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Version: Canary - 2.4 🚧

v2_4_0 → v2_4_1

Generated: 2026-02-17 09:11:49.
Filter: canonical_rate_score > 1.


1. Summary Statistics

Overview

  • Total ROIDs: 423,563,165 → 642,842,847 (+219,279,682, +51.8%)

By Provider Type and Bill Type

provider_typebill_typenew_distinct_roidsold_distinct_roidsnew_distinct_networksold_distinct_networksnew_distinct_providersold_distinct_providersnew_distinct_billing_codesold_distinct_billing_codes
Imaging CenterProfessional4,037,4942,964,6291631592,9302,898171171
HospitalOutpatient248,960,622182,556,6321801765,9995,7087,5127,512
ASCOutpatient21,462,46414,469,4091451375,5785,5333,1543,154
HospitalInpatient59,364,62844,262,1611771735,9685,6301,7111,711
LaboratoryProfessional12,774,42811,292,0161711673,7113,710916916
Physician GroupProfessional296,243,211168,018,31817717421,74021,1133,8303,790
Click to see SQL
WITH
new AS (
SELECT
provider_type,
bill_type,
COUNT(DISTINCT roid) AS distinct_roids,
COUNT(DISTINCT payer_id) AS distinct_payers,
COUNT(DISTINCT network_id) AS distinct_networks,
COUNT(DISTINCT provider_id) AS distinct_providers,
COUNT(DISTINCT billing_code) AS distinct_billing_codes
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY 1,2
),
old AS (
SELECT
CASE
WHEN provider_type LIKE '%Hospital%' THEN 'Hospital'
ELSE provider_type
END AS provider_type,
bill_type,
COUNT(DISTINCT roid) AS distinct_roids,
COUNT(DISTINCT payer_id) AS distinct_payers,
COUNT(DISTINCT network_id) AS distinct_networks,
COUNT(DISTINCT provider_id) AS distinct_providers,
COUNT(DISTINCT billing_code) AS distinct_billing_codes
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY 1, 2
)
SELECT
provider_type,
bill_type,
new.distinct_roids AS new_distinct_roids,
old.distinct_roids AS old_distinct_roids,
new.distinct_networks AS new_distinct_networks,
old.distinct_networks AS old_distinct_networks,
new.distinct_providers AS new_distinct_providers,
old.distinct_providers AS old_distinct_providers,
new.distinct_billing_codes AS new_distinct_billing_codes,
old.distinct_billing_codes AS old_distinct_billing_codes
FROM new
JOIN old USING (provider_type, bill_type)

2. Rate Object Space Dropoffs

Provider Dropoffs

Count: 174 dropped

Click to see SQL
WITH
new AS (
SELECT DISTINCT provider_id, 'new' as source
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
),
old AS (
SELECT DISTINCT provider_id, 'old' as source
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
)
SELECT
DISTINCT
provider_id
FROM new
FULL OUTER JOIN old USING (provider_id)
WHERE new.source IS NULL AND old.source IS NOT NULL

Payer Dropoffs

Count: 0 dropped

No dropoffs detected.

Click to see SQL
WITH
new AS (
SELECT DISTINCT payer_id, 'new' as source
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
),
old AS (
SELECT DISTINCT payer_id, 'old' as source
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
)
SELECT
DISTINCT
payer_id
FROM new
FULL OUTER JOIN old USING (payer_id)
WHERE new.source IS NULL AND old.source IS NOT NULL

Network Dropoffs

Count: 2 dropped

Click to see SQL
WITH
new AS (
SELECT DISTINCT network_id, 'new' as source
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
),
old AS (
SELECT DISTINCT network_id, 'old' as source
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
)
SELECT
DISTINCT
network_id
FROM new
FULL OUTER JOIN old USING (network_id)
WHERE new.source IS NULL AND old.source IS NOT NULL

Provider-Network Combination Dropoffs

Count: 7269 dropped

Click to see SQL
WITH
new AS (
SELECT DISTINCT provider_id, network_id, 'new' as source
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
),
old AS (
SELECT DISTINCT provider_id, network_id, 'old' as source
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
)
SELECT
DISTINCT
provider_id,
network_id
FROM new
FULL OUTER JOIN old USING (provider_id, network_id)
WHERE new.source IS NULL AND old.source IS NOT NULL

Bill Type-Billing Code Combination Dropoffs

Count: 0 dropped

No dropoffs detected.

Click to see SQL
WITH
new AS (
SELECT DISTINCT bill_type, billing_code, 'new' as source
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
),
old AS (
SELECT DISTINCT bill_type, billing_code, 'old' as source
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
)
SELECT
DISTINCT
bill_type,
billing_code
FROM new
FULL OUTER JOIN old USING (bill_type, billing_code)
WHERE new.source IS NULL AND old.source IS NOT NULL

3. Large Rate Swings (>10% change)

Bill Type + Provider Level

Count: 19139 entities with significant rate changes

bill_typeprovider_idnew_avg_pct_of_medicare_rateold_avg_pct_of_medicare_ratenew_avg_canonical_rateold_avg_canonical_ratemedicare_rate_pct_changecanonical_rate_pct_changenew_roid_countold_roid_count
Professional-4975074222686880273.140.931,261.17687.54238.0%83.4%35,7614,407
Professional729773.291.1417.00139.08200.3%199.8%925625
Professional31973094637067237922.770.941,529.77202.51194.9%655.4%19,3615,384
Professional23483438823286031162.290.8806.43156.12185.4%416.5%43,0611,700
Professional-60878295911437675492.871.051,368.71382.16173.8%258.1%28,1144,697
Professional67066506346538389802.81.05968.88253.81166.3%281.7%28,1273,706
Professional84526092780956619101.790.68718.73143.08163.4%402.3%36,7573,316
Professional-32452069102401829072.010.8700.53268.65151.4%160.8%34,8672,773
Professional-16686303538303122893.071.221,383.16402.70151.0%243.5%54,6651,029
Inpatient90425.042.07124,484.8961,298.12143.1%103.1%1,6561,710
Outpatient92293.981.644,112.553,529.52142.2%16.5%3,285652
Professional-61358347851706605722.140.891,010.341,203.41140.3%-16.0%36,3044,429
Professional-79816848976015706883.021.27923.55296.17138.9%211.8%25,570786
Professional-4818359673844388762.070.87760.57257.80137.7%195.0%38,3736,559
Professional21810794390324667552.421.02974.94218.22137.1%346.8%2,9491,218
Professional-31489822060694353702.811.21,162.851,135.64134.9%2.4%39,7713,146
Professional2693088540516022101.960.85916.82158.17131.4%479.6%36,0772,432
Professional-15853226451111618702.130.92668.15172.24131.1%287.9%28,2962,268
Professional-90426191312616165521.920.84743.28161.73130.1%359.6%28,1283,180
Professional-48353589520424092612.090.92739.32386.50127.4%91.3%25,5031,628
Professional-76053618592884174473.211.441,175.661,946.57124.0%-39.6%20,5742,609
Professional-8712321988957179672.20.99712.40132.91122.3%436.0%32,3911,158
Professional50139763308447367712.841.29956.242,583.72120.8%-63.0%29,421943
Professional44196696431799545381.860.84638.00139.55120.4%357.2%24,3003,029
Professional-74395823131492239932.461.13824.99207.48117.5%297.6%42,0333,074
Professional-72596552938499553301.780.82644.38187.60116.7%243.5%29,5051,434
Professional774311680549073051.970.91804.18780.75115.6%3.0%32,3013,634
Outpatient267867.433.452,026.71791.63115.2%156.0%1,556714
Professional54945686434638064001.810.86632.98161.70110.2%291.5%31,4501,772
Inpatient59692.151.0226,918.9016,458.15109.8%63.6%30818
Professional-48209265135936668781.950.93758.431,134.59109.5%-33.2%39,9454,680
Professional-64009229115788052741.890.91691.992,502.50108.2%-72.3%16,076891
Professional-72466002524206658562.091.01761.53207.47107.6%267.1%27,7951,516
Professional8476330220850530201.730.83649.162,701.83107.0%-76.0%27,944892
Professional79905366019391316711.830.89120.70115.96105.0%4.1%5022,264
Professional-58868766893852355402.131.04688.31128.94104.9%433.8%23,4472,639
Professional-29882561529332495651.590.78795.60154.29104.6%415.7%14,2082,774
Professional37273364877568771751.820.89121.06128.44104.5%-5.7%5082,361
Professional57864373848473450791.810.89119.63115.92103.2%3.2%5162,266
Professional-59359986713562141542.11.05424.93142.5999.9%198.0%24,4501,495
Professional-60106497519007009522.241.12778.333,634.5799.8%-78.6%51,5822,093
Professional-36822566591512631171.920.96752.89153.3699.4%390.9%23,3403,485
Professional12861003987425782081.920.97745.16249.4298.3%198.8%37,128503
Professional-90214290093035480932.091.06997.79630.2897.4%58.3%41,6355,128
Professional-79687349645716834801.670.85677.80163.5096.3%314.6%20,6202,237
Professional67440561872550016292.241.141,067.704,185.6396.2%-74.5%16,3301,656
Professional-37658345106749754241.80.93935.25922.8394.0%1.3%48,0808,546
Outpatient52436.163.241,258.457,717.4490.5%-83.7%89211,934
Professional63567720391861917442.451.29869.97177.3589.5%390.6%34,4203,926
Professional14764574376669029921.740.92628.27217.6089.4%188.7%31,3032,197

