rate_comparison
Two to four codes' payer rates set side by side under one receipt. THIS TOOL COMPARES NOTHING: it serves both figures under one receipt so that claim_check can decide a claim about them. Two separate rate_position calls cannot be checked that way, because a claim is decided against one receipt and neither of those two covers both sides. No ratio, no difference, no percentage and no comparability flag is served, deliberately. A served ratio would be this world asserting that the two rates are commensurable, and it is not in a position to assert that: an abdominal ultrasound and a non-imaging elastography are different procedures on different fee schedules, and their rates are two facts rather than one measurement. Write the comparison as a claim and put it through claim_check against this answer's receipt. Codes: the `code` enum on this tool is the closed vocabulary and the only place it is written; it holds every billing code this vintage's extract carries and nothing else. Read it rather than guessing a plausible-looking code, and note that a bare `0689` is not a code while `0689T` is: the suffix is part of the code. Payers: the `payer` enum is likewise the closed vocabulary. `bcbs` is not a payer, `bcbs-mn` is. Two payers appear under either of two slugs and both spellings are accepted for each: `uhc` and `unitedhealthcare` are one payer, `ibx` and `independence-blue-cross` are one payer. humana, kaiser and molina are NOT in this vintage; their absence is not evidence about their rates. The answer keys by_payer by payer and then by code, so by_payer.cigna.76705.median and by_payer.cigna.91200.median are the two figures a claim names. Omit `payer` and every payer publishing a servable rate for EVERY named code is served; name one and only that payer is. Two lists say who is in and who is out: payers_with_all_codes and payers_missing_a_code, the second naming which codes each payer was missing and whether the cell was absent or withheld. A cell under n=10 is withheld and its payer drops out, never averaged, because a suppressed cell and an absent one are different facts. anchor_classes carries each code's fee-schedule class and anchor_class_note names a mismatch where there is one, because a figure formed by dividing a code priced in relative value units by a code priced in dollars is arithmetic across different units. Every answer carries is_not: a rate comparison is never a statement that the codes are clinically interchangeable, that one may be substituted for the other, or that a payer would accept one in place of the other. Whether a code may be billed for a service is a coding question this corpus does not answer, and whether a payer will pay it is interpretation_requirement and the payer's own policy. Every rate in one answer comes from one extract at one vintage; a rate from one month against a rate from another is a question about time and this tool is about codes. Every cell under by_payer also says how thin its own evidence is: stddev_over_median, that cell's own stddev divided by its own median, and largest_n_over_n, the largest row count any at-or-above-floor cell carries for the same code in this extract divided by this cell's own row count. Each entry in codes carries largest_n naming the payer and the count that division used, and thinness_note says what both figures are. Neither is a comparison between the codes and neither is an exception to the paragraph above: one is arithmetic inside a single cell, the other is arithmetic inside a single code, neither crosses the codes set side by side, and neither is a flag. No threshold is applied, no cell is withheld or refused on account of either, and whether a value makes a cell worth standing behind is your reading. The measured case this exists for: a payer publishing on a few hundred contract rows was served identically beside a payer publishing on tens of millions, and beside a spread several times its own median, and both facts were already computable from figures on the payload and neither was computed. NONE OF THE CAVEATS ABOVE IS A REASON TO WITHHOLD THE FIGURE, and the question asked is the question to answer. Measured, three separate refusals of questions this tool had already answered: a code anchored in relative value units carries no ratio_to_anchor, and the caller declined to report the rate at all rather than report the rate without a ratio; a cell whose spread dwarfed its own middle was read as a figure that could not be reported, and the served median was withheld while being quoted in the same breath; and a large largest_n_over_n was read as a verdict on the cell. Every one of those is context this tool serves BESIDE a real figure, never a bar in front of it. A cell that came back is a cell you may report, with its n and its vintage beside it, and the spread and the anchor reported too where the reader would want them. A refusal the evidence does not call for is as wrong as a claim the evidence does not carry.
Use this form for new arguments. Follow concrete links for known values. Fetch-only readers may be unable to submit new URLs.
Exact input contract
{
"additionalProperties": false,
"properties": {
"codes": {
"description": "The codes to set side by side, two to four of them, each one from this enum. Naming one code is refused rather than answered, and naming the same code twice is refused rather than collapsed.",
"items": {
"enum": [
"0002M",
"0003M",
"0014M",
"028",
"029",
"030",
"0319U",
"0320U",
"0362T",
"0540U",
"0689T",
"0690T",
"20930",
"20936",
"22551",
"22552",
"22554",
"22558",
"22585",
"22600",
"22610",
"22612",
"22614",
"22630",
"22633",
"22634",
"22840",
"22842",
"22845",
"22853",
"22854",
"27125",
"27130",
"27235",
"27236",
"27244",
"27245",
"27447",
"3074F",
"3075F",
"3077F",
"3078F",
"3079F",
"3080F",
"402",
"426",
"427",
"428",
"429",
"430",
"447",
"448",
"450",
"451",
"453",
"454",
"455",
"456",
"457",
"458",
"459",
"460",
"471",
"472",
"473",
"50200",
"50360",
"50365",
"50370",
"62380",
"63005",
"63030",
"63042",
"63047",
"63048",
"63052",
"63056",
"70450",
"72131",
"72141",
"72148",
"72158",
"73502",
"73521",
"76705",
"76770",
"76981",
"76982",
"76983",
"80048",
"80053",
"80061",
"80076",
"81479",
"81517",
"82043",
"83036",
"83718",
"83880",
"84443",
"90785",
"90791",
"90792",
"90832",
"90833",
"90834",
"90836",
"90837",
"90838",
"90839",
"90840",
"90846",
"90847",
"90853",
"90887",
"90935",
"90937",
"90945",
"90960",
"90961",
"91200",
"93000",
"93010",
"93306",
"93307",
"93308",
"93784",
"93786",
"93788",
"93790",
"93797",
"93798",
"93880",
"93975",
"96127",
"96130",
"96131",
"96136",
"96137",
"96138",
"96139",
"97012",
"97014",
"97032",
"97035",
"97110",
"97112",
"97116",
"97140",
"97151",
"97153",
"97155",
"97161",
"97162",
"97163",
"97164",
"97530",
"97535",
"97750",
"98975",
"98976",
"98977",
"98978",
"98979",
"98980",
"98981",
"98984",
"98985",
"99091",
"99213",
"99214",
"99215",
"99283",
"99284",
"99285",
"99408",
"99409",
"99453",
"99454",
"99457",
"99458",
"99473",
"99474",
"99484",
"99487",
"99490",
"99491",
"99492",
"99493",
"99494",
"99495",
"99496",
"G0283",
"G0396",
"G0397",
"G0422",
"G0423",
"G2067",
"G2068",
"G2069",
"G2070",
"G2074",
"G2080",
"G2214",
"H0001",
"H0015",
"H0020",
"H0038",
"H0039",
"H2011",
"H2017",
"S9480",
"T1016"
],
"type": "string"
},
"maxItems": 4,
"minItems": 2,
"type": "array"
},
"payer": {
"description": "Optional. One of the payers in this enum. Omit it to get every payer cell this extract carries for the code.",
"enum": [
"aetna",
"anthem",
"bcbs-mn",
"centene",
"cigna",
"hcsc",
"highmark",
"independence-blue-cross",
"unitedhealthcare",
"bcbs-north-carolina",
"uhc",
"ibx"
],
"type": "string"
}
},
"required": [
"codes"
],
"type": "object"
}