### Attestation Object Example Source: https://github.com/cmsgov/hospital-price-transparency/blob/master/documentation/JSON/README.md This JSON object demonstrates the required structure and content for the attestation fields. The 'confirm_attestation' field must be 'true' to meet regulatory requirements. ```json { "attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Leigh Attester" } ``` -------------------------------- ### CSV Tall Format File Structure Example Source: https://context7.com/cmsgov/hospital-price-transparency/llms.txt This example illustrates the header rows and a data row for the CSV Tall format. Placeholders in brackets must be replaced with actual values. The format includes hospital metadata, attestation, and detailed item/service charges. ```csv hospital_name,last_updated_on,version,location_name,hospital_address,license_number|CA,type_2_npi,"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50...",attester_name West Mercy Hospital,11/14/2025,3.0.0,West Mercy Hospital|West Mercy Surgical Center,"12 Main Street, Fullerton, CA 92832|23 Ocean Ave, San Jose, CA 94088",50056,0000000001 | 0000000002 | 0000000003,TRUE,Leigh Attester description,code|1,code|1|type,code|2,code|2|type,modifiers,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,payer_name,plan_name,standard_charge|negotiated_dollar,standard_charge|negotiated_percentage,standard_charge|negotiated_algorithm,median_amount,10th_percentile,90th_percentile,count,standard_charge|methodology,standard_charge|min,standard_charge|max,additional_generic_notes "Evaluation of hearing function...",92626,CPT,,,,outpatient,,,150,125,Platform Health Insurance,PPO,98.98,,,,,,,fee schedule,98.98,105.34,110% of the Medicare fee schedule. "Evaluation of hearing function...",92626,CPT,,,,outpatient,,,150,125,Region Health Insurance,HMO,105.34,,,,,,,fee schedule,98.98,105.34,115% of the state's workers' compensation amount Aspirin 81 milligram chewable tablet,10135-0729-62,NDC,,,,both,1,UN,2,1.5,Platform Health Insurance,PPO,0.75,,,,,,,fee schedule,0.75,0.95, ``` -------------------------------- ### CSV Tall Format Encoding Example Source: https://context7.com/cmsgov/hospital-price-transparency/llms.txt Illustrates how to encode percentage or algorithm charges in the CSV Tall format. It shows required columns like 'count' and 'additional_generic_notes' based on remittance data availability. ```csv description,code|1,code|1|type,code|2,code|2|type,modifiers,setting,...,payer_name,plan_name,standard_charge|negotiated_dollar,standard_charge|negotiated_percentage,standard_charge|negotiated_algorithm,median_amount,10th_percentile,90th_percentile,count,standard_charge|methodology,...,additional_generic_notes # Percentage charge with full allowed amounts: Major hip and knee joint replacement...,470,MS-DRG,175869,LOCAL,,inpatient,,,Platform Health Insurance,PPO,,50,,21345.12,18765.9,39627.88,23,percent of total billed charges,25678,25678, # Count = 0 (no lookback remittances), explanation in notes: Heart transplant...,2,MS-DRG,123478,LOCAL,,inpatient,,,Platform Health Insurance,PPO,,45,,,,,0,percent of total billed charges,,,No services performed during 15-month lookback period. # Count "1 through 10": Heart transplant...,2,MS-DRG,123478,LOCAL,,inpatient,,,Region Health Insurance,HMO,,40,"40% of billed charges up to $1 million...",560043.22,256789.17,945001.98,1 through 10,percent of total billed charges,,, ``` -------------------------------- ### Validate JSON MRF with ajv-cli Source: https://context7.com/cmsgov/hospital-price-transparency/llms.txt Use `ajv-cli` to validate a JSON MRF against the v3.0 schema. Ensure `ajv-cli` is installed globally. The command outputs 'valid' on success or detailed error messages on failure. ```bash # Validate a JSON MRF against the v3.0 schema using ajv-cli npm install -g ajv-cli ajv validate \ -s documentation/JSON/schemas/V3.0.0_Hospital_price_transparency_schema.json \ -d my_hospital_mrf.json # Expected output on success: # my_hospital_mrf.json valid # Expected output on failure (example): # my_hospital_mrf.json invalid # [ { instancePath: '/standard_charge_information/0/standard_charges/0', # message: 'must match "then" schema', # ... } ] ``` -------------------------------- ### Payer-Specific Charges: Percentage and Algorithm Source: https://context7.com/cmsgov/hospital-price-transparency/llms.txt Use this structure when payer-specific charges are expressed as a percentage or algorithm. The 'count' field is required, and if not '0', 'median_amount', '10th_percentile', and '90th_percentile' are also required. 