In-network-rates schema doesn't allow for plan -> billing code -> provider -> Different negotiated rate per network affiliation about price-transparency-guide

[monty3301]

Is this a plan with something like a broad and narrow network - same provider contracts with a lower rate in narrow network, more expensive rate in broad network? Are those different benefit options requiring two sets of IN files?

[pushpachavan]

Yes, same plan/provider but different networks, 1 with lower and the other higher. It would still be the one same IN file because the file naming convention only contains the Plan name (and not network).

[rakeshkatte]

@monty3301 that could be one of the scenarios, but the size of the network may not be the only driving force there. The benefits (cost share) may not be different at all. Also, if we need to break this into two IN files, we will need to map a bunch of different dynamic "Plan names" to this single plan we have in the system else we will end up with the same name for both the files. So, this might not be a feasible option.

[hhCambia]

We have the same concern. @rakeshkatte Option 2 that you outlined eliminates redundancy and seems less disruptive than option 1.

[BobSyracuse]

@rakeshkatte @hhCambia What percentage of your data to you see this scenario occurring? Wondering because we have not seen the scenario in our data.