Skip to main content
Version: 3.0

Versions

Version NameInternal Release DateAPI Release DateLatest Payer MRF MonthProduction SchemaRelease Notes
2026_0608/07/202608/17/20262026_06tq_production.clear_rates_2026_06Release Notes
3.0.106/09/202606/15/20262026_04tq_production.clear_rates_2026_04
3.0.005/10/202606/01/20262026_03tq_production.clear_rates_2026_03
2.4.304/10/202605/01/20262026_02tq_production.clear_rates_2026_02
2.4.203/12/202604/01/20262026_01tq_production.clear_rates_2026_01
2.4.102/19/202602/25/20262025_12tq_production.clear_rates_2025_12Slack Release Notes
2.4.002/05/202602/11/20262025_11tq_production.clear_rates_greg_2025_11Slack Release Notes
2.3.201/22/202601/28/20262025_11tq_production.clear_rates_calcifer_2025_11Slack Release Notes
2.3.101/08/202601/14/20262025_11tq_production.clear_rates_2025_11Slack Release Notes
2.3.012/4/202512/10/20252025_10tq_production.clear_rates_2025_10Slack Release Notes
2.2.211/14/202511/19/20252025_09Slack Release Notes
2.2.110/30/202511/5/20252025_08Slack Release Notes
2.2.010/15/202510/21/20252025_08Slack Release Notes

v2026_06 Release Notes​

Internal notes for tq_production.clear_rates_2026_06. Customer-facing notes are published separately to Zendesk. Full ticket detail on the CLD board.

  • Payers & Networks
    • Claritev / MultiPlan (1109) wired up: PHCS (33.7M rates) and MultiPlan (31.9M rates) national PPO networks. Needed a payer-scoped exception (ppo_exclusion_payer_overrides) because MULTIPLAN and PHCS are global ppo_exclusions keywords in variables_ppo.sql and were zeroing out 1109's own plan-bridge rows [CLD-165]
    • UnitedHealthcare Neighborhood Health HMO Open Access (FL) added as its own network, payer data only (5.0M rates) [CLD-165]
    • Did not ship despite being in scope: Wellcare (706), AmeriHealth Caritas (959), and BCBS Rhode Island Medicare Advantage (397) are absent from prod_combined_abridged — 706 and 959 have zero rows, 397 has only PPO and Exchange. Needs follow-up [CLD-165]
  • Rate selection & scoring
    • Prefer ffs over bundle rates. negotiation_arrangement was absent from the rates_ordered ORDER BY in raw/payer_mrf/build.sql, so the negotiated_rate DESC tiebreaker picked the flat bundle amount for every code in a family [CLD-152]
    • CMS MS-DRG weights migrated off the stale cld_utils.msdrg_weights_by_year (FY2025) to reference_internal.ipps_msdrg (FY2026). 761 of 765 shared codes had a materially different weight [CLD-169]
    • Base-rate imputations now join each contract's own canonical_base_rate_weight_year rather than always the latest fiscal year — ~30% of scored provision rows use a non-current weight year [CLD-158]
    • Removed msdrg_mrf_base_rate_mult_cms_weight end-to-end, plus its 5 supporting columns and dead upstream CTEs. MRF-inferred base rates are not trustworthy enough to publish when a provider has no provision-sourced base rate [CLD-168]
    • Base rates no longer get a flat provision_score of 8 (which mapped to canonical_rate_score 5). They now score 7 when validated against a non-outlier counterpart, else 6.999 → floor 6 → canonical_rate_score 4 [CLD-173]
    • provision_* columns pinned to the current release's own latest subversion. The provision_latest CTE previously searched backward across all subversions, pairing current rates with provision detail from runs up to 8 months stale [CLD-166]
  • Codes
    • APR-DRG severity-of-illness suffix stripped before the spines_services_clinical_categories join in code.sql. Before the fix 0 of 1,340 APR-DRG codes matched a clinical category; after, 1,312 [CLD-157]
    • APR-DRG billing codes padded in hospital MRF build.sql and build_pg.sql, a follow-up to v2.4's hosp_prepare_base.sql fix that left the raw ingestion path unpadded [CLD-171]
    • EAPG crosswalk join normalized on both sides ahead of the Aug 21 hospital_rates code-format change. APC, RC, and APR-DRG paths already used LPAD / SPLIT_PART and were unaffected [CLD-159]
    • Verified every mapped_from_apc = true row has an APC sibling with byte-identical rates across all 1,318,965 groups. No change required [CLD-170]
  • Traceability
    • Anesthesia conversion-factor formulas carry the payer's time_unit as an explicit parameter instead of a hardcoded literal, flowing through to canonical_method_params [CLD-164]
  • Bug fixes
    • Plan-bridge network_name not matching the network spine silently dropped every hospital-posted rate for Health Net (504), HealthPartners (121), AultCare (155), University of Utah Health Plans (353), and BCBS Kansas City (47). Health Net PPO went 8,924 → 1,046,040 rates [CLD-162]
    • EPO removed from exchange_exclusions in variables_exchange.sql, which was dropping legitimate Individual EPO marketplace plans already self-tagged Exchange by the hospital (Oscar 567, Cigna Connect EPO Exchange) [CLD-172]
    • best_hospital_rate_score / best_payer_rate_score non-zero while the rate is NULL — traced to the best_payer_hospital_cols CASE block in merge_combined_abridged_joined_chunks.sql. Diagnosed only, no fix in this release [CLD-167]
  • Data shifts worth knowing
    • Rated rate objects 2.16B → 2.05B (-4.90%). Payers 96 → 97, networks 299 → 302, providers 74,670 → 76,807
    • Physician Group -8.24% (-127.4M), which is two independent effects: the PG rate object space contracted 11.8% for existing payers (1,683.2M → 1,484.0M objects, provider count flat), while Claritev added 193.1M objects of which only 22.8M rated. Rated share improved 92% → 95%. Not traced to any 2026_06 ticket — needs engineering sign-off
    • Rate score 1 +50.33% is almost entirely Claritev: 163.5M of its rows land outside outlier bounds, at a median 850% of Medicare. Its 11.9% rated share is well below the 50-60% typical for PG, so its rates may not be landing as negotiated PPO amounts
    • Eight networks lost their payer MRF entirely (payer-sourced rates → 0, hospital-posted retained): Cigna NY / New England / TN HMO, BCBS Minnesota Aware PPO and HMO, Healthfirst NY Essential Plan, WPS PPO, Providence PEBB Choice