'additional_payer_notes' must explain the absence of remittances when 'count' is '0'. ```json { "description": "Major hip and knee joint replacement or reattachment of lower extremity without mcc", "code_information": [ { "code": "470", "type": "MS-DRG" }, { "code": "175869", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25678, "maximum": 25678, "payers_information": [ { "payer_name": "Platform Health Insurance", "plan_name": "PPO", "standard_charge_percentage": 50, "median_amount": 21345.12, "10th_percentile": 18765.9, "90th_percentile": 39627.88, "count": "23", "methodology": "percent of total billed charges" }, { "payer_name": "Region Health Insurance", "plan_name": "HMO", "standard_charge_dollar": 25678, "standard_charge_algorithm": "If days in visit is less than or equal to 3, then the standard charge is $25,678.00. Otherwise, the standard charge is $25,678.00 plus 80% of billed charges on the days exceeding 3 days.", "median_amount": 25678, "10th_percentile": 25678, "90th_percentile": 45964, "count": "43", "methodology": "other", "additional_payer_notes": "The standard charge methodology is a case rate plus additional modifications." } ] } ] } ``` -------------------------------- ### Valid Standard Charge Methodologies Source: https://context7.com/cmsgov/hospital-price-transparency/llms.txt These are the five enumerated values for the 'standard charge methodology' field, required when encoding payer-specific charges. Use 'other' only if a specific explanation is provided in the notes. ```plaintext case rate Flat rate for a diagnosis/treatment package for a defined period fee schedule Charge based on a named fee schedule (Medicare, Medicaid, commercial) percent of total billed charges Percentage of total billed charges; encode numeric value (e.g., "70.5" not ".705") per diem Per-day charge for hospital items and services other Any arrangement not described above; requires explanation in notes ``` -------------------------------- ### CSV Placeholder Substitution Rules Source: https://context7.com/cmsgov/hospital-price-transparency/llms.txt Details the four types of placeholders used in CSV column headers and their corresponding substitution rules. Errors occur if placeholders remain after substitution. ```text [state] → Two-letter state/territory code (e.g., CA, NY, PR) license_number|[state] → license_number|CA [i] → Sequential integer starting at 1, matching code and code|type pairs code|[i] → code|1, code|2, ... code|[i]|type → code|1|type, code|2|type, ... [payer_name] → Exact name of the third-party payer (Wide format only) standard_charge|[payer_name]|[plan_name]|negotiated_dollar → standard_charge|Platform Health Insurance|PPO|negotiated_dollar [plan_name] → Exact name of the payer's plan (Wide format only) median_amount|[payer_name]|[plan_name] → median_amount|Region Health Insurance|HMO ``` -------------------------------- ### Modifier Information Array Source: https://context7.com/cmsgov/hospital-price-transparency/llms.txt The optional 'modifier_information' array documents how procedure modifiers affect standard charges. Each modifier object requires 'description', 'code', and 'modifier_payer_information'. An optional 'setting' field was introduced in v3.0. ```json "modifier_information": [ { "description": "Bilateral procedure", "code": "50", "setting": "both", "modifier_payer_information": [ { "payer_name": "Platform Health Insurance", "plan_name": "PPO", "description": "150% payment adjustment for the item or service to which the modifier is appended" }, { "payer_name": "Region Health Insurance", "plan_name": "HMO", "description": "145% payment adjustment for the item or service to which the modifier is appended" } ] }, { "description": "Bilateral procedure with co-surgeon", "code": "50|62", "modifier_payer_information": [ { "payer_name": "Platform Health Insurance", "plan_name": "PPO", "description": "93.75% of the amount for the item or service to which this combination of modifiers is appended for each co-surgeon" } ] } ] ``` -------------------------------- ### JSON MRF Root Object Structure Source: https://context7.com/cmsgov/hospital-price-transparency/llms.txt The root JSON object contains essential hospital-level metadata required once per file. Ensure all fields, including attestation, are correctly populated. ```json { "hospital_name": "West Mercy Hospital", "last_updated_on": "2025-11-14", "version": "3.0.0", "location_name": ["West Mercy Hospital", "West Mercy Surgical Center"], "hospital_address": [ "12 Main Street, Fullerton, CA 92832", "23 Ocean Ave, San Jose, CA 94088" ], "license_information": { "license_number": "50056", "state": "CA" }, "type_2_npi": ["0000000001", "0000000002", "0000000003"], "attestation": { "attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Leigh Attester" } // ... standard_charge_information array follows } ``` -------------------------------- ### JSON MRF Standard Charge Information Structure Source: https://context7.com/cmsgov/hospital-price-transparency/llms.txt Each element in the standard_charge_information array details an item or service, including its billing codes and standard charges. Payer-specific charges require additional details like methodology and notes. ```json "standard_charge_information": [ { "description": "Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour", "code_information": [ { "code": "92626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150, "discounted_cash": 125, "minimum": 98.98, "maximum": 105.34, "payers_information": [ { "payer_name": "Platform Health Insurance", "plan_name": "PPO", "standard_charge_dollar": 98.98, "methodology": "fee schedule", "additional_payer_notes": "110% of the Medicare fee schedule" }, { "payer_name": "Region Health Insurance", "plan_name": "HMO", "standard_charge_dollar": 105.34, "methodology": "fee schedule", "additional_payer_notes": "115% of the state's workers' compensation amount" } ] } ] } ] ``` -------------------------------- ### JSON MRF: Optional General Contract Provisions Source: https://context7.com/cmsgov/hospital-price-transparency/llms.txt The `general_contract_provisions` array in a JSON MRF can include aggregate payer contract provisions. Each object may specify a `payer_name` and `plan_name` to scope the `provisions` text. ```json "general_contract_provisions": [ { "payer_name": "Platform Health Insurance", "plan_name": "PPO", "provisions": "When total claim charges exceed $200,000.00 for a Platform Health Insurance plan, the entire claim will be reimbursed at 50% of charges. This amount will supersede any other contracted rate that would otherwise apply." }, { "payer_name": "Region Health Insurance", "plan_name": "HMO", "provisions": "When total claim charges exceed $250,000.00 for a Region Health Insurance plan, the entire claim will be reimbursed at 45% of charges." } ] ``` -------------------------------- ### CSV Wide Format Header Structure Source: https://context7.com/cmsgov/hospital-price-transparency/llms.txt Defines the three-row header structure for the CSV Wide format. Payer and plan names are embedded in column headers, with nine standard charge columns per payer-plan pair. ```csv hospital_name,last_updated_on,version,location_name,hospital_address,license_number|[state],type_2_npi,"To the best of its knowledge and belief...",attester_name ,,3.0.0,,,,,,,, description,code|[i],code|[i]|type,modifiers,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,standard_charge|Platform Health Insurance|PPO|negotiated_dollar,standard_charge|Platform Health Insurance|PPO|negotiated_percentage,standard_charge|Platform Health Insurance|PPO|negotiated_algorithm,median_amount|Platform Health Insurance|PPO,10th_percentile|Platform Health Insurance|PPO,90th_percentile|Platform Health Insurance|PPO,count|Platform Health Insurance|PPO,standard_charge|Platform Health Insurance|PPO|methodology,additional_payer_notes|Platform Health Insurance|PPO,standard_charge|min,standard_charge|max,additional_generic_notes # Data row example (one row per item/service, columns for each payer-plan): "Behavioral health; residential...",H0017,HCPCS,,inpatient,,,2500,2250,1500,,,,,,,,per diem,,, ``` -------------------------------- ### Valid Code Types for Hospital Price Transparency Source: https://context7.com/cmsgov/hospital-price-transparency/llms.txt These are the accepted enumerated values for the 'code type' field in both CSV and JSON formats. 