Health Insurance Provider Network PUF

$179 / year

This dataset shows the issuer-level data identifying provider network URLs by the Centers for Medicare & Medicaid Services (CMS).

Complexity

The Centers for Medicare & Medicaid Services (CMS) Center for Consumer Information and Insurance Oversight (CCIIO) is releasing the State-Based Marketplace (SBM) PUF (Public Use Files) in order to improve the transparency and increase access to the SBM data. The SBM PUF includes data on Qualified Health Plans (QHPs) and Stand-alone Dental Plans (SADPs) offered in states which operate their own Marketplaces that do not rely on the federal information technology platform for QHP eligibility and enrollment functionality. This includes states which operate their own Small Business Health Options Programs (SHOP).

The Network PUF (Ntwrk-PUF) is one of the six files that make up the state-based Marketplace Public Use Files (SBM PUF). The Ntwrk-PUF contains issuer level data identifying provider network URLs. These data originate from the Network ID template (i.e., template field), an Excel-based form used by issuers to describe their plans in the QHP/SADP application process, and were provided by the National Association of Insurance Commissioners (NAIC) by extracting the information from their System for Electronic Rate and Form Filing (SERFF).

Date Created

2014-11-27

Last Modified

2019-04-25

Version

2019-04-25

Update Frequency

Annual

Temporal Coverage

2019

Spatial Coverage

United States

Source

John Snow Labs; Centers for Medicare and Medicaid Services;

Source License URL

Source License Requirements

N/A

Source Citation

N/A

Keywords

Health Insurance, Insurance Marketplace, Network PUF, Insurance Rate Review, Insurance Rate Increase, Insurance Market Competition, Health Benefits, Benefits and Cost Sharing PUF, Exchange PUFs

Other Titles

Health Insurance Exchange Public Use Files, Qualified Health Plan Network PUF

NameDescriptionTypeConstraints
State_AbbreviationTwo-character state abbreviation indicating the state where the plan is offeredstring-
Issuer_IDFive-digit numeric code that identifies the issuer organization in the Health Insurance Oversight System (HIOS)integerlevel : Nominal
Source_NameCategorical identifier of source of data importstring-
Import_DateDate when data was importeddatetime-
Network_NameName of a healthcare provider networkstring-
Network_IDIdentifier for a healthcare provider networkstring-
Network_URLThe URL of the network's provider directorystring-
Market_CoverageCategorical indicator of market coverage of plansstring-
Is_Dental_Only_PlanCategorical indicator of dental-only status of plansboolean-
State_AbbreviationIssuer_IDSource_NameImport_DateNetwork_NameNetwork_IDNetwork_URLMarket_CoverageIs_Dental_Only_Plan
TX29817HIOS2018-08-21T03:20:34IndemnityTXN001Indemnity
TN23552HIOS2018-11-03T03:21:18Oscar EPOTNN001https://www.hioscar.com/
TX20069HIOS2018-09-22T03:21:24Oscar EPOTXN001https://www.hioscar.com/
WI37833HIOS2018-08-15T02:21:10PrimeWIN001https://quartzbenefits.com/Prime
WI37833HIOS2018-08-15T02:21:10EliteWIN002https://quartzbenefits.com/Elite
TN14002HIOS2019-01-18T03:20:20Network STNN002http://www.bcbst.com/network-s
WI58326HIOS2019-01-18T03:20:20HMOWIN001http://mercycarehealthplans.com/hmo/
AZ53901HIOS2018-08-18T03:21:16PimaFocusAZN001https://www.azblue.com/PimaFocus
GA89942HIOS2019-01-17T03:20:34Kaiser Permanente HMOGAN001https://kp.org/gaprovider
WI37833HIOS2018-08-15T02:21:10Beloit OneWIN003https://quartzbenefits.com/BeloitOne