Insurer negotiated rates

CMS Transparency in QHP Coverage PUF — partial Individual QHP serving derivative

medicare_silver.fact_tc_puf_issuer_claims·live·silver·Individual Exchange

Rows

25,666

Columns

History

N/A

Card

nocolumns only

Typed tools

What it is

1A 25,666-row partial derivative of the CMS CCIIO Transparency in QHP Coverage PUF: only the Individual QHP tabs from publication years 2022-2026.
2Those publications contain measurement data from 2020-2024 respectively.
3Do not treat plan_year as the measure year, aggregate repeated issuer measures across plans, or publish payer rankings until denominator and suppression semantics pass review.

Grain

Key	Grain
N/A	1Partial table: one Individual-QHP row per (publication-year label stored as plan_year, 14-character Plan_ID); issuer-level measures repeat across plan rows.

Columns (60)

Column	Type	Meaning
`plan_year`	int
`individual_shop`	string
`exchange_type`	string
`state`	string
`issuer_name`	string
`issuer_id`	string
`sadp_only`	string
`plan_id`	string
`plan_type`	string
`qhp_or_sadp`	string
`metal_level`	string
`is_issuer_new_to_exchange`	string
`url_claims_payment_policies`	string
`rate_review_url`	string
`financial_information_url`	string
`claims_received_oon`	double
`claims_received_in`	double
`claims_denied_oon`	double
`claims_denied_in`	double
`claims_resubmitted_oon`	double
`claims_resubmitted_in`	double
`internal_appeals_filed`	double
`internal_appeals_overturned`	double
`pct_internal_appeals_overturned`	double
`external_appeals_filed`	double
`external_appeals_overturned`	double
`pct_external_appeals_overturned`	double
`avg_monthly_enrollment`	double
`avg_monthly_disenrollment`	double
`plan_claims_received_oon`	double
`plan_claims_received_in`	double
`plan_claims_denied_oon`	double
`plan_claims_denied_in`	double
`plan_claims_resubmitted_oon`	double
`plan_claims_resubmitted_in`	double
`plan_denied_referral_required`	double
`plan_denied_out_of_network`	double
`plan_denied_services_excluded`	double
`plan_denied_not_med_nec`	double
`plan_denied_not_med_nec_bh`	double
`plan_denied_benefit_limit`	double
`plan_denied_member_not_covered`	double
`plan_denied_investigational`	double
`plan_denied_administrative`	double
`plan_denied_other`	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

Query it

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

Item	Value
Typed tools that read it	none; raw SQL
Identity key	`plan_year,plan_id`
Join	`how_to_join(source_fqn="medicare_silver.fact_tc_puf_issuer_claims")`
Raw door	Athena (read-only via query_substrate): medicare_silver.fact_tc_puf_issuer_claims
Company names	`issuer_name` resolve to a permanent Vlada ID: `resolve_entity(text=<name>)`; the company pages hold owners and holdings
Note	Iceberg table remains live and unchanged. The canonical manifest-driven runner is now no-write certification only; production execution is disabled pending a lossless history writer and semantic review.

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