SOMC Pricing Results
V3 Run (2026-04-08)
Background: We discovered that the CSLI table contained duplicates due to additional lines with revenue code differentiation, which caused all benchmarking results to appear inflated. After identifying this (indicated by uniformly high benchmarking across the board), we resolved the issue and reran the QA pipeline. Results below reflect the corrected run.
QA App: SOMC Pricing QA Dashboard
Customer Details
| Field | Value |
|---|---|
| Customer Name | somc |
| Org ID | 730 |
| Charge Multiplier | 0.50 |
Pre-Processing Test Results
Test 1: Error in Notes Field
| Status | Count | Δ vs V2 | Notes |
|---|---|---|---|
| PASSED | 0 | — | No records containing errors in line_item_price notes field |
Resolution:
- No action needed
Test 2: Hospital Rates Plans Missing
| Status | Count | Δ vs V2 | Notes |
|---|---|---|---|
| FAILED | 23 | ↑ 19 | Found 23 payer/plan builds missing from line_item_price |
Resolution:
- @Evelyn Ting confirmed that there are some builds that are only MRF compatible. Removing this test from future runs.
Test 3: CSLI Subpackage Line Items Not Priced
| Status | Count | Δ vs V2 | Notes |
|---|---|---|---|
| PASSED | 0 | — | All subpackage line items were successfully priced |
Resolution:
- No action needed
Test 4: CSLI Subpackages Not Priced
| Status | Count | Δ vs V2 | Notes |
|---|---|---|---|
| PASSED | 0 | — | All subpackages were successfully priced |
Resolution:
- No action needed
Test 5: Duplicate Active Contracts
| Status | Count | Δ vs V2 | Notes |
|---|---|---|---|
| PASSED | 0 | ↓ 1 | No duplicate active contracts found |
Resolution:
- No action needed
Test 6: Pricing Flags
| Flag Type | Count | Δ vs V2 | Notes |
|---|---|---|---|
| ZERO_PRICE | 5 | ↓ 3887 | Found 5 line items with $0 pricing or extreme pricing ratios |
Resolution:
- [ ]
Post-Processing Test Results
Test 7: Zero Prices in Final Table
| Status | Count | Notes |
|---|---|---|
| PASSED | 0 | All output rows have non-zero prices |
Resolution:
- No action needed
Test 8: SSP Contract Prices vs Production Band
| Status | Count | Notes |
|---|---|---|
| FAILED | 3 | Found 3 SSPs with prices outside production p5-p95 band |
SSPs outside production p5-p95 band
| SSP ID | SSP Name | Above p95 | Below p5 | Total Non-Zero | p5 | p50 | p95 | N (prod) |
|---|---|---|---|---|---|---|---|---|
| RA010 | Mammogram | 13 (68.4%) | 0 (0.0%) | 19 | 262.30 | 525.33 | 1064.06 | 63,858 |
| RA005 | MRI without contrast | 9 (47.4%) | 0 (0.0%) | 19 | 594.82 | 1818.15 | 5448.24 | 79,026 |
| RA012 | Breast ultrasound | 0 (0.0%) | 1 (5.3%) | 19 | 280.31 | 554.24 | 1345.46 | 71,410 |
Full row-level detail: tq_dev.internal_dev_mmalhotra_pet.pricing_service_custom_ssp_somc_qa
Resolution:
- [ ]
Test 9: SSP Cash Prices vs Production Band
| Status | Count | Notes |
|---|---|---|
| PASSED | 0 | All SSP cash prices within production p5-p95 band |
Resolution:
- No action needed
Test 10: Professional Fee Pricing Coverage (Informational)
| Coverage % | Matched | Attempted | Detail Table |
|---|---|---|---|
| 20.4% | 31 | 152 | tq_dev.internal_dev_mmalhotra_pet.pricing_service_custom_ssp_somc_qa WHERE price_type = 'professional_coverage' |
Resolution:
- Informational only — no action required unless coverage target not met.
Test 11: SSPs Priced Below 5% of Charge
| Status | Count | Notes |
|---|---|---|
| PASSED | 0 | No SSPs priced below 5% of charge |
Resolution:
- No action needed
Test 12: SSPs Priced Above 200% of Charge
| Status | Count | Notes |
|---|---|---|
| PASSED | 0 | No SSPs priced above 200% of charge |
Resolution:
- No action needed
V2 Run (2026-04-03)
Customer Details
| Field | Value |
|---|---|
| Customer Name | somc |
| Org ID | 730 |
| Charge Multiplier | 0.50 |
Pre-Processing Test Results
Test 1: Error in Notes Field
| Status | Count | Δ vs V1 | Notes |
|---|---|---|---|
| PASSED | 0 | ↓ 338 | No records containing errors in line_item_price notes field |
Resolution:
- No action needed
Test 2: Hospital Rates Plans Missing
| Status | Count | Δ vs V1 | Notes |
|---|---|---|---|
| FAILED | 4 | ↑ 2 | Found 4 payer/plan builds missing from line_item_price |
| Payer | Plan Group | Issue |
|---|---|---|
| MOLINA HEALTHCARE | MEDICAID | In hospital_rates, no contract build in line_item_price |
| UHCCP | MEDICAID | In hospital_rates, no contract build in line_item_price |
| AETNA | CHP/MEDICAID | In hospital_rates, no contract build in line_item_price |
| HUMANA | OH MEDICAID | In hospital_rates, no contract build in line_item_price |
Resolution:
- [ ]
Test 3: CSLI Subpackage Line Items Not Priced
| Status | Count | Δ vs V1 | Notes |
|---|---|---|---|
| PASSED | 0 | — | All subpackage line items were successfully priced |
Resolution:
- No action needed
Test 4: CSLI Subpackages Not Priced
| Status | Count | Δ vs V1 | Notes |
|---|---|---|---|
| PASSED | 0 | — | All subpackages were successfully priced |
Resolution:
- No action needed
Test 5: Duplicate Active Contracts
| Status | Count | Δ vs V1 | Notes |
|---|---|---|---|
| FAILED | 1 | — | Found 1 payer/plan/provider combo with multiple active contracts |
| Payer | Plan Group | Duplicate Builds |
|---|---|---|
| Cigna | Commercial | Cigna_Commercial_MCF_2024_2025 | Cigna_Commerical_SOMC_2024_2025 |
Resolution:
- @Kavya Ravikanti is handling next steps for the multiple Cigna builds.