v3.0.0 Release Notes​

  • Accuracy
    • Tightened counterparty validation to a flat 5% tolerance across all provider types (was 20%/10% with a $15k threshold)
    • Medical validation now requires 5% agreement in both directions with both sides non-outlier — prevents outlier-to-outlier cross-validation
  • Codeset / Data
    • Added 26 Drug SSP/Episode J-codes (24 J-codes + 2 biosimilars) to PG codeset
    • Combined PG + infusion center NPIs in provider.sql — fixes NPI drops for dual-type providers
    • Coalesced HPT v3 median_amount with estimated_allowed_amount for hospital MRF rates
    • Excluded venipuncture codes (36415, 36416) and HCPCS Category II F-codes from is_surg_code heuristic
  • Plan Bridge / Network Mappings
    • Cigna (payer 76): added plan_name ranking hierarchy
    • BCBS Kansas City (payer 47): prefer Preferredcare over Preferredcare Blue
    • UHC (payer 643): added Options PPO network
    • Medical Mutual of Ohio (payer 272): prefer SUPERMED COMMERCIAL plan_name
    • Added HMO/PPO exclusion exceptions (affects Priority Health, payer 299)
  • Traceability
    • Fixed payer_hospital traceability join that was dropping opposite-side metadata (hospital or payer columns NULL depending on which side won)
    • Fixed per_diem traceability: OP rates now show {rate}; IP rates keep {per_diem} × {glos} decomposition
  • Bug Fixes
    • Fixed combined_brit imputation filter dropping non-first payers
    • Fixed ambiguous service_code column in build_payer_mrf

v2.4.1 Release Notes​

Updates:

  • Professional Rates now have Modifiers 26 and TC. These new ROIDs will not be loaded to the API yet, but they will be included in the underlying data release
  • Adds hospital subtype: Long Term Acute Care Hospitals
  • Adds networks: Cigna National PPO, Aetna National PPO, UHC Select EPO
  • For Exchange, start pulling payer data as well (we'd only been using hospital data for Exchange)
  • Added Nomi rates for Consumer
  • Cleans up canonical_gross_charge so that canonical_gross_charge is only populated if greater than canonical_rate
  • Include service code 23 for professional fees
  • Use provider_parent_system as the health_system_name for labs
  • SelectHealth network naming and product_network_label selection updates