'LOCAL' is for internal use when no standard billing code exists. ```plaintext CPT Current Procedural Terminology NDC National Drug Code HCPCS Healthcare Common Procedural Coding System RC Revenue Code ICD International Classification of Diseases DRG Diagnosis Related Groups MS-DRG Medicare Severity Diagnosis Related Groups R-DRG Refined Diagnosis Related Groups S-DRG Severity Diagnosis Related Groups APS-DRG All Patient, Severity-Adjusted Diagnosis Related Groups AP-DRG All Patient Diagnosis Related Groups APR-DRG All Patient Refined Diagnosis Related Groups APC Ambulatory Payment Classifications LOCAL Local Code Processing EAPG Enhanced Ambulatory Patient Grouping HIPPS Health Insurance Prospective Payment System CDT Current Dental Terminology CDM Charge Description Master (chargemaster) TRIS-DRG TriCare Diagnosis Related Groups CMG Case Mix Group (new in v3.0) MS-LTC-DRG Medicare Severity Long-Term Care DRG (new in v3.0) ``` -------------------------------- ### Drug Information Object with NDC Code Source: https://context7.com/cmsgov/hospital-price-transparency/llms.txt Include the 'drug_information' object when a service involves a drug with an NDC code type. 'unit' must be a positive number, and 'type' must be one of the seven enumerated measurement types. ```json { "description": "Fluconazole 2 milligrams/milliliter", "drug_information": { "unit": 100, "type": "ML" }, "code_information": [ { "code": "J1450", "type": "HCPCS" }, { "code": "25021-0184-82", "type": "NDC" } ], "standard_charges": [ { "setting": "both", "gross_charge": 75, "discounted_cash": 45, "minimum": 35, "maximum": 37, "payers_information": [ { "payer_name": "Platform Health Insurance", "plan_name": "PPO", "standard_charge_dollar": 35, "methodology": "fee schedule" }, { "payer_name": "Region Health Insurance", "plan_name": "HMO", "standard_charge_dollar": 37, "methodology": "fee schedule" } ] } ] } ``` -------------------------------- ### Conditional Requirements for MRF Validation Source: https://context7.com/cmsgov/hospital-price-transparency/llms.txt These rules govern data validation for CSV and JSON MRFs. Violating these requirements results in a deficiency during CMS validation. ```plaintext Requirement 1: If payer_name / plan_name are encoded → at least one payer-specific charge (dollar, percentage, or algorithm) must also be encoded. Requirement 2: If any standard charge is encoded → a corresponding code + code_type pair is required. Requirement 3: code and code|type must always be encoded together as a pair. Requirement 4: If methodology = "other" → additional_payer_notes / additional_generic_notes required. Requirement 5: Each encoded item/service must have at least one of: gross_charge, discounted_cash, negotiated_dollar, negotiated_percentage, or negotiated_algorithm. Requirement 6: If standard_charge_dollar is present → minimum and maximum are required. Requirement 7: If standard_charge_percentage OR standard_charge_algorithm is encoded → count required. Requirement 8: If standard_charge_percentage OR standard_charge_algorithm AND count ≠ "0" → median_amount, 10th_percentile, 90th_percentile required. Requirement 9: If count = "0" → explanation required in additional_generic_notes or additional_payer_notes. Requirement 10: If code type = NDC → drug_unit_of_measurement and drug_type_of_measurement required. Requirement 11: A modifier encoded without an associated item/service must have a description plus at least one of: negotiated_dollar/percentage/algorithm or additional notes. Requirement 12: drug_unit_of_measurement and drug_type_of_measurement must be encoded together. ``` === COMPLETE CONTENT === This response contains all available snippets from this library. No additional content exists. Do not make further requests.