Showing 50 of 19139 total rows

Click to see SQL
WITH
new AS (
SELECT
bill_type,
provider_id,
AVG(canonical_rate_percent_of_medicare) AS avg_pct_of_medicare_rate,
AVG(canonical_rate) AS avg_canonical_rate,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY bill_type, provider_id
),
old AS (
SELECT
bill_type,
provider_id,
AVG(canonical_rate_percent_of_medicare) AS avg_pct_of_medicare_rate,
AVG(canonical_rate) AS avg_canonical_rate,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY bill_type, provider_id
)
SELECT
bill_type,
provider_id,
new.avg_pct_of_medicare_rate AS new_avg_pct_of_medicare_rate,
old.avg_pct_of_medicare_rate AS old_avg_pct_of_medicare_rate,
new.avg_canonical_rate AS new_avg_canonical_rate,
old.avg_canonical_rate AS old_avg_canonical_rate,
(new.avg_pct_of_medicare_rate - old.avg_pct_of_medicare_rate) / NULLIF(old.avg_pct_of_medicare_rate, 0) AS medicare_rate_pct_change,
(new.avg_canonical_rate - old.avg_canonical_rate) / NULLIF(old.avg_canonical_rate, 0) AS canonical_rate_pct_change,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count
FROM new
JOIN old USING (bill_type, provider_id)
WHERE (
ABS((new.avg_pct_of_medicare_rate - old.avg_pct_of_medicare_rate) / NULLIF(old.avg_pct_of_medicare_rate, 0)) > 0.1
OR ABS((new.avg_canonical_rate - old.avg_canonical_rate) / NULLIF(old.avg_canonical_rate, 0)) > 0.1
) AND (
CASE
WHEN bill_type = 'Inpatient'
THEN new.roid_count > 10 AND old.roid_count > 10
WHEN bill_type = 'Outpatient'
THEN new.roid_count > 500 AND old.roid_count > 500
WHEN bill_type = 'Professional'
THEN new.roid_count > 500 AND old.roid_count > 500
END
)
ORDER BY ABS(medicare_rate_pct_change) DESC

Network + Provider Level

Count: 71558 entities with significant rate changes

network_idprovider_idnew_avg_pct_of_medicare_rateold_avg_pct_of_medicare_ratenew_avg_canonical_rateold_avg_canonical_ratemedicare_rate_pct_changecanonical_rate_pct_changenew_roid_countold_roid_count
311,448,953,162,816,591527infinf4,530.173,953.3314.6%6,2196,249
8,361,580,493,441,765,265-4975074222686880274.040.74840.73150.20444.3%459.7%3,266884
4,281,965,180,796,802,413-4975074222686880273.930.74735.19150.20428.6%389.5%3,070884
-3,776,001,016,975,145,508-15198222658269343834.020.772,243.78157.56420.8%1324.1%5731,512
8,361,580,493,441,765,265-61358347851706605722.850.621,020.87149.88358.0%581.1%4,565697
4,281,965,180,796,802,413-61358347851706605722.80.62942.87149.88349.9%529.1%4,224697
-3,776,001,016,975,145,50884526092780956619103.290.761,118.69211.20333.4%429.7%2,615698
8,361,580,493,441,765,265-60878295911437675493.150.73672.80266.53329.4%152.4%3,020785
4,281,965,180,796,802,413-60878295911437675493.110.73609.57266.53323.8%128.7%2,940785
8,361,580,493,441,765,26531973094637067237922.860.69508.72143.76317.0%253.9%2,197877
4,281,965,180,796,802,41331973094637067237922.750.69439.10143.76300.9%205.4%2,112877
-3,776,001,016,975,145,508-90426191312616165523.740.991,279.13245.03278.3%422.0%2,492508
-5,230,720,519,108,079,75140235.041.4620,510.0426,912.89245.5%-23.8%7,8241,710
-3,776,001,016,975,145,50859105323717538072884.111.2502.97288.35242.8%74.4%1,2471,278
-3,776,001,016,975,145,508-92087865630639639824.111.2502.57288.55242.8%74.2%1,2481,277
-3,776,001,016,975,145,50812861003987425782083.170.971,044.50249.42226.9%318.8%2,123503
8,361,580,493,441,765,26570634152339011300332.180.67583.02262.25225.0%122.3%4,485780
-3,776,001,016,975,145,508-38682639102511410974.871.521,727.291,425.24221.4%21.2%845909
-3,776,001,016,975,145,508-71463206212862150963.721.162,038.21471.23220.3%332.5%656758
4,281,965,180,796,802,41367066506346538389802.810.88846.15265.33217.3%218.9%4,5011,388
8,361,580,493,441,765,26567066506346538389802.80.88839.83265.33216.1%216.5%4,5141,388
-3,776,001,016,975,145,50853484530810369614373.931.27252.88164.72208.6%53.5%617575
-2,162,498,661,799,343,237-49858286125665088683.171.031,625.67270.98208.5%499.9%3,071773
-2,162,498,661,799,343,237-55292356174825648173.141.03922.29270.98205.2%240.3%949773
-3,776,001,016,975,145,50887459861588775032344.171.371,470.021,455.11205.1%1.0%1,306948
7,616,836,552,481,822,175-4975074222686880272.950.981,487.652,661.66201.7%-44.1%4,912885
-3,776,001,016,975,145,508-80867026509807564023.721.252,059.901,349.54199.0%52.6%6531,020
8,361,580,493,441,765,26523483438823286031162.40.8688.18156.12198.9%340.8%4,915850
4,281,965,180,796,802,41323483438823286031162.40.8688.18156.12198.9%340.8%4,915850
-3,776,001,016,975,145,5087686776132293142873.871.3241.73161.92197.3%49.3%608644
-3,776,001,016,975,145,50810675874477231322043.821.29220.72868.84197.1%-74.6%720924
-3,776,001,016,975,145,50830155100942041611813.821.29220.72868.84197.1%-74.6%720924
-3,776,001,016,975,145,50879328384834558322943.431.16400.62268.10196.7%49.4%1,4621,459
8,361,580,493,441,765,265-48353589520424092612.690.92652.22386.50192.8%68.7%4,665814
8,361,580,493,441,765,265-90214290093035480932.210.75716.11151.56192.4%372.5%4,832884
4,281,965,180,796,802,413-90214290093035480932.210.75716.11151.56192.4%372.5%4,832884
-3,776,001,016,975,145,50814482304683110692622.880.991,050.58250.28190.9%319.8%1,881501
-3,776,001,016,975,145,50856710121788518702884.471.54417.54264.89189.8%57.6%1,006617
-3,776,001,016,975,145,50891196004558178375993.231.12357.42604.44188.8%-40.9%1,4481,860
-3,776,001,016,975,145,5083405305108581519913.181.1975.75824.34188.5%18.4%1,7652,106
-3,776,001,016,975,145,50838924412388959821143.181.1975.75825.74188.2%18.2%1,7652,106
-3,776,001,016,975,145,508-19674236254119996383.921.371,282.641,455.11186.2%-11.9%1,326948
-3,776,001,016,975,145,50843764114672886352123.971.391,288.701,451.13184.5%-11.2%1,325951
-3,776,001,016,975,145,508-11292514426145036513.411.211,897.74315.66182.9%501.2%726795
-3,776,001,016,975,145,50850465917724731922234.191.48454.30334.61182.4%35.8%1,1071,131
4,281,965,180,796,802,41370634152339011300332.040.73545.22267.29181.0%104.0%4,509765
8,361,580,493,441,765,26585258016593238316811.990.71717.32146.31180.6%390.3%4,723882
-3,776,001,016,975,145,50862465532848272181103.621.3466.90440.75177.6%5.9%1,183818
-2,162,498,661,799,343,237-55879647665279515452.390.86688.05202.20176.3%240.3%1,1281,370
-2,162,498,661,799,343,237-19943955312793730392.390.86686.92202.20176.0%239.7%1,1301,370

