health insurance

Part 1: Turning Machine Readable into Human Readable 🤖

Unpack price transparency in coverage files to give you and your employees new insight into the interworkings of your health plan(s).

Beep boop. Boop-boop-beep. Beepity-boop. Boop-boop. Beep-boop. Beep-beep-boop.

Oh, you're not a machine? Well, the CMS should have remembered that when developing their price transparency in coverage (TIC) guidelines. Fear not, if you're looking to make the most of the recent regulation changes to enable your employees to be better consumers of healthcare, here's part 1 of a guide on how to turn "machine-readable" files into "human-readable" files.

First, we need to locate your machine-readable file(s). Your broker or insurance advisor most likely gave you a link to post on your website earlier this year to meet the employer requirements of the new TIC regulations. Highmark Blue Shield is the largest insurer in our area (Central Pennsylvania). If you have coverage through Highmark, you can use this link to follow along in this guide.

Highmark owns multiple health plans and does back-office works for many other health plans. Because of this, we need to select the appropriate carrier from the list on the screen. In our case, we'll choose Highmark Blue
 Shield Pennsylvania.

When you choose Highmark Blue Shield Pennsylvania, a file will be downloaded to your device. The file will be named "date"_"carrier".json. In our case, our file's name is "2023-07-01_Highmark_Blue_Shield_of_Pennsylvania_index.json". JSON files can be a bit tricky to parse through without a code editor to assist with visual formatting. If you don't have a code editor, I recommend Visual Studio Code which is free and can be downloaded here.

We're in, now what? We now need to search through the file, using your business's EIN, to find all of the applicable networks and each network's in-network files. At first the files can be overwhelming to look at, but they follow a simple convention that makes it easier to get your head around what's going on. The convention is as follows:

"reporting_entity_name" : "Highmark Blue Shield Pennsylvania" ,
"reporting_entity_type" : "Health Insurance Issuer" ,
"reporting_structure" : [
"reporting_plans" : [ ... ],
"in_network_files" : [ ... ],
"allowed_amount_file" : { ... }

To get started, Command + F and enter your EIN. Your EIN is most likely associated with 2-5 networks or groupings of { "reporting_plans": [ ... ], "in_network_files": [ ... ], "allowed_amount_file": { ... } } so you should see multiple results. Once your find your EIN within a "reporting_plans" code block, scroll down to the "in_network_files" code block to find hyperlinks to all of that networks in-network negotiated rate files. From here you can copy and paste your applicable links in a new file and repeat this process for each network.

If that sounds like a lot of works it's because it is. To simplify the process we've created a Google Colab notebook to do the work for you. Access the Colab notebook here, click on the file icon with the up arrow and upload your file (in our case 2023-07-01_Highmark_Blue_Shield_of_Pennsylvania_index.json), within the code snippet, change
filename and EIN to be the name of your file and the EIN of your business and press run (the button with the play icon to the left of "import json"). Once done running (it should only take a few seconds), click on the file folder icon with the refresh loop and you'll see a new file available to you. Download the new file and open it with Visual Studio Code to access all of the links to your in-network negotiated rate for each of your networks.

You now have an easy method to find and access all of your in-network negotiated rate files. In my next post I'll walk you through how to turn these links into workable material. Stay tuned! 

*If for some reason you aren't getting results it may be because your carrier has your incorrect EIN on file. This happen with a few of our clients and, unfortunately, is a common occurrence. Reach out to your broker or carrier account executive to verify the EIN they have on record for your business and try again.


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