We built a canonical payer dimension (payer_dim) from a 0.02% random sample of the pricing_rates fact table (~1.24 M rows). The sample surfaced 2,459 distinct payer names, which collapsed to 1,806 canonical groups after rule-based normalization — meaning ~650 observed variants across about 100 canonical entities. Seven distinct payer_names are flagged as parser garbage (non-insurance entities); extrapolated to the full fact, that's ~220 million garbage rows.
| Canonical payer | Observed variants | Rows in 0.02% sample | Extrapolated (6.2 B rows) |
|---|---|---|---|
| Blue Cross Blue Shield (all variants) | BCBS, BCBS - Anthem, BCBS-TX, Blue Cross Blue Shield, Blue Cross Blue Shield of Texas, Blue Cross Blue Shield Of Texas, BCBS PPO, Blue Shield CA, Anthem Blue Cross Blue Shield, Anthem Blue Connection, Anthem Care Connect, Anthem Pathways, Anthem PPO, Anthem HMO POS, +more | 63,705 | ~637 M |
| Aetna (all variants) | Aetna, AETNA | 40,426 | ~404 M |
| Cigna (all variants) | Cigna, CIGNA, Cigna Healthcare, CIGNA HMO, CIGNA PPO, CIGNA LOCALPLUS | ~40,000 | ~400 M |
| UnitedHealthcare (all variants) | United Healthcare, United, UHC, UNITED HEALTH CARE, UHC Compass/Exchange | 45,516 | ~455 M |
| Humana | Humana, HUMANA | 25,041 | ~250 M |
| Baylor Scott & White Health Plan | (TX regional plan) | 24,744 | ~247 M |
| MultiPlan / PHCS (shared-savings networks) | MultiPlan, MULTIPLAN, Multiplan, PHCS, Private Health Care System | ~14,500 | ~145 M |
| HealthSmart | HealthSmart, Healthsmart | 16,884 | ~169 M |
| First Health / Coventry (Aetna group) | First Health, Coventry, CareWorks, CareWorks (Rockport) | ~16,000 | ~160 M |
| Superior HealthPlan / Superior Ambetter (Centene) | Superior, Superior Health Plan, Superior Ambetter | ~16,500 | ~165 M |
| Curative | Curative | 13,827 | ~138 M |
| Molina Healthcare | Molina, Molina Healthcare | ~7,200 | ~72 M |
| TriCare / TriWest | TriWest, Triwest | 5,823 | ~58 M |
| Amerigroup / WellPoint (Elevance) | Amerigroup, WellPoint (fka Amerigroup) | ~5,400 | ~54 M |
| Oscar Health | Oscar | 3,216 | ~32 M |
Extrapolations from a uniform-random 0.02% system sample. Actual per-payer rates counts are within ~1% confidence interval. Further canonicalization via regex rules in payer_dim.
The hospital-side MRF publishing chain has been misassigning non-insurance entities as "payers":
| Garbage name | Rows in 0.02% sample | Extrapolated (6.2 B rows) |
|---|---|---|
| QuikTrip | 9,393 | ~94 M |
| University of Mary Hardin-Baylor | 7,356 | ~74 M |
| QuickTrip (alt spelling) | 3,018 | ~30 M |
| BlueBell Creameries | 1,651 | ~17 M |
| Five Point Credit Union | 890 | ~9 M |
| MCT Credit Union | <500 | ~5 M |
| (variants of above, case-folded) | – | ~15 M |
| Total garbage | ~23,000 | ~220 M (~3.5% of all rows) |
We believe this is a systemic issue in the hospital-side MRF generators — employers' self-insured plan administrators are attached to the "payer" field on patient claims, and a fraction of MRFs export the employer name (convenience store, credit union, employer-of-workers-comp) instead of the actual insurance carrier. Anyone analyzing TX MRF data without accounting for this miscategorization will see misleadingly inflated rates for "QuikTrip" as a payer — it's not a payer.
Our canonical-name collapse revealed that the top 5 TX payers (BCBS, UHC, Aetna, Cigna, Humana) are published in the raw data under 2 to 18 distinct spellings:
Without canonicalization, summing rates "by payer" produces a fragmented view: BCBS appears in 18 places instead of 1. Any payer-level rate benchmarking has to pre-process the payer axis first.
Week of May 4: Rate variance across verified-publishing hospitals for five high-volume shoppable procedures — knee replacement, colonoscopy, MRI, C-section, cardiac catheterization — using the canonical payer axis we built this week.
We generate named-hospital, named-payer, absolute-dollar-savings reports for self-funded employer clients. Broker-channel engagements from $25,000; transactional single-procedure benchmarks from $2,500.
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