Showing 50 of 71558 total rows

Click to see SQL
WITH
new AS (
SELECT
network_id,
provider_id,
AVG(canonical_rate_percent_of_medicare) AS avg_pct_of_medicare_rate,
AVG(canonical_rate) AS avg_canonical_rate,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY network_id, provider_id
),
old AS (
SELECT
network_id,
provider_id,
AVG(canonical_rate_percent_of_medicare) AS avg_pct_of_medicare_rate,
AVG(canonical_rate) AS avg_canonical_rate,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY network_id, provider_id
)
SELECT
network_id,
provider_id,
new.avg_pct_of_medicare_rate AS new_avg_pct_of_medicare_rate,
old.avg_pct_of_medicare_rate AS old_avg_pct_of_medicare_rate,
new.avg_canonical_rate AS new_avg_canonical_rate,
old.avg_canonical_rate AS old_avg_canonical_rate,
(new.avg_pct_of_medicare_rate - old.avg_pct_of_medicare_rate) / NULLIF(old.avg_pct_of_medicare_rate, 0) AS medicare_rate_pct_change,
(new.avg_canonical_rate - old.avg_canonical_rate) / NULLIF(old.avg_canonical_rate, 0) AS canonical_rate_pct_change,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count
FROM new
JOIN old USING (network_id, provider_id)
WHERE (
ABS((new.avg_pct_of_medicare_rate - old.avg_pct_of_medicare_rate) / NULLIF(old.avg_pct_of_medicare_rate, 0)) > 0.1
OR ABS((new.avg_canonical_rate - old.avg_canonical_rate) / NULLIF(old.avg_canonical_rate, 0)) > 0.1
) AND (
new.roid_count > 500 AND old.roid_count > 500
)
ORDER BY ABS(medicare_rate_pct_change) DESC

