How it works and where the figures come from

The filings

Since July 2022, the federal Transparency in Coverage rule has required commercial health plans to publish the rates they have agreed with every in-network provider. Insurers post these as very large machine-readable files and update them each month. In those files the insurer is called the payer; on our pages we say insurer.

The group health plan or health insurance issuer must clearly indicate the date that the files were most recently updated.

From the federal rule

What Practice Signal reads

Practice Signal reads each insurer's files, keeps an exact copy, and records the file name and the date the insurer gave it. Nothing is typed in by hand.

Reading every Minnesota insurer's new files each month. ComingComing: not available yet

How practices are grouped

Practices appear in the filings under the tax ID they bill with. Practice Signal matches each one to the national registry of health care providers to learn where it is. You are compared with practices near you first; where too few are nearby, the area widens to your metro area or the state, and the screen says which.

Comparison by license level, so you see practices whose clinicians hold the same license as yours. ComingComing: not available yet

Why some cells say too few practices

When too few practices near you have a rate for a code, Practice Signal says so instead of showing a figure. With very few practices, a figure could point to one of them, so we show none.

Other reasons a figure can be missing

One practice dominates ComingComing: not available yet

Where one practice holds most of the rates nearby, named practices are not shown, so no view points to that one practice.

Held this month

When an insurer's newest file is held for review, the screen keeps last month's figures, marked with that month, until the hold is cleared.

Unavailable

When there is no usable file for an insurer, the cell reads Unavailable. Nothing is filled in by guessing, and no other area or code stands in.

What every figure shows

The insurer, the billing code, the area it was compared within, and the filing it came from with its date. If an insurer's file carries no date, the screen says which month's file it was seen in instead.

What Practice Signal never shows or collects

• It never shows a named clinician's rate.
• It never says what you should be paid.
• It never needs to know what you are paid. There is nowhere to enter a rate, a contract or a payment statement.
• It never stores patient information. None of the data is about patients.
• Where it shows a practice's public ratings, it keeps the rating and the count, never the text of a review. ComingComing: not available yet
• It never shares your account or what you look at with other practices.

The filing is the source

Every figure is the insurer's own published figure, named with its file and date. Practice Signal does not adjust or estimate it. A filed rate is what the insurer published, not a record of claims paid and not your contract, and an insurer's file can contain mistakes. When a decision depends on a figure, check the cited file.

Practice Signal is not affiliated with any insurer.

Sources

• Insurer rate filings under the federal Transparency in Coverage rule: in effect, each insurer's fee schedule for its in-network providers, published by the insurer and updated monthly.
• The national registry of health care providers, kept by the federal government, for practice locations and clinician licenses.
• A page listing each insurer's file status this month and the number of practices in each file. ComingComing: not available yet

Words used on these pages

Each word as Practice Signal uses it.

Insurer

A health plan company. Its files list the rates it has agreed with in-network providers.

Rate file

A large machine-readable file an insurer publishes under the federal rule, listing those rates.

Filed rate

The rate an insurer lists for a practice and a billing code. It is not a record of claims paid and not your contract.

Billing code

The code a practice puts on a claim to name the service, such as an hour of psychotherapy.

Tax ID

The number a practice bills insurers under. Practices appear in the filings by tax ID.

Practices near you

Practices in your area. When too few are nearby, the area widens and the screen names the area used.

Practices you follow

Practices you choose to see beside yours, each as a whole practice, never one clinician.

License level ComingComing: not available yet

The kind of license a clinician holds. Comparison by license level is coming.

Too few practices

Shown when there are not enough practices nearby to give a figure without pointing to one of them.