`raw: hospital_per_diem_allowed_amount`	hospital	per diem	Hospital per diem rates from allowed amounts
`raw: hospital_case_rate_untransformed_allowed_amount`	hospital	case rate	Untransformed hospital case rates from allowed amounts
`raw: hospital_fee_schedule_untransformed_allowed_amount`	hospital	fee schedule	Untransformed hospital fee schedule from allowed amounts
`raw: hospital_null_methodology_untransformed_allowed_amount`	hospital	null	Untransformed hospital null methodology from allowed amounts
`raw: hospital_other_untransformed_allowed_amount`	hospital	other	Untransformed hospital other methodology from allowed amounts
`raw: hospital_percent_of_total_billed_charges_untransformed_allowed_amount`	hospital	percent of charge	Untransformed hospital percentage rates from allowed amounts
`raw: hospital_per_diem_untransformed_allowed_amount`	hospital	per diem	Untransformed hospital per diem from allowed amounts

Claims Raw Rates

Rate Type	Source	Contract Methodology*	Description
`raw: komodo_allowed_amount_line_item`	claims	allowed amount	Komodo allowed amounts at line item level
`raw: komodo_allowed_amount_claim`	claims	allowed amount	Komodo allowed amounts at claim level

Imputed Posted Rates

Rate Type	Source	Contract Methodology*	Description
`impute: opg_base_rate`	both	case rate	Outpatient grouper base rate
`impute: msdrg_mrf_base_rate_mult_cms_weight`	both	fee schedule	MS-DRG MRF base rate multiplied by CMS weight

*as reported in MRF file

Canonical Rate Type Format

Posted rates use the canonical rate type format: {category}: {rate_source} where:

Category indicates the processing level (raw, impute)
Rate Source identifies the specific rate column used

Rate Types​

Raw Posted Rates​

Payer Raw Rates​

Hospital Raw Rates​

Claims Raw Rates​

Imputed Posted Rates​

Canonical Rate Type Format​

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