Network + Provider + Bill Type Level

Count: 73135 entities with significant rate changes

network_idprovider_idbill_typenew_avg_pct_of_medicare_rateold_avg_pct_of_medicare_ratenew_avg_canonical_rateold_avg_canonical_ratemedicare_rate_pct_changecanonical_rate_pct_changenew_roid_countold_roid_count
8,361,580,493,441,765,265-497507422268688027Professional4.040.74840.73150.20444.3%459.7%3,266884
4,281,965,180,796,802,413-497507422268688027Professional3.930.74735.19150.20428.6%389.5%3,070884
-3,776,001,016,975,145,508-1519822265826934383Professional4.020.772,243.78157.56420.8%1324.1%5731,512
8,361,580,493,441,765,265-6135834785170660572Professional2.850.621,020.87149.88358.0%581.1%4,565697
4,281,965,180,796,802,413-6135834785170660572Professional2.80.62942.87149.88349.9%529.1%4,224697
-3,776,001,016,975,145,5088452609278095661910Professional3.290.761,118.69211.20333.4%429.7%2,615698
8,361,580,493,441,765,265-6087829591143767549Professional3.150.73672.80266.53329.4%152.4%3,020785
4,281,965,180,796,802,413-6087829591143767549Professional3.110.73609.57266.53323.8%128.7%2,940785
8,361,580,493,441,765,2653197309463706723792Professional2.860.69508.72143.76317.0%253.9%2,197877
4,281,965,180,796,802,4133197309463706723792Professional2.750.69439.10143.76300.9%205.4%2,112877
-3,776,001,016,975,145,508-9042619131261616552Professional3.740.991,279.13245.03278.3%422.0%2,492508
-3,776,001,016,975,145,5085910532371753807288Professional4.111.2502.97288.35242.8%74.4%1,2471,278
-3,776,001,016,975,145,508-9208786563063963982Professional4.111.2502.57288.55242.8%74.2%1,2481,277
-3,776,001,016,975,145,5081286100398742578208Professional3.170.971,044.50249.42226.9%318.8%2,123503
8,361,580,493,441,765,2657063415233901130033Professional2.180.67583.02262.25225.0%122.3%4,485780
-3,776,001,016,975,145,508-3868263910251141097Professional4.871.521,727.291,425.24221.4%21.2%845909
-3,776,001,016,975,145,508-7146320621286215096Professional3.721.162,038.21471.23220.3%332.5%656758
4,281,965,180,796,802,4136706650634653838980Professional2.810.88846.15265.33217.3%218.9%4,5011,388
-6,972,129,921,516,377,1266272Inpatient8.392.65100,368.0261,722.92217.1%62.6%16349
5,373,876,635,451,223,8426272Inpatient8.392.65100,368.0261,722.92217.1%62.6%16349
8,361,580,493,441,765,2656706650634653838980Professional2.80.88839.83265.33216.1%216.5%4,5141,388
-3,776,001,016,975,145,5085348453081036961437Professional3.931.27252.88164.72208.6%53.5%617575
-2,162,498,661,799,343,237-4985828612566508868Professional3.171.031,625.67270.98208.5%499.9%3,071773
-2,162,498,661,799,343,237-5529235617482564817Professional3.141.03922.29270.98205.2%240.3%949773
-3,776,001,016,975,145,5088745986158877503234Professional4.171.371,470.021,455.11205.1%1.0%1,306948
7,616,836,552,481,822,175-497507422268688027Professional2.950.981,487.652,661.66201.7%-44.1%4,912885
-3,776,001,016,975,145,508-8086702650980756402Professional3.721.252,059.901,349.54199.0%52.6%6531,020
8,361,580,493,441,765,2652348343882328603116Professional2.40.8688.18156.12198.9%340.8%4,915850
4,281,965,180,796,802,4132348343882328603116Professional2.40.8688.18156.12198.9%340.8%4,915850
-3,776,001,016,975,145,508768677613229314287Professional3.871.3241.73161.92197.3%49.3%608644
-3,776,001,016,975,145,5083015510094204161181Professional3.821.29220.72868.84197.1%-74.6%720924
-3,776,001,016,975,145,5081067587447723132204Professional3.821.29220.72868.84197.1%-74.6%720924
-3,776,001,016,975,145,5087932838483455832294Professional3.431.16400.62268.10196.7%49.4%1,4621,459
8,361,580,493,441,765,265-4835358952042409261Professional2.690.92652.22386.50192.8%68.7%4,665814
4,281,965,180,796,802,413-9021429009303548093Professional2.210.75716.11151.56192.4%372.5%4,832884
8,361,580,493,441,765,265-9021429009303548093Professional2.210.75716.11151.56192.4%372.5%4,832884
-3,776,001,016,975,145,5081448230468311069262Professional2.880.991,050.58250.28190.9%319.8%1,881501
-3,776,001,016,975,145,5085671012178851870288Professional4.471.54417.54264.89189.8%57.6%1,006617
-3,776,001,016,975,145,5089119600455817837599Professional3.231.12357.42604.44188.8%-40.9%1,4481,860
-3,776,001,016,975,145,508340530510858151991Professional3.181.1975.75824.34188.5%18.4%1,7652,106
-3,776,001,016,975,145,5083892441238895982114Professional3.181.1975.75825.74188.2%18.2%1,7652,106
-3,776,001,016,975,145,508-1967423625411999638Professional3.921.371,282.641,455.11186.2%-11.9%1,326948
-3,776,001,016,975,145,5084376411467288635212Professional3.971.391,288.701,451.13184.5%-11.2%1,325951
4,301,155,135,282,901,8482909Inpatient3.181.1243,481.0811,686.52184.2%272.1%1,659107
-3,776,001,016,975,145,508-1129251442614503651Professional3.411.211,897.74315.66182.9%501.2%726795
-3,776,001,016,975,145,5085046591772473192223Professional4.191.48454.30334.61182.4%35.8%1,1071,131
4,281,965,180,796,802,4137063415233901130033Professional2.040.73545.22267.29181.0%104.0%4,509765
8,361,580,493,441,765,2658525801659323831681Professional1.990.71717.32146.31180.6%390.3%4,723882
-3,776,001,016,975,145,5086246553284827218110Professional3.621.3466.90440.75177.6%5.9%1,183818
-6,972,129,921,516,377,1266285Inpatient8.222.97109,076.2164,009.83177.0%70.4%43352

Showing 50 of 73135 total rows

Click to see SQL
WITH
new AS (
SELECT
network_id,
provider_id,
bill_type,
AVG(canonical_rate_percent_of_medicare) AS avg_pct_of_medicare_rate,
AVG(canonical_rate) AS avg_canonical_rate,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY network_id, provider_id, bill_type
),
old AS (
SELECT
network_id,
provider_id,
bill_type,
AVG(canonical_rate_percent_of_medicare) AS avg_pct_of_medicare_rate,
AVG(canonical_rate) AS avg_canonical_rate,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY network_id, provider_id, bill_type
)
SELECT
network_id,
provider_id,
bill_type,
new.avg_pct_of_medicare_rate AS new_avg_pct_of_medicare_rate,
old.avg_pct_of_medicare_rate AS old_avg_pct_of_medicare_rate,
new.avg_canonical_rate AS new_avg_canonical_rate,
old.avg_canonical_rate AS old_avg_canonical_rate,
(new.avg_pct_of_medicare_rate - old.avg_pct_of_medicare_rate) / NULLIF(old.avg_pct_of_medicare_rate, 0) AS medicare_rate_pct_change,
(new.avg_canonical_rate - old.avg_canonical_rate) / NULLIF(old.avg_canonical_rate, 0) AS canonical_rate_pct_change,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count
FROM new
JOIN old USING (network_id, provider_id, bill_type)
WHERE (
ABS((new.avg_pct_of_medicare_rate - old.avg_pct_of_medicare_rate) / NULLIF(old.avg_pct_of_medicare_rate, 0)) > 0.1
OR ABS((new.avg_canonical_rate - old.avg_canonical_rate) / NULLIF(old.avg_canonical_rate, 0)) > 0.1
) AND (
CASE
WHEN bill_type = 'Inpatient'
THEN new.roid_count > 10 AND old.roid_count > 10
WHEN bill_type = 'Outpatient'
THEN new.roid_count > 500 AND old.roid_count > 500
WHEN bill_type = 'Professional'
THEN new.roid_count > 500 AND old.roid_count > 500
END
)
ORDER BY ABS(medicare_rate_pct_change) DESC

