Insurer negotiated rates

CMS Federal IDR (No Surprises Act) Determinations — OON arbitration fair price

medicare_silver.fact_idr_determination·live·silver

Rows

8,233,903

Columns

History

N/A

Card

nocolumns only

Typed tools

What it is

1The CMS Federal Independent Dispute Resolution (No Surprises Act) OON Emergency and Non-Emergency line-item PUF.
2It reports who prevailed and provider, plan, and prevailing offers as a percentage of QPA by service code, place of service, location, specialty, practice size, and plan type.
3Air Ambulance and QPA/Offers are separate accepted grains.

Grain

Key	Grain
N/A	1One row per OON dispute line item (year, quarter, row_seq) — outcome + offers as % of QPA.

Columns (77)

Column	Type	Meaning
`year`	int
`quarter`	int
`row_seq`	bigint
`dispute_number`	string
`dli_number`	string
`payment_determination_outcome`	string
`default_decision`	string
`type_of_dispute`	string
`provider_group_name`	string
`provider_name`	string
`provider_npi`	string
`practice_size`	string
`health_plan_name`	string
`health_plan_type`	string
`dispute_line_item_type`	string
`type_of_service_code`	string
`service_code`	string
`place_of_service_code`	string
`item_description`	string
`location_of_service`	string
`specialty`	string
`offer_selected_from`	string
`initiating_party`	string
`time_to_determination_days`	double
`idre_compensation`	double
`provider_offer_pct_qpa`	double
`health_plan_offer_pct_qpa`	double
`prevailing_offer_pct_qpa`	double
`qpa_pct_of_median_qpa`	double
`observed_period`	date
`asserted_at`	date
`effective_period_start`	date
`effective_period_end`	date
`cms_vintage_sequence`	int
`parse_revision`	int
`parser_artifact_hash`	string
`source_url`	string
`sha256_content_hash`	string
`source_id`	string
`is_current`	boolean
`bronze_object_key`	string
`s3_version_id`	string
`vintage_tag`	string
`drug_source_version_id`	string
`provider_email_domain`	string
`health_plan_email_domain`	string
`service_code_modifiers`	string
`certified_idr_entity`	string
`time_to_determination_days_source_value`	string
`time_to_determination_days_status`	string
`idre_compensation_source_value`	string
`idre_compensation_status`	string
`provider_offer_pct_qpa_source_value`	string
`provider_offer_pct_qpa_status`	string
`health_plan_offer_pct_qpa_source_value`	string
`health_plan_offer_pct_qpa_status`	string
`prevailing_offer_pct_qpa_source_value`	string
`prevailing_offer_pct_qpa_status`	string
`qpa_pct_of_median_qpa_source_value`	string
`qpa_pct_of_median_qpa_status`	string
`provider_offer_pct_median_provider_offer`	double
`provider_offer_pct_median_provider_offer_source_value`	string
`provider_offer_pct_median_provider_offer_status`	string
`health_plan_offer_pct_median_health_plan_offer`	double
`health_plan_offer_pct_median_health_plan_offer_source_value`	string
`health_plan_offer_pct_median_health_plan_offer_status`	string
`prevailing_offer_pct_median_prevailing_offer`	double
`prevailing_offer_pct_median_prevailing_offer_source_value`	string
`prevailing_offer_pct_median_prevailing_offer_status`	string
`date_of_initiation`	date
`date_of_initiation_source_value`	string
`date_of_initiation_status`	string
`source_member`	string
`source_row_number`	bigint
`source_member_crc32`	string
`quality_flags`	string
`is_analytics_eligible`	boolean

Query it

describe_data_source(source_fqn="medicare_silver.fact_idr_determination")     # the card, live
query_substrate(sql="SELECT * FROM medicare_silver.fact_idr_determination WHERE <filter> LIMIT 100")

Item	Value
Typed tools that read it	none; raw SQL
Identity key	`provider_npi`
Join	`how_to_join(source_fqn="medicare_silver.fact_idr_determination")`
Raw door	Athena (read-only via query_substrate): medicare_silver.fact_idr_determination
Note	Iceberg medicare_silver.fact_idr_determination, partition by (year, quarter); bulk-load (append_buffered per 200k chunk -> flush_buffered_replace_partitions per quarter, atomic). row_seq makes each line-item row unique.

This page as markdown: /docs-md/data/medicare_silver_fact_idr_determination.md · every page in one file: /llms-full.txt