Payerset

Payerset is a healthcare price transparency data company that parses every payer Transparency in Coverage (TiC) machine-readable file and compliant hospital MRF each quarter, enriches negotiated rates with provider, payer, and claims metadata, and delivers it as analytics-ready datasets. The Payerset Data Lake API exposes payer-provider negotiated rate lookups, NPI/TIN provider mapping, billing-code classification, and hospital MRF discovery via a REST API authenticated with an x-api-key header.

4 APIs 0 Features
HealthcarePrice TransparencyNegotiated RatesMachine-Readable FilesPayer Data

APIs

Payerset Negotiated Rates

Returns the payer-provider negotiated rate for a given billing code, payer, and provider NPI, derived from payer Transparency in Coverage machine-readable files (GET /v1/rates/r...

Payerset Rate Search

Reference-data search endpoints used to resolve a rate query - payer listings and detail, provider NPI detail, NPI/TIN/parent mappings, and billing-code detail and code types ac...

Payerset Datasets

Dataset discovery and reference endpoints powering the Payerset Data Lake - hospital MRF hospital, system, and payer lists, plus provider EIN/TIN/NPI mapping and billing-code cl...

Payerset Benchmarks

Reimbursement benchmarking built on Payerset negotiated-rate data, comparing payer-provider rates across payers, providers, and billing codes. Surfaced through the Rate Explorer...

Collections

Payerset Data Lake API

OPEN

Pricing Plans

Payerset Plans Pricing

2 plans

PLANS

Rate Limits

Payerset Rate Limits

2 limits

RATE LIMITS

FinOps

Payerset Finops

FINOPS

Resources

👥
GitHubOrganization
GitHubOrganization
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LinkedIn
LinkedIn
🔗
Website
Website
🔗
Documentation
Documentation
🔗
Plans
Plans
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RateLimits
RateLimits
🔗
FinOps
FinOps

Sources

Raw ↑ 
opencollection: 1.0.0
info:
  name: Payerset Data Lake API
  version: '2024-10-31'
request:
  auth:
    type: apikey
    key: x-api-key
    value: '{{apiKey}}'
    in: header
items:
- info:
    name: Rates
    type: folder
  items:
  - info:
      name: Query negotiated rate
      type: http
    http:
      method: GET
      url: https://api.payerset.com/v1/rates/rate_query?billing_code=27447&payer=Aetna&npi=1234567890
    docs: Returns the negotiated rate for a given billing code, payer, and provider NPI from Transparency in Coverage MRFs.
- info:
    name: Payers
    type: folder
  items:
  - info:
      name: Get payer detail
      type: http
    http:
      method: GET
      url: https://api.payerset.com/v1/metadata/payers/payer_detail
    docs: Returns payer metadata including region, category, friendly name, and system name.
  - info:
      name: Get payer list
      type: http
    http:
      method: GET
      url: https://api.payerset.com/v1/metadata/payers/payer_list
    docs: Returns the list of payer system names available in the Data Lake.
- info:
    name: Providers
    type: folder
  items:
  - info:
      name: Get NPI detail
      type: http
    http:
      method: GET
      url: https://api.payerset.com/v1/metadata/providers/npi_detail?npi=1234567890
    docs: Returns enriched provider metadata for an NPI, including NPPES details, taxonomy, EIN, and Medicare enrollment.
  - info:
      name: Get NPI to TIN
      type: http
    http:
      method: GET
      url: https://api.payerset.com/v1/metadata/providers/npi_to_tin
    docs: Returns the TIN value(s) associated with provider NPIs.
  - info:
      name: Get TIN to NPI
      type: http
    http:
      method: GET
      url: https://api.payerset.com/v1/metadata/providers/tin_to_npi
    docs: Returns the provider NPI(s) associated with a given TIN.
  - info:
      name: Get NPI to parent
      type: http
    http:
      method: GET
      url: https://api.payerset.com/v1/metadata/providers/npi_to_parent
    docs: Returns the parent organization NPI and TIN associated with provider NPIs.
  - info:
      name: Get NPI parent
      type: http
    http:
      method: GET
      url: https://api.payerset.com/v1/metadata/providers/npi_parent
    docs: Returns parent organization NPI relationships for providers.
- info:
    name: Billing Codes
    type: folder
  items:
  - info:
      name: Get billing code detail
      type: http
    http:
      method: GET
      url: https://api.payerset.com/v1/metadata/billing_codes/code_detail?billing_code=99213
    docs: Returns metadata for a billing code, including code type, name, category, and subcategory.
  - info:
      name: Get billing code types
      type: http
    http:
      method: GET
      url: https://api.payerset.com/v1/metadata/billing_codes/code_types
    docs: Returns the list of supported billing code types (e.g., CPT, HCPCS, MS-DRG).
- info:
    name: Hospital MRF
    type: folder
  items:
  - info:
      name: Get hospital list
      type: http
    http:
      method: GET
      url: https://api.payerset.com/v1/hospital_mrf/hospital_list
    docs: Returns the list of hospitals with published price transparency MRFs.
  - info:
      name: Get system list
      type: http
    http:
      method: GET
      url: https://api.payerset.com/v1/hospital_mrf/system_list
    docs: Returns the list of hospital systems in the hospital MRF dataset.
  - info:
      name: Get hospital payer list
      type: http
    http:
      method: GET
      url: https://api.payerset.com/v1/hospital_mrf/payer_list
    docs: Returns the list of payers present in the hospital price transparency MRF dataset.