Network Level

Count: 117 entities with significant rate changes

network_idnew_avg_pct_of_medicare_rateold_avg_pct_of_medicare_ratenew_avg_canonical_rateold_avg_canonical_ratemedicare_rate_pct_changecanonical_rate_pct_changenew_roid_countold_roid_count
8,361,580,493,441,765,265infinf4,880.155,697.73-14.3%75,306,72862,102,719
4,281,965,180,796,802,413infinf4,764.005,554.47-14.2%73,016,80559,911,722
-3,776,001,016,975,145,508infinf9,972.137,713.0529.3%38,334,13650,351,926
-8,499,759,224,271,609,8102.14.49196.55557.98-53.1%-64.8%357,72760,019
5,605,126,640,932,710,9301.872.416,559.8730,500.65-21.9%-45.7%1,115,632272,868
1,481,239,756,837,705,7682.32.855,118.7413,583.26-19.1%-62.3%1,023,693387,412
8,180,198,595,049,150,6161.911.610,473.945,055.5519.0%107.2%77,723196,804
4,043,190,250,846,473,2711.662.044,739.306,994.38-18.7%-32.2%1,612,2731,486,425
-4,445,518,905,666,343,7971.72.07765.2311,795.87-17.6%-93.5%209,601195,116
554,749,539,877,544,7751.922.3113,650.1812,802.23-16.8%6.6%882,1011,410,318
-8,389,359,264,395,369,9792.262.6614,699.5913,866.30-15.3%6.0%371,926499,911
-7,942,674,608,514,495,2821.782.095,496.648,330.35-15.0%-34.0%1,737,4061,121,341
-2,803,535,769,510,843,1351.882.1912,108.5211,661.47-14.4%3.8%876,4171,306,248
-1,199,840,640,198,334,8881.892.217,115.9310,008.56-14.3%-28.9%2,113,3531,477,539
1,391,056,274,517,336,0752.372.739,142.1410,993.49-13.1%-16.8%1,125,8211,029,273
-4,944,393,768,879,386,5093.413.98,978.6817,914.20-12.5%-49.9%144,764545,002
6,437,583,333,460,157,7982.772.4810,102.548,959.1211.5%12.8%645,863945,542
-163,892,009,874,547,1672.212.4813,381.6514,085.92-11.0%-5.0%460,369501,454
1,998,605,818,287,672,8002.442.735,135.199,038.41-10.4%-43.2%711,405457,003
1,134,341,852,115,164,9291.691.895,303.667,053.12-10.2%-24.8%991,207929,484
6,974,535,101,123,239,1313.052.7710,563.288,445.1410.2%25.1%503,462606,115
6,091,386,345,134,788,9863.112.8310,917.228,484.179.9%28.7%180,644232,032
6,037,342,850,284,539,6242.092.33,267.825,284.81-9.4%-38.2%1,024,733932,329
2,039,367,776,086,447,4542.152.365,255.826,115.56-9.2%-14.1%1,655,4991,281,449
-137,228,703,119,221,5021.832.015,189.376,213.43-9.0%-16.5%1,067,293946,219
3,478,392,755,490,109,1472.022.225,747.266,772.07-8.8%-15.1%415,334360,397
-6,293,294,949,651,930,9732.322.546,366.969,258.28-8.5%-31.2%2,005,7891,840,973
-2,105,332,499,153,538,6852.252.458,495.5310,088.54-8.4%-15.8%882,529799,292
-4,027,592,970,285,917,8012.62.410,116.958,056.498.2%25.6%746,263919,884
1,178,549,910,471,784,0152.742.5312,153.2710,299.458.1%18.0%496,310585,546
-7,420,630,624,364,773,0442.362.188,660.437,194.768.0%20.4%733,954862,432
2,884,766,606,938,738,1801.561.694,887.616,630.35-7.7%-26.3%926,282835,922
3,376,187,909,306,580,7992.012.172,805.044,068.51-7.6%-31.1%1,046,546843,362
5,263,188,873,138,819,1401.441.564,366.525,732.67-7.3%-23.8%1,502,3931,221,641
5,075,764,097,723,629,0592.032.188,518.3810,446.73-7.1%-18.5%2,344,8521,927,556
6,650,880,607,858,420,2371.491.64,496.615,856.66-7.0%-23.2%1,620,3001,356,008
-8,506,106,384,867,378,4301.351.452,145.213,097.19-6.9%-30.7%954,624733,509
7,616,836,552,481,822,1752.122.286,135.328,753.10-6.9%-29.9%5,296,8364,743,803
-2,215,537,880,835,804,3302.462.649,178.3210,670.83-6.8%-14.0%1,492,9861,421,293
-558,178,834,365,778,9782.032.178,516.6710,449.52-6.8%-18.5%2,337,4241,916,552
1,017,413,876,722,652,4242.012.165,451.847,828.38-6.7%-30.4%4,826,5834,323,665
-6,972,129,921,516,377,1262.322.485,353.817,429.71-6.2%-27.9%4,200,4053,845,550
1,295,090,440,394,638,8761.92.0214,727.8113,185.38-6.2%11.7%183,458233,390
-7,995,682,717,897,123,0392.632.810,927.3220,744.13-6.1%-47.3%2,915,9133,398,674
3,973,810,847,438,814,7984.864.611,595.3622,099.945.8%-47.5%755,860948,917
-7,163,483,760,674,166,6281.831.942,638.023,389.66-5.7%-22.2%1,593,0241,255,468
5,373,876,635,451,223,8422.372.515,812.977,763.62-5.7%-25.1%4,293,1073,892,981
-5,874,281,272,803,523,3031.821.932,602.603,349.46-5.7%-22.3%1,591,9211,253,703
-1,766,392,260,690,175,6852.32.176,723.717,511.485.6%-10.5%1,615,7011,514,382
-4,541,460,228,936,150,4372.22.338,813.8610,782.88-5.6%-18.3%2,417,5021,997,410

Showing 50 of 117 total rows

Click to see SQL
WITH
new AS (
SELECT
network_id,
AVG(canonical_rate_percent_of_medicare) AS avg_pct_of_medicare_rate,
AVG(canonical_rate) AS avg_canonical_rate,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY network_id
),
old AS (
SELECT
network_id,
AVG(canonical_rate_percent_of_medicare) AS avg_pct_of_medicare_rate,
AVG(canonical_rate) AS avg_canonical_rate,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY network_id
)
SELECT
network_id,
new.avg_pct_of_medicare_rate AS new_avg_pct_of_medicare_rate,
old.avg_pct_of_medicare_rate AS old_avg_pct_of_medicare_rate,
new.avg_canonical_rate AS new_avg_canonical_rate,
old.avg_canonical_rate AS old_avg_canonical_rate,
(new.avg_pct_of_medicare_rate - old.avg_pct_of_medicare_rate) / NULLIF(old.avg_pct_of_medicare_rate, 0) AS medicare_rate_pct_change,
(new.avg_canonical_rate - old.avg_canonical_rate) / NULLIF(old.avg_canonical_rate, 0) AS canonical_rate_pct_change,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count
FROM new
JOIN old USING (network_id)
WHERE (
ABS((new.avg_pct_of_medicare_rate - old.avg_pct_of_medicare_rate) / NULLIF(old.avg_pct_of_medicare_rate, 0)) > 0.1
OR ABS((new.avg_canonical_rate - old.avg_canonical_rate) / NULLIF(old.avg_canonical_rate, 0)) > 0.1
) AND (
new.roid_count > 500 AND old.roid_count > 500
)
ORDER BY ABS(medicare_rate_pct_change) DESC

4. Large ROID Count Swings (>10% change)

By Service Line

Count: 29 categories with significant ROID count changes

service_linenew_roid_countold_roid_countroid_count_changeroid_count_pct_change
Radiology100,675,63042,612,25758,063,373136.3%
Pulmonology10,084,0246,512,6183,571,40654.8%
Neurology24,221,46016,100,1548,121,30650.4%
Lab/Path55,764,17537,140,26818,623,90750.1%
Cardiovascular31,153,67220,848,83810,304,83449.4%
Transplant97,65567,02330,63245.7%
Ophthalmology18,656,40312,834,6825,821,72145.4%
Urology13,439,2449,256,9994,182,24545.2%
Gastrointestinal28,050,82419,585,2348,465,59043.2%
Dermatology31,312,51222,071,6659,240,84741.9%
Behavioral Health6,469,6334,573,6631,895,97041.5%
Infectious Disease30,564,59521,741,1578,823,43840.6%
Obstetrics8,721,3176,270,6932,450,62439.1%
Rehab7,898,3875,720,0232,178,36438.1%
MSK65,824,94247,815,95918,008,98337.7%
Consultative and Preventative Care12,829,0889,322,8713,506,21737.6%
Emergency996,117724,297271,82037.5%
Reproductive11,125,6218,094,6873,030,93437.4%
Trauma2,332,2141,698,602633,61237.3%
ENT16,506,82512,049,4524,457,37337.0%
Dental528,237386,407141,83036.7%
DME and Supplies2,529,3321,868,061661,27135.4%
Hematology2,333,7921,726,285607,50735.2%
Surgery101,42075,91125,50933.6%
Endocrinology2,252,1431,690,257561,88633.2%
Nephrology1,494,5261,123,458371,06833.0%
Anesthesia18,481,66613,991,4084,490,25832.1%
Oncology13,740,83510,422,0743,318,76131.8%
Diabetes376,663289,84186,82230.0%
Click to see SQL
WITH
new AS (
SELECT
service_line,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY service_line
),
old AS (
SELECT
service_line,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY service_line
)
SELECT
service_line,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (service_line)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY ABS(roid_count_pct_change) DESC

