NOTE: This service is no longer available.

We’re happy to announce our new ACA Data Compliance Checker (Shut down). This tool shows the current state of insurance company compliance with the data transparency rulings under the Affordable Care Act. As part of the ruling, insurance companies were required to publicly disclose their network adequacy and drug formularies in predefined data formats.

  • Network adequacy refers to a health plan’s ability to provide a timely access to in-network doctors; including primary care physicians, specialists, and other healthcare professionals that are included in their statement of benefits. In order to confirm their adequacy, the insurance companies have made their provider directories available to the public.
  • Drug formularies are the list of prescription drugs, both generic and brand name, that are covered by a particular health insurance plan. It allows consumers to understand how much drugs will actually cost before they purchase a plan

While it’s great that this ruling came into effect, we found that many insurance companies had a lot of issues with supplying their data in the required machine-readable format (MRF). We built this site to help make those errors transparent and initiate constructive conversations on how to fix them. Also, we believe this is a great resource for researchers or individual to better understand the size of insurance networks for particular companies and their respective insurance plans. In the future, we’ll also use this site to offer plan specific insights and give guidance on how these numbers can drive better consumer decisions at the point of purchase for their insurance coverage.

Here is a map of our current coverage of insurance company data by state:

At HealthJoy, we are all about helping people make better healthcare decisions. This data, we hope, is a step towards a more transparent, consumer driven healthcare experience.

If you are interested in this data and accessing it via our API, email us at “data at healthjoy dot com”. If you are a researcher or reporter that needs further clarification, contact us today.

 

 


Here is a short explanation of the columns and fields in our report

ACA Obamacare Data Compliance Checker LEGEND

Known Plans – All aggregated health plans that we have for a given carrier. Clicking on this will allow you to see the data at the plan level.
CMS Plans – All health plans aggregated from the Centers for Medicare & Medicaid Services (CMS) Data Navigator product.
MRF Plans – All health plans that have their benefits formatted in the Machine Readable Format.
Plans Mapped to Providers – The number of plans that are connected to a provider directory. If this number does not match the MRF plan number, it means that the carrier has not connected certain plans to any provider network.
Providers in Network – The number of providers at the carrier and plan level. Clicking on this will display the number of doctors by speciality.
Facilities in Network – The number of facilities at the carrier and plan level. Clicking on this will display the number of facilities by type.
Covered Drugs – The number of drugs that we have been able to map and import at the carrier and plan level
Import Errors – The number of errors that we find in each import. Clicking on this number will allow you to see the actual errors that occurred during the imports.

Some Notes

  • The green/red for plus or minus is based on the difference from the last import that was ran. We download, connect, and count about 1TB weekly
  • When there is 1 import error it most likely means we can’t access the data for a given carrier. Either the carrier did not supply a url for the data or that the url itself is not accessible
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