Hello, readers!

We’re back for another round of MRF processing notes for April. For this month, we’ll go with a good, bad, and ugly approach. The good - some payers posted more (a LOT more data). The bad - several BCBS entities posted less, or no data. The ugly - Highmark. It's been ugly for a while, read more to find out why.

Summary:

• UnitedHealthcare restores their MRF data file contents to former levels
• Cigna now includes Cigna Behavioral Health (d.b.a Evernorth) rates in their national PPO and OAP files
• Several Blues posted broken indexes and/or MRF URLs in April
• Highmark continues to post broken indexes and ridiculously small files, for a full six months now

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UHC Restores MRF Data Volumes

Every month when we sit down to look at the last indexes and file ingestion run, we pay a close eye to the data volumes for BUCAH plans (perhaps soon to be re-acronym'd BUCA with Humana exiting commercial markets...?).

We’re very happy to report that UHC has gone back to posting price transparency files sized identically to what they were posting last August. (There’s still 30% of unused provider group references, but we’ll follow up with a deeper dive on why that is). With the return to size, each full network contains over a BILLION price data points and unpacks to nearly 250GB - hope you used the leaner months to performance optimize your ingest pipeline! 

Here’s the April Select Plus S2 network stats:

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You won’t find many behavioral health organizations’ rates in the latest UHC files, despite the comically mis-labeled 2023-04-01_UnitedHealthcare-Insurance-Company_Insurer_Behavior-Health_P3_in-network-rates.json.gz file; for that you have to remember to go and look in Optum’s TiC directory (https://transparency-in-coverage.optum.com/) as we’d posted about in previous months - an excellent segue to our next topic.

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Cigna Posts Cigna Behavioral Health Rates in National PPO / OAP files

Finally! We’ve had numerous behavioral health providers reach out asking us to verify Cigna behavioral health rates since TiC went live. To date, we’ve generally found nothing in the Cigna networks posted in their index, and we’ve been emailing Cigna and Evernorth on a regular basis about this one for months now. Evernorth doesn’t post anything, and Cigna doesn’t make it clear Cigna Behavioral Health is a different entity in their index. 

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Check out the count differences for Behavioral Health providers from March -> April. This is great, since no one was buying that Cigna only had 3000 LCSWs and Psychologists under contract nationwide. Not sure what happened to all those family medicine docs, but that’s a story for a different blog post.

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BCBS Entities Who Didn’t Update Index URLs in April

A bunch of Blues decided to play a ‘price opacity’ April fools joke this month and either didn’t post, posted index files full of links to March in-network rate MRFs, or otherwise served up expired URLs:

Excellus - no new posting, missing index file since Febuary: 

https://excellusbcbs.healthsparq.com/healthsparq/public/#/one/insurerCode=EXC_I&brandCode=EXC&productCode=MRF/machine-readable-transparency-in-coverage

BCBS SC - no new posting: 

https://dcq69z5ycmha5.cloudfront.net/bcbssc_index.json

BCBS KS - no new posting, all their file links expired: https://stcms9915fbcbsks001.blob.core.windows.net/toc-public/table-of-contents.json?sv=2021-04-10&st=2023-04-19T09%3A20%3A48Z&se=2023-04-19T14%3A20%3A48Z&sr=b&sp=r&sig=yqYOwc9C6karQim0zzmCYQ4GZBMDle90gUDLTzT%2BVTg%3D&rscc=no-cache

Horizon BCBS - : https://horizonblue.sapphiremrfhub.com/tocs/202304/2023-04-01_horizon-healthcare-services_index.json (partial credit, they have one file that was updated late march, but most of their network files are from like September 2022)

BCBS MS: https://www.bcbsms.com/about-us/transparency-in-coverage (you’ll get a 404 trying to even get the TOC)

Ah well, at least you have reciprocity and historical files to work off of in most of these cases.

Some bonus hilarity - while I was researching this article, on April 28th, Univera has apparently found a time machine and decided to live in the future.

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What’s up, Highmark?

And finally, the ugly. If you've been trying to get transparency data for Highmark for the past six months, you already know what I'm about to write.

While Highmark posted on July 1, 2022, and continues posting regular updates to their files monthly, their index files continue to contain broken URLs, and the file sets you can find are woefully inadequate for a health plan covering 2.5 million lives. I’ve personally been in touch with Highmark about this issue since November when we noticed it. Their team has been responsive and seems genuinely helpful at looking into these issues…but so far it hasn’t resulted in a better set of Highmark postings, and we're coming up on a solid six months since reporting the issues. Even at the speed of healthcare, that seems slow to fix a compliance posting required by federal law.

Let’s start with file size. As an order of magnitude, price transparency filesets for any meaningfully sized network is on the order of hundreds of megabytes to a gigabyte, compressed. National networks can be many times larger, small regionals might be 10x smaller, but fundamentally there’s a minimum file size for a price transparency posting that represents reasonable and for a BUCAH those orders of magnitude should hold. 

You can scrape every. single. Highmark West New York machine readable file index file and sum them together to get a whopping 4.452 MB of data to work with (it’s not even valid to do that, as you’d be conflating their different networks and a bunch of the data files overlap).

Looking at the overall stats for this ‘network’, code counts are low, price counts are way too low (and again, this is with some price overlap and duplication).

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For a fun relative comparison, let’s look at Blue Cross Blue Shield of Vermont. ~250k covered lives - from a covered life count perspective, you’d expect Vermont’s postings to be smaller, right? Wrong. Their base files are 15.8MB compressed. Even BCBS Vermont has about a million price entries if you squint at it…with substantially fewer providers in the network.

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This issue isn’t just limited to West New York - all Highmark networks (NNY, PA, WY, ND) as well as their sibling Independence Blue Cross (IBX) share the same issues, low posting data volume and commensurate low utility to folks who want to leverage transparency data. Perhaps we'll get a happy surprise in May?

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Here's to all you processors out there! As always, if your team is looking to leverage our deep expertise working with machine readable files, get in touch.

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