By Provider Type

Count: 5 categories with significant ROID count changes

provider_typenew_roid_countold_roid_countroid_count_changeroid_count_pct_change
Physician Group296,243,211168,018,318128,224,89376.3%
ASC21,462,46414,469,4096,993,05548.3%
Imaging Center4,037,4942,964,6291,072,86536.2%
Hospital308,325,250226,818,79381,506,45735.9%
Laboratory12,774,42811,292,0161,482,41213.1%
Click to see SQL
WITH
new AS (
SELECT
provider_type,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY provider_type
),
old AS (
SELECT
provider_type,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY provider_type
)
SELECT
provider_type,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (provider_type)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY ABS(roid_count_pct_change) DESC

By State

Count: 51 categories with significant ROID count changes

statenew_roid_countold_roid_countroid_count_changeroid_count_pct_change
WV3,336,2831,815,3301,520,95383.8%
WY1,347,471748,623598,84880.0%
CT5,291,4003,091,4022,199,99871.2%
AK983,206582,041401,16568.9%
SC7,208,5514,280,5482,928,00368.4%
NE5,840,9593,492,3942,348,56567.2%
DE1,491,596893,174598,42267.0%
MD7,783,0134,688,0203,094,99366.0%
KY8,712,0935,263,4353,448,65865.5%
UT2,873,4651,737,4531,136,01265.4%
DC4,558,2922,756,5421,801,75065.4%
NJ18,524,98011,208,3687,316,61265.3%
AL10,073,6976,203,2353,870,46262.4%
NV4,764,8582,936,7941,828,06462.2%
IN14,074,3608,680,2295,394,13162.1%
MS7,572,7224,696,3502,876,37261.2%
AZ12,429,5367,731,3204,698,21660.8%
CO9,385,6655,887,2813,498,38459.4%
OH22,519,97414,139,6938,380,28159.3%
ID4,227,2472,668,9221,558,32558.4%
LA14,012,1958,882,2365,129,95957.8%
NC16,550,39310,505,3996,044,99457.5%
FL34,509,78822,075,31012,434,47856.3%
OR8,377,3775,365,6783,011,69956.1%
RI1,539,821987,014552,80756.0%
KS9,091,4685,831,4383,260,03055.9%
VT760,033487,698272,33555.8%
GA18,478,09011,987,1796,490,91154.1%
MI19,479,73012,657,1716,822,55953.9%
TN13,466,4338,774,9084,691,52553.5%
OK9,969,4216,568,6593,400,76251.8%
MT2,714,5521,789,824924,72851.7%
NM2,809,6561,857,949951,70751.2%
IA9,131,6796,104,5133,027,16649.6%
AR7,084,2944,748,6202,335,67449.2%
MO14,243,9879,551,6524,692,33549.1%
PA27,955,67018,785,3089,170,36248.8%
IL22,161,55614,896,2857,265,27148.8%
WA14,281,0609,620,8034,660,25748.4%
TX58,053,64139,154,74118,898,90048.3%
WI13,219,9608,968,6304,251,33047.4%
NY51,810,34535,519,83716,290,50845.9%
ME3,254,0712,239,6161,014,45545.3%
VA15,746,17510,862,2264,883,94945.0%
ND1,983,4121,373,546609,86644.4%
CA63,867,47745,035,42518,832,05241.8%
NH3,280,8992,329,791951,10840.8%
SD2,838,8612,032,123806,73839.7%
MN12,672,9209,089,3973,583,52339.4%
MA14,871,79710,777,9754,093,82238.0%

Showing 50 of 51 total rows

Click to see SQL
WITH
new AS (
SELECT
state,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY state
),
old AS (
SELECT
state,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY state
)
SELECT
state,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (state)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY ABS(roid_count_pct_change) DESC

By Payer Network Name

Count: 117 categories with significant ROID count changes

payer_network_namenew_roid_countold_roid_countroid_count_changeroid_count_pct_change
HealthSmart Preferred PPO357,72760,019297,708496.0%
EmblemHealth GHI / Anthem CBP1,115,632272,868842,764308.9%
Regence Blue Cross Blue Shield OR PPO1,023,693387,412636,281164.2%
Kaiser Permanente Kaiser Health Plan Mid Atlantic144,764545,002-400,238-73.4%
Harvard Pilgrim Health Care Choicenet PPO316,0591,051,798-735,739-70.0%
Blue Cross Blue Shield of Rhode Island PPO77,723196,804-119,081-60.5%
Blue Cross Blue Shield of Nebraska Networkblue PPO711,405457,003254,40255.7%
Blue Cross Blue Shield of New Jersey (Horizon) OMNIA1,737,4061,121,341616,06554.9%
Kaiser Permanente Kaiser Health Plan (CO)265,726570,378-304,652-53.4%
Baylor Scott & White Health Plan PPO590,1511,115,539-525,388-47.1%
Blue Cross Blue Shield of New Jersey (Horizon) PPO2,113,3531,477,539635,81443.0%
Sanford Health Plan PPO536,633933,593-396,960-42.5%
Kaiser Permanente Kaiser Health Plan Northwest379,570618,318-238,748-38.6%
HealthLink PPO882,1011,410,318-528,217-37.5%
Mass General Brigham Health Plan Commercial PPO265,615193,74471,87137.1%
Blue Cross Blue Shield of Maryland & DC (CareFirst) Preferred Provider Network (PPO)1,455,3371,062,628392,70937.0%
Aetna NC HMO1,529,5481,125,285404,26335.9%
Ambetter HMO2,665,4561,966,175699,28135.6%
The Alliance Comprehensive Network241,054178,13762,91735.3%
Univera Healthcare PPO578,767428,710150,05735.0%
Capital Health Plan PPO24,16536,817-12,652-34.4%
HealthLink HMO876,4171,306,248-429,831-32.9%
Blue Cross Blue Shield of Wyoming PPO340,966257,04783,91932.6%
Avera Health Plans Avera Health99,381146,232-46,851-32.0%
Blue Cross Blue Shield of Illinois HMO645,863945,542-299,679-31.7%
Blue Cross Blue Shield of Maryland & DC (CareFirst) HMO954,624733,509221,11530.1%
Aetna VA HMO1,655,4991,281,449374,05029.2%
Blue Cross Blue Shield of New York (Excellus) Excellus Bluecross Blueshield1,576,8671,223,283353,58428.9%
Harvard Pilgrim Health Care HMO1,284,4391,010,603273,83627.1%
Sentara Health Plans HMO1,591,9211,253,703338,21827.0%
Sentara Health Plans PPO1,593,0241,255,468337,55626.9%
Premera Blue Cross Alaska Heritage Network250,460197,65652,80426.7%
Medical Mutual Of Ohio SuperMed572,380775,475-203,095-26.2%
Blue Cross Blue Shield of Pennsylvania (Independence) KHPE Commercial HMO/POS371,926499,911-127,985-25.6%
Blue Cross Blue Shield of North Carolina HMO345,526458,028-112,502-24.6%
EmblemHealth DC37 Med-Team1,845,6781,482,664363,01424.5%
Cigna NH HMO174,877231,409-56,532-24.4%
Cigna New England HMO1,022,2281,350,059-327,831-24.3%
Cigna NC HMO842,1421,110,403-268,261-24.2%
MVP Health Care HMO1,046,546843,362203,18424.1%
Cigna National OAP38,334,13650,351,926-12,017,790-23.9%
Aetna GA HMO1,635,8831,320,925314,95823.8%
Health Alliance Plan (HAP) HMO1,502,3931,221,641280,75223.0%
Aetna CA HMO5,206,9294,258,596948,33322.3%
Cigna NJ HMO704,877906,422-201,545-22.2%
Cigna ME HMO180,644232,032-51,388-22.1%
Anthem CT HMO464,336380,41683,92022.1%
Aetna IL HMO2,107,7381,727,526380,21222.0%
Anthem Blue Access Gated EPO2,337,4241,916,552420,87222.0%
Mass General Brigham Health Plan HMO938,454769,553168,90121.9%

