Glossary
The price transparency glossary
The words you'll meet in machine-readable files and medical bills, defined in plain English.
Allowed-amount file
The MRF reporting historical amounts a plan allowed for out-of-network services, along with billed charges.
Billing code
A standard code, such as CPT, HCPCS or MS-DRG, that identifies the service or item a rate applies to.
Cash price
The price a provider charges when you pay yourself instead of using insurance.
CPT code
Current Procedural Terminology: five-character codes that describe medical, surgical and diagnostic services.
Fee schedule
A list of set payment amounts by billing code, often based on a percentage of Medicare rates.
HCPCS code
Healthcare Common Procedure Coding System codes, used for supplies, drugs, equipment and services not covered by CPT.
Hospital price transparency
A separate federal rule requiring hospitals to publish their standard charges, including payer-specific negotiated charges.
In-network rate file
The MRF listing every rate a plan has negotiated with its in-network providers, by billing code and provider.
Machine-readable file (MRF)
A standardized JSON file that a health plan publishes to disclose its negotiated rates and out-of-network allowed amounts.
MS-DRG
Medicare Severity Diagnosis Related Groups: codes that group inpatient hospital stays for a single, bundled payment.
National Provider Identifier (NPI)
A unique 10-digit number that identifies every healthcare provider in the United States.
Negotiated rate
The price a health plan and a provider have agreed to for a specific service.
Place of service
A two-digit code that records where a service was delivered, such as an office, hospital outpatient department or ambulatory surgery center.
Provider group
A set of NPIs under one TIN that share the same negotiated rates in an MRF.
Table-of-contents (index) file
A file that lists a reporting entity's plans and links each one to the in-network and allowed-amount files that apply to it.
Taxpayer Identification Number (TIN)
The tax ID of the business entity a provider bills under, used in MRFs to group providers that share a contract.
Transparency in Coverage (TiC)
The federal rule requiring most health plans and insurers to publicly post their negotiated rates and allowed amounts.
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