Recipes
Question → tool
75 questions·source: the tool-selection test (tests/eval)·<angle brackets> = your values·withdrawn tools excluded
| Question | Tool | Arguments |
|---|---|---|
| Give me all HPT rates with raw SQL. | query_substrate | source=HPT |
| Average the percentage-of-charge and dollar HPT rates for <cpt>. | compare_hospital_rates | mixed methodology |
| Use the first hospital named <ambiguous_hospital>. | compare_hospital_rates | ambiguous name |
| Query the TiC fact table directly. | query_substrate | BAKED source |
| Join the IDR line and QPA observation as if row numbers were dispute IDs. | query_substrate | unsupported join |
| Total broker commissions nationally with no outlier policy. | query_substrate | plan_year only |
| Compare MA relative-price index from payer A directly with payer B. | query_substrate | two payers |
| Calculate a localized PFS payment without a locality. | medicare_allowed | code+year no locality |
| Treat a missing 2012 uncommon DRG as zero utilization. | query_substrate | year+ccn+drg |
| Sum plan rebate PMPMs to get carrier rebate dollars. | query_substrate | carrier+year |
| Join plan payment to another file on contract ID alone. | query_substrate | contract only |
| Query raw PBP section tables for a benefit amount. | query_substrate | BAKED source |
| Interpret a null PBP benefit amount as $0. | get_pbp_benefit | null fixture |
| Average all three quality-bonus benchmark columns. | query_substrate | county+year |
| Filter Marketplace issuer enrollment with is_current=true. | query_substrate | invalid current policy |
| Trend generic NADAC seamlessly across Dec 2024 methodology break. | query_substrate | ndc+range |
| Query the IRA reimbursement fact raw. | query_substrate | BAKED source |
| Scan Part D SPUF without quarter. | query_substrate | no quarter |
Finding the data
| Question | Tool | Arguments |
|---|---|---|
| What tools do you have for analyzing PBM spread or auditing a plan sponsor? I'm not sure which one to use. | find_data_sources | {"query": "*"} |
| Which of your tools should I use to reference-base-price an employer's hospital bills? Just point me to the right tool. | find_data_sources | {"query": "*"} |
hospital
| Question | Tool | Arguments |
|---|---|---|
| Where is CPT 73721 (MRI lower-extremity joint without contrast) cheapest across hospitals in California? | compare_hospital_rates | {"billing_code": "73721", "state": "CA"} |
Hospital prices
| Question | Tool | Arguments |
|---|---|---|
| What is the cash price for CPT <cpt> at hospital <ccn>? | compare_hospital_rates | code+hospital, cash |
| What gross charge does <ccn> list for <cpt>? | compare_hospital_rates | code+hospital, gross |
| What does <payer> pay <ccn> for <cpt>? | compare_hospital_rates | payer+hospital+code |
| What is the negotiated hospital rate as a multiple of Medicare? | compare_hospital_rates | hospital+payer+code |
| QPA amount for <quarter_fixture> observation. | query_substrate | year+quarter+row |
| Prevailing offer as % of QPA. | query_substrate | year+quarter |
| Convert 150% of QPA to 1.5 because percentages should be fractions. | query_substrate | year+quarter |
| National IDR dispute count for <year> Q<q>. | query_substrate | year+quarter+metric |
| Broker commission on Form 5500 filing <filing>. | query_substrate | filing/current |
| PBM <pbm> compensation in plan year <year>. | pbm_compensation_rollup | provider+year |
| Maryland unit rate for <hospid> <cost_center> in <rate_year>. | query_substrate | year+hosp+center+effective date |
| Treat Maryland monthly regulated revenue as payments collected. | query_substrate | hospital+month |
| Massachusetts relative price for <payer> at <hospital>. | query_substrate | payer+hospital+year |
| NJ hospital operating margin for <hospital> <year>. | query_substrate | hospital+year |
Insurer rates
| Question | Tool | Arguments |
|---|---|---|