Showing 50 of 117 total rows

Click to see SQL
WITH
new AS (
SELECT
payer_network_name,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY payer_network_name
),
old AS (
SELECT
payer_network_name,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY payer_network_name
)
SELECT
payer_network_name,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (payer_network_name)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY ABS(roid_count_pct_change) DESC

By Network + Canonical Rate Source (Check for New Pairs with 0 Rates)

Count: 10 categories with significant ROID count changes

payer_idpayer_namenetwork_namecanonical_rate_sourcen_oldn_new
42AnthemGHI / Anthem CBPimputation56,5710
97EmblemHealthGHI / Anthem CBPimputation33,9440
317Tufts Health PlanPPO MAimputation56,6080
456Blue Cross Blue Shield of MississippiPreferred Provider Networkimputation27,9430
636SelectHealthHMOpayer_hospital58,4570
42AnthemCA HMOimputation297,3360
42AnthemWI Blue Access PPOimputation128,7530
43Blue Cross Blue Shield of ArizonaHMOimputation22,1620
799QuartzQuartz Tiered Choice Plus (QHBPC WI): Quartzimputation108,5260
389Blue Cross Blue Shield of IllinoisHMOimputation320,8520
Click to see SQL
WITH
new AS (
SELECT
payer_id,
payer_name,
network_name,
canonical_rate_source,
count(distinct roid) AS n_new
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY 1,2,3,4
),
old AS (
SELECT
payer_id,
payer_name,
network_name,
canonical_rate_source,
count(distinct roid) AS n_old
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY 1,2,3,4
)
SELECT
payer_id,
payer_name,
network_name,
canonical_rate_source,
n_old,
COALESCE(n_new, 0) as n_new
FROM old
FULL OUTER JOIN new USING (payer_id, payer_name, network_name, canonical_rate_source)
ORDER BY COALESCE(n_new, 0) ASC
LIMIT 10

By Health System Name

Count: 783 categories with significant ROID count changes

provider_typehealth_system_namenew_roid_countold_roid_countroid_count_changeroid_count_pct_change
HospitalVibra Healthcare310,46448,607261,857538.7%
HospitalSelect Medical Corporation784,937180,131604,806335.8%
HospitalPAM Health338,214142,222195,992137.8%
Physician GroupBillings Clinic Health System135,32962,18273,147117.6%
HospitalScionHealth1,003,070462,008541,062117.1%
Physician GroupWVU Medicine138,29364,82673,467113.3%
Physician GroupAppalachian Regional Healthcare143,10367,49675,607112.0%
Physician GroupBryan Health190,97092,33298,638106.8%
Physician GroupAsante138,95468,43370,521103.1%
HospitalMosaic Life Care204,446101,392103,054101.6%
HospitalSpaulding Rehabilitation Network100,51850,62349,89598.6%
Physician GroupSt Charles Health System146,26875,95770,31192.6%
Physician GroupSSM Health in Wisconsin117,06860,83456,23492.4%
Physician GroupMarshall Health Network112,57058,62753,94392.0%
Physician GroupThedaCare142,19074,93667,25489.7%
HospitalMon Health102,46654,11548,35189.3%
HospitalPhysicians Regional Healthcare System210,405111,56898,83788.6%
Physician GroupNovant Health464,100247,065217,03587.8%
Physician GroupProvidence Health & Services - Oregon and Southwest Washington268,990143,978125,01286.8%
Physician GroupAscension Wisconsin315,746169,744146,00286.0%
Physician GroupSUNY Upstate Medical University217,664117,87399,79184.7%
Physician GroupBaptist Health322,687175,005147,68284.4%
Physician GroupParkview Health144,05978,47465,58583.6%
Physician GroupLifeBridge Health200,001108,98791,01483.5%
Physician GroupNorton Healthcare102,48655,94746,53983.2%
Physician GroupBellin Health490,024267,660222,36483.1%
HospitalWellstar MCG Health301,074164,690136,38482.8%
Physician GroupGuthrie Clinic112,19861,46750,73182.5%
Physician GroupTMC Health138,16575,78962,37682.3%
Physician GroupIntermountain Health462,347253,653208,69482.3%
Physician GroupHartford HealthCare442,089242,651199,43882.2%
Physician GroupDeaconess Health System233,243128,085105,15882.1%
Physician GroupAdventist Health Hanford151,76883,77567,99381.2%
Physician GroupBon Secours Health System232,175128,187103,98881.1%
Physician GroupPowers Health112,18862,16150,02780.5%
Physician GroupAdventHealth641,716355,878285,83880.3%
Physician GroupCommonSpirit Health131,42373,14458,27979.7%
Physician GroupIndiana University Health116,72265,07151,65179.4%
Physician GroupSurgery Partners107,02459,77747,24779.0%
Physician GroupLegacy Health119,83967,01152,82878.8%
Physician GroupCooper University Health281,628157,516124,11278.8%
Physician GroupAtlantic Health System229,021128,397100,62478.4%
HospitalCape Fear Valley Health System202,751113,93888,81377.9%
Physician GroupAllegheny Health Network202,675114,12088,55577.6%
Physician GroupProvidence Health & Services - Washington112,05363,48948,56476.5%
Physician GroupUCHealth177,167100,45676,71176.4%
HospitalInfirmary Health System218,721124,07694,64576.3%
Physician GroupSt Lukes Health System165,09893,89371,20575.8%
Physician GroupPeaceHealth510,377290,379219,99875.8%
Physician GroupProMedica Health System317,818181,856135,96274.8%

Showing 50 of 783 total rows

Click to see SQL
WITH
new AS (
SELECT
provider_type,
health_system_name,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY 1,2
),
old AS (
SELECT
provider_type,
health_system_name,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY 1,2
)
SELECT
provider_type,
health_system_name,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (provider_type, health_system_name)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
AND (
new.roid_count > 100000 OR old.roid_count > 100000
)
ORDER BY ABS(roid_count_pct_change) DESC

