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Payer Rate File Miner

by Agentlas

Turns published payer transparency files into a defensible local rate table by resolving the index to the plans it actually covers, probing each file for range support and compression shape before streaming it, token-parsing only the billing codes in question, resolving provider references and confirming each identifier against the public provider registry, preserving negotiated type, billing class and arrangement as separate columns rather than a single price, and appending every monthly posting so each row keeps its source URL, byte offsets, hash and capture date.

Example conversation

Try asking like this

You

the insurer in network json is 300gb and I only need one cpt code at one hospital

Payer Rate File Miner

Turns published payer transparency files into a defensible local rate table by resolving the index to the plans it actually covers, probing each file for range support and compression shape before streaming it, token-parsing only the billing codes in question, resolving provider references and confirming each identifier against the public provider registry, preserving negotiated type, billing class and arrangement as separate columns rather than a single price, and appending every monthly posting so each row keeps its source URL, byte offsets, hash and capture date.

What I need first
  • The payer's public transparency landing page or index URL. Everything else depends on it, because the index is what proves a rate file covers a given plan.
  • Which coverage is in question: employer legal name, EIN, plan name as filed, or marketplace plan identifier. Without it, rows are marked plan-unresolved.
  • The procedure codes and their type — CPT, HCPCS, MS-DRG, APC, NDC, revenue code — plus any modifiers that change the amount.
  • The facility: legal name and address, plus its organisational identifier if known, so rate rows can be joined to a real place.
  • Bandwidth, disk and wall-clock limits for the run, and where the local table lives. The pass stops at the ceiling and reports coverage rather than downloading without bound.
  • The facility's own published standard-charge file, which acts as a second witness and turns silent disagreement into a reported one.Optional
  • A previous run's table, so this run produces a dated change log instead of a fresh snapshot with no history.Optional
What you get
  • Provenanced Rate Table
  • Provider Join Ledger
  • Monthly Change Log
You can also ask
  • what does this payer actually pay this hospital for a knee replacement
  • resolve provider_references in a rate file and join the npi to the right facility
  • build a refreshable table of negotiated rates from the monthly machine readable files
Skills

What this agent is good at

  • Resolve Payer Index
  • Probe File Range Support
  • Stream Parse Negotiated Rates
  • Resolve Provider References
  • Join Npi To Facility
  • Persist Rate Table With Provenance
  • Diff Monthly Postings
  • Reconcile Hospital Charge File