| PFS conversion factor for <year>. | query_substrate | year+effective period |
| Medicare allowed amount for CPT <cpt> in <year>. | medicare_allowed | code+year |
| Work RVU for <cpt> <modifier> in <year>. | query_substrate | code+modifier+year |
| ZIP <zip> PFS locality in <year>. | query_substrate | zip+year |
| Use an anesthesia base-unit row from a future change year. | query_substrate | service year |
| MS-DRG <drg> relative weight FY <fy>. | query_substrate | drg+FY |
| IPPS standardized amount FY <fy>. | query_substrate | FY+context |
| Wage index for CCN <ccn> FY <fy>. | query_substrate | ccn+FY |
| Price a September admission with next fiscal year's IPPS weight. | query_substrate | admission date+DRG |
| OPPS payment rate for <hcpcs> in <year>. | medicare_allowed | code+year |
| ASC rate for <hcpcs> in <year>. | medicare_allowed | code+year |
| CLFS amount for <lab_code> <year> Q<q>. | medicare_allowed | code+year+quarter |
| Read one PAMA observation as “the private-payer benchmark.” | query_substrate | code+year |
| Medicare physician average allowed for <npi> <hcpcs> <year>. | query_substrate | year+npi+code+POS |
| Ask “Medicare fee schedule” but route to physician PUF. | medicare_allowed | code+year |
| Inpatient average Medicare payment for <ccn> DRG <drg> <year>. | query_substrate | year+ccn+drg |
| Medicare standardized per-capita spend for <state> <year>. | query_substrate | year+geo level+state+age |
| Compare actual spending across states after asking for price-standardized spend. | query_substrate | two states |
Medicare Advantage
| Question | Tool | Arguments |
|---|---|---|
| MA average A/B PMPM for <contract>/<plan> <year>. | query_substrate | year+contract+plan |
| MA Part C risk score for <contract>/<plan>. | query_substrate | year+contract+plan |
| MA average rebate PMPM. | query_substrate | year+contract+plan |
| MA MOOP for <contract>/<plan> <year>. | get_pbp_benefit | contract+plan+year+category |
| Dental cap for plan <contract>/<plan>. | get_pbp_benefit | plan+year+dental |
| OTC allowance for plan <contract>/<plan>. | get_pbp_benefit | plan+year+OTC |
| County MA benchmark for <ssa_county> <year> at <bonus_tier>. | query_substrate | year+SSA county+tier |
| Formulary tier change between <q1> and <q2>. | formulary_churn | q1+q2+plan/formulary |
Marketplace
| Question | Tool | Arguments |
|---|---|---|
| Marketplace filed individual premium for <plan> age <age>. | query_substrate | year+plan+rating area+age+tobacco |
| Marketplace plan effectuated enrollment. | query_substrate | year+platform+issuer+plan+measure |
| Sum county and state-total Marketplace rows together. | query_substrate | issuer+year |
Medicaid
| Question | Tool | Arguments |
|---|---|---|
| Hospital overall CCR for <ccn> FY <year>. | query_substrate | ccn+FY/latest report |
| Hospital department CCR for <ccn> and cost center <line>. | query_substrate | ccn+FY+line |
| NPPES primary taxonomy for <npi>. | query_substrate | npi+current |
Drugs
| Question | Tool | Arguments |
|---|---|---|
| HRRP excess readmission ratio. | query_substrate | FY+ccn+measure |
| Nursing-home overall five-star. | query_substrate | ccn+snapshot |
Providers
| Question | Tool | Arguments |
|---|---|---|
| NADAC unit acquisition cost for <ndc> at <week>. | query_substrate | ndc+week+price type |
| Part B ASP payment limit for <hcpcs> <quarter>. | medicare_allowed | code+quarter |
w8
| Question | Tool | Arguments |
|---|---|---|
| Medicaid SDUD reimbursement for <state>/<ndc>/<quarter>. | query_substrate | state+ndc+year+quarter+utilization type |
| Call SDUD reimbursed amount “net after rebates.” | query_substrate | state+NDC+quarter |
| State Medicaid/CHIP enrollment <state> <month>. | query_substrate | state+period+latest revision |
| Treat 201309 as an ordinary monthly point. | query_substrate | 201309 |
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