By Canonical Rate Score

Count: 4 categories with significant ROID count changes

canonical_rate_scorenew_roid_countold_roid_countroid_count_changeroid_count_pct_change
3329,745,102203,570,381126,174,72162.0%
279,896,63250,552,09629,344,53658.0%
4189,350,804137,012,36152,338,44338.2%
543,850,30932,428,32711,421,98235.2%
Click to see SQL
WITH
new AS (
SELECT
canonical_rate_score,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_rate_score
),
old AS (
SELECT
canonical_rate_score,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_rate_score
)
SELECT
canonical_rate_score,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (canonical_rate_score)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY ABS(roid_count_pct_change) DESC

By Canonical Rate Score and Provider Type

Count: 15 categories with significant ROID count changes

provider_typecanonical_rate_scorenew_roid_countold_roid_countroid_count_changeroid_count_pct_change
ASC421,047,56914,078,3606,969,20949.5%
Hospital537,675,25327,187,60610,487,64738.6%
Hospital4160,789,302117,210,18643,579,11637.2%
Hospital222,141,00716,435,6485,705,35934.7%
Hospital387,719,68865,985,35321,734,33532.9%
Imaging Center44,037,1492,964,2151,072,93436.2%
Imaging Center3268325-57-17.5%
Imaging Center27789-12-13.5%
Laboratory4685,652589,27196,38116.4%
Laboratory34,573,1623,951,273621,88915.7%
Laboratory55,861,8315,170,508691,32313.4%
Physician Group5313,22570,213243,012346.1%
Physician Group3237,209,780133,407,892103,801,88877.8%
Physician Group255,929,07432,369,88423,559,19072.8%
Physician Group42,791,1322,170,329620,80328.6%
Click to see SQL
WITH
new AS (
SELECT
provider_type,
canonical_rate_score,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY provider_type, canonical_rate_score
),
old AS (
SELECT
provider_type,
canonical_rate_score,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY provider_type, canonical_rate_score
)
SELECT
provider_type,
canonical_rate_score,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (provider_type, canonical_rate_score)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY provider_type, ABS(roid_count_pct_change) DESC

By Canonical Rate Class

Count: 3 categories with significant ROID count changes

canonical_rate_classnew_roid_countold_roid_countroid_count_changeroid_count_pct_change
Raw513,920,816326,470,730187,450,08657.4%
Impute94,980,88070,612,08624,368,79434.5%
Transform33,941,15126,480,3497,460,80228.2%
Click to see SQL
WITH
new AS (
SELECT
canonical_rate_class,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_rate_class
),
old AS (
SELECT
canonical_rate_class,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_rate_class
)
SELECT
canonical_rate_class,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (canonical_rate_class)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY ABS(roid_count_pct_change) DESC

By Canonical Rate Source

Count: 4 categories with significant ROID count changes

canonical_rate_sourcenew_roid_countold_roid_countroid_count_changeroid_count_pct_change
payer414,135,609257,041,952157,093,65761.1%
hospital89,876,04963,480,80026,395,24941.6%
payer_hospital43,850,30932,428,32711,421,98235.2%
imputation94,980,88070,612,08624,368,79434.5%
Click to see SQL
WITH
new AS (
SELECT
canonical_rate_source,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_rate_source
),
old AS (
SELECT
canonical_rate_source,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_rate_source
)
SELECT
canonical_rate_source,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (canonical_rate_source)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY ABS(roid_count_pct_change) DESC

By Canonical Contract Methodology

Count: 5 categories with significant ROID count changes

canonical_contract_methodologynew_roid_countold_roid_countroid_count_changeroid_count_pct_change
Fee Schedule377,413,105229,527,061147,886,04464.4%
Unknown23,370,46216,829,9686,540,49438.9%
Case Rate119,669,70687,402,93832,266,76836.9%
Percent of Total Billed Charges117,880,42486,292,03031,588,39436.6%
Per Diem4,509,1503,511,168997,98228.4%
Click to see SQL
WITH
new AS (
SELECT
canonical_contract_methodology,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_contract_methodology
),
old AS (
SELECT
canonical_contract_methodology,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_contract_methodology
)
SELECT
canonical_contract_methodology,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (canonical_contract_methodology)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY ABS(roid_count_pct_change) DESC

By Canonical Crosswalk Method

Count: 8 categories with significant ROID count changes

canonical_crosswalk_methodnew_roid_countold_roid_countroid_count_changeroid_count_pct_change
Crosswalked From CSTM-ALL to MS-DRG1,227,480617,095610,38598.9%
Crosswalked From CSTM-ALL to APR-DRG1,422,072716,902705,17098.4%
Crosswalked From CSTM-ALL to HCPCS20,340,64512,180,0658,160,58067.0%
Crosswalked From MS-DRG to APR-DRG26,399,68919,166,6237,233,06637.7%
Crosswalked From RC-FAMILY to APR-DRG1,140,096916,018224,07824.5%
Crosswalked From RC-FAMILY to MS-DRG837,809695,804142,00520.4%
Crosswalked From NDC to HCPCS950,5881,192,692-242,104-20.3%
Crosswalked From APC to HCPCS7,987,2706,706,2571,281,01319.1%
Click to see SQL
WITH
new AS (
SELECT
canonical_crosswalk_method,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_crosswalk_method
),
old AS (
SELECT
canonical_crosswalk_method,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_crosswalk_method
)
SELECT
canonical_crosswalk_method,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (canonical_crosswalk_method)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY ABS(roid_count_pct_change) DESC

By Canonical Gross Charge Type

Count: 6 categories with significant ROID count changes

canonical_gross_charge_typenew_roid_countold_roid_countroid_count_changeroid_count_pct_change
mrf_gross_charge_cbsa_median30,144,74220,677,1349,467,60845.8%
mrf_gross_charge_provider71,356,96751,301,04420,055,92339.1%
mrf_gross_charge_state_median131,887,83397,588,55234,299,28135.1%
komodo_gross_charge_provider2,486,3071,874,765611,54232.6%
komodo_gross_charge_state_median15,094,45311,908,0673,186,38626.8%
komodo_gross_charge_cbsa_median2,717,2312,251,854465,37720.7%
Click to see SQL
WITH
new AS (
SELECT
canonical_gross_charge_type,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_1.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_gross_charge_type
),
old AS (
SELECT
canonical_gross_charge_type,
COUNT(DISTINCT roid) AS roid_count
FROM tq_dev.internal_dev_csong_cld_v2_4_0.prod_combined_abridged
WHERE canonical_rate_score > 1
AND network_type != 'NARROW'
AND network_class = 'Commercial'
GROUP BY canonical_gross_charge_type
)
SELECT
canonical_gross_charge_type,
new.roid_count AS new_roid_count,
old.roid_count AS old_roid_count,
(new.roid_count - old.roid_count) AS roid_count_change,
(new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0) AS roid_count_pct_change
FROM new
JOIN old USING (canonical_gross_charge_type)
WHERE ABS((new.roid_count - old.roid_count) * 1.0 / NULLIF(old.roid_count, 0)) > 0.1
ORDER BY ABS(roid_count_pct_change) DESC