v2.4.0 Release Notes​

  • Provisions
    • Introduced limited-scope, data-only provision-based features to support UX ideation and early data feedback
    • New Provisions Table including:
      • Implant carveouts
      • Drug carveouts
      • Stoploss
      • Inpatient base rate / percentage / per diem
      • Outpatient surgical groupers
      • Draft table: tq_dev.internal_dev_mmalhotra.provisions_final
    • Implant carveouts:
      • Uses inferred provisions and DevPR to generate bundled rates for device-dependent procedures
      • Logic currently applies to a limited set of providers
      • New fields added to prod_combined_abridged
  • Taxonomy updates
    • Added taxonomy_classification
    • Added taxonomy_specialization
    • Fields added to the API table
  • Provider updates
    • provider_subtype now includes all physician group specialties
    • Physical Therapy Physician Groups added

v2.3.2 Release Notes​

  • RC to HCPCS imputations
  • Best payer and best hospital rate columns to kick off API work on filtering templates to payer- or hospital-data only
  • Add remaining OPPS codes that were previously excluded. We should now have all OPPS codes
  • Bug fix Exchange plans that were previously including many "Commercial" payer_class_name rates from hospital MRF

v2.3.1 Release Notes​

  • For Market Solutions:
    • New Networks and Payers:
      • HealthPartners
      • PEHP
      • Capital Health
      • HealthLink
      • SelectHealth
      • The Alliance
      • HealthSmart
      • Medica
    • Add ASP Dosage Amount and Unit to prod_combined_abridged
    • ML to MG Conversion Logic
    • Add PLA Codes
  • Cigna Anesthesia transformation update
  • Ensure only single affiliated PGs get hospital MRF rates
  • ASC and PG Provider Subtypes

v2.3.0 Release Notes​

v2.2.2 Release Notes​

  • Labs
    • Guardant rates are now available for all payers
    • Implemented lab-specific accuracy scoring methodology
  • More Hospital MRF Rates:
    • Include rates for Providers Posting HCPCS as Inpatient. This adds 260 more providers with OP hospital rates.
    • Include rates for Providers ALWAYS Posting DRGs w/ Rev Codes. Previously, we only included rates with NULL Rev Codes. Affects just a handful of providers, but important ones!
  • New Payers:
    • Added SummaCare
  • Misc:
    • Always populate medicare_rate in prod tables
    • Remove "capitation" negotiation_arranagment from payer MRF data pulls (only happens 0.02% of the time, but on average these rates are 7x higher than ffs rates)
    • Validated Rates tiebreaker fix: in v2.3.0 we started selecting the highest rate. This introduced problems where a hospital PoC and payer PoC validated each other, because then the highest GC would be used (even if it were a state-average when a hospital-reported GC is available). Now, in this case, we rely on the hierarchy of GC sources to break ties.

v2.2.1 Release Notes​

  • Tables are in tq_production!
  • Accuracy :
    • Validated rates: select the higher rate as the canonical rate
    • Anesthesia rates: always prioritize normalized over raw (@Stefano DiSano)
  • Life Sciences:
    • Add NDC to Drug Code Crosswalk for Hospital rates with an NDC but NULL billing code (ty @Monika Malhotra for PRs!)
  • Employer:
    • A Network Check version of Clear Rates enhanced w/ extra imputation tiers
  • Medicare:
    • Update to Fixed Medicare Reference Data Tables (we had been using static ones)
    • Lab Medicare Fee Schedule for Physician Groups (@Sam Jones)
  • Plan Mappings:
    • Fix Premera Blue Cross mapping so we have AK rates for Alaska Heritage Network (@Hunter Brown | thread)
    • Fix Wellmark Bluecard to use PPO plan and rename from IA HMO to IA PPO (@Sam Jones | thread)
    • Implement Plan Bridge Hierarchies for MO Blue (@Stefano DiSano)
    • IBC Hospital Data added for Main Line Health (@Stefano DiSano)
  • Misc:
    • Round all rate features to 2 decimals

v2.2.0 Release Notes​

  • Highlights:
    • Analyze: features for next week's lab template demos
    • Adds is_lab_code indicator
    • Adds medicare reference pricing for the new lab codes
  • Spines:
    • We built Physician Group Spines and Clear Rates is now using it (s/o @Nick Pattison for the design and architecture, it's quite a technical marvel he cooked up!). This will help to boost coverage and improve rates for Employer Network Check reports and add more PGs for Analyze.
  • Market Solutions:
    • Two New Drug Dosage Standardization Methods (s/o @Monika Malhotra for the research and PRs to add these net new transformations to the Clear Rates codebase!)
    • Uses new unit/quantity fields in Hospital MRF data to dosage standardize
    • Uses NDC field from Hospital MRF data + strength/strength_unit from Medispan to dosage standardize
On this page: