Medicare and Medicaid In-Network Rates

This content provides details on Medicare and Medicaid in-network rates reported by CMS on August 27, 2020. It includes information on plan names, IDs, market types, and negotiation information. The file also contains links to relevant network files. The data is structured to facilitate understanding of allowed amounts for healthcare services.

• Medicare
• Medicaid
• In-Network Rates
• CMS
• Healthcare

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1. <YYYY-MM-DD>_<payer or issuer name>_<plan name>_<file type name>.<file extension> 2020-08-27_cms_medicare_in-network-rates.json 2020-08-27_cms_medicare_in-network-rates.json { { "reporting_entity_name": "cms", "reporting_entity_type": "cms", "reporting_plans": [{ "reporting_entity_name": "cms", "reporting_entity_type": "cms", "plan_name": : medicare", "plan_id_type": "his", "plan_id": "0000000000", "plan_market_type": "individual" "last_updated_on": "2020-08-27", "version": "1.0.0", "in_network": [{negotiation information}] "plan_name": medicare", "plan_id_type": "his", "plan_id": "0000000000", "plan_market_type": "individual" },{ "plan_name": medicaid", "plan_id_type": "hios", "plan_id": "11111111111", "plan_market_type": "individual" }], "last_updated_on": "2020-08-27", "version": "1.0.0", "in_network": [{negotiation information}] } }

2. <YYYY-MM-DD>_<payer or issuer name>_<plan name>_<file type name>.<file extension> 2020-08-27_cms_medicare_in-network-rates.json { "reporting_entity_name": "cms", "reporting_entity_type": "cms", "reporting_plans": [{ 2020-08-27_cms_medicare_medicaid_in-network-rates.json "plan_name": medicare", "plan_id_type": "his", "plan_id": "0000000000", "plan_market_type": "individual" },{ 2020-08-27_cms_???_in-network-rates.json "plan_name": medicaid", "plan_id_type": "hios", "plan_id": "11111111111", "plan_market_type": "individual" }], "last_updated_on": "2020-08-27", "version": "1.0.0", "in_network": [{negotiation information}] }

3. In-Network/Allowed Amounts MRF NEW TABLE OF CONTENTS FILE { "reporting_entity_name": "cms", { "reporting_entity_name": "cms", "reporting_entity_type": "cms", "reporting_structure":[{ "reporting_plans": [{ "reporting_entity_type": "cms", "reporting_plans": [{ "plan_name": medicare", https://www.cms.gov/cciio/medicare-in-network-file.json "plan_name": "medicaid", "plan_id_type": "hios", "plan_id": "11111111111", "plan_market_type": "individual" "plan_id_type": "his", { "plan_id": "0000000000", "last_updated_on": "2020-08-27", "plan_market_type": "individual" "version": "1.0.0", },{ },{ "plan_name": "medicare", "plan_id_type": "hios", "plan_id": "0000000000", "plan_market_type": "individual" "in_network": [{negotiation information}] "plan_name": medicaid", } "plan_id_type": "hios", "plan_id": "11111111111", }], "in_network_file": { "plan_market_type": "individual" "description": "In-network file", "file": "https://www.cms.gov/cciio/medicare-in- }], "last_updated_on": "2020-08-27", network-file.json" "version": "1.0.0", } "in_network": [{negotiation information}] }

4. NEW TABLE OF CONTENTS FILE { In-Network File "reporting_entity_name": "cms", "reporting_entity_type": "cms", "reporting_structure":[{ "reporting_plans": [{ https://www.cms.gov/cciio/medicare-in-network-file.json "plan_name": "medicaid", "plan_id_type": "hios", "plan_id": "11111111111", "plan_market_type": "individual" { "last_updated_on": "2020-08-27", },{ "version": "1.0.0", "plan_name": "medicare", "plan_id_type": "hios", "plan_id": "0000000000", "plan_market_type": "individual" "in_network": [{negotiation information}] } }], "in_network_file": { "description": "National network file", "file": "https://www.cms.gov/cciio/medicare-in- network-file.json" } The Table of Contents needs the naming standard, not the individual files. The In-network/allowed amounts files can be named anything now

5. NEW TABLE OF CONTENTS FILE <date>_<payer-name>_index.<file extension> { "reporting_entity_name": "cms", "reporting_entity_type": "cms", "reporting_structure":[{ "reporting_plans": [{ 2020-08-07_cms_index.json "plan_name": "medicare", "plan_id_type": "hios", "plan_id": "11111111111", "plan_market_type": "individual" },{ "plan_name": "medicaid", "plan_id_type": "hios", "plan_id": "0000000000", "plan_market_type": "individual" }], "in_network_file": { "description": "In-network file", "file": "https://www.cms.com/files/in-network-file- 123134.json" } }]