Test 6: No Match in Hospital Rates
| Status | Count | Δ vs V1 | Notes |
|---|---|---|---|
| FAILED | 1270 | ↓ 336 | Found 1270 line items with no match in hospital_rates |
Resolution:
- [ ]
Test 7: Multiple Matches in Hospital Rates
| Status | Count | Δ vs V1 | Notes |
|---|---|---|---|
| FAILED | 4767 | — | Found 4767 line items with multiple matches in hospital_rates (96.58% of total) |
Resolution:
- [ ]
Test 11: Pricing Flags
| Flag Type | Count | Δ vs V1 | Notes |
|---|---|---|---|
| ZERO_PRICE | 3892 | ↓ 338 | All flagged items are $0 pricing |
| UNDER_5_PCT | 0 | — | |
| UNDER_10_PCT | 0 | — | |
| OVER_200_PCT | 0 | — |
Sample ZERO_PRICE records
| Subpackage | Line Item | Priced Rate | Charge Amount | Payer | Plan | Build |
|---|---|---|---|---|---|---|
| 4809 | 17895 | 0.000 | 304.56 | Ambetter | Exchange | Ambetter_Exchange_MCF_2024_2025 |
| 4809 | 17895 | 0.000 | 304.56 | Medical Mutual Of Ohio | HMO/POS/PPO/Workers Compensation | MMO_Commercial, WC_MCF_2024_2025 |
| 4809 | 17895 | 0.000 | 304.56 | Buckeye | Individual/Medicaid | Buckeye_Individual_MCF_2024_2025 |
| 4809 | 17895 | 0.000 | 304.56 | United Healthcare | Non-Options | UHC_Options, Non-Options_MCF_2024_2025 |
| 4809 | 17895 | 0.000 | 304.56 | Anthem | HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional | Anthem_Commercial, Medicare Advantage_MCF_2025 |
Resolution:
- [ ]
Post-Processing Test Results
Test 8: Zero Prices in Final Table
| Status | Count | Notes |
|---|---|---|
Resolution:
- [ ]
Test 9: Benchmark vs Production SSPs
| Status | Count | Max Variance | Notes |
|---|---|---|---|
SSPs with >25% variance
| SSP ID | SSP Name | Output Avg | Prod Avg | Variance % |
|---|---|---|---|---|
Resolution:
- [ ]
Test 10: Benchmark vs Cash Prices
| Status | Count | Max Variance | Notes |
|---|---|---|---|
SSPs with >25% variance
| SSP ID | SSP Name | Output Avg | Prod Avg | Variance % |
|---|---|---|---|---|
Resolution:
- [ ]
V1 Run
Customer Details
| Field | Value |
|---|---|
| Customer Name | somc |
| Org ID | 730 |
| Charge Multiplier | 0.50 |
Pre-Processing Test Results
Test 1: Error in Notes Field
| Status | Count | Notes |
|---|---|---|
| FAILED | 338 | Found 338 records containing errors in notes field |
Resolution:
- Reviewed error messages in notes field. These are due to an EAPG schedule issue due to Medicaid.
- Confirmed with @Evelyn Ting we are good to move forward.
Test 2: Hospital Rates Plans Missing
| Status | Count | Notes |
|---|---|---|
| FAILED | 2 | Found 2 payer/plan builds missing from line_item_price |
Resolution:
- Reviewed the two builds (below). These are both Medicaid plans. Flagged to @Gillian Halpin and @Megan Leak in #proj-pet-2_0.
| MOLINA HEALTHCARE | MEDICAID |
|---|---|
| UHCCP | MEDICAID |
Test 3: CSLI Subpackage Line Items Not Priced
| Status | Count | Notes |
|---|---|---|
| PASSED | 0 | All subpackage line items were successfully priced |
Resolution:
- No action needed
Test 4: CSLI Subpackages Not Priced
| Status | Count | Notes |
|---|---|---|
| PASSED | 0 | All subpackages were successfully priced |
Resolution:
- No action needed
Test 5: Duplicate Active Contracts
| Status | Count | Notes |
|---|---|---|
| FAILED | 1 | Found 1 payer/plan/provider combo with multiple active contracts |
Resolution:
- Reviewed the duplicates (below). @Megan Leak confirmed this is expected for SOMC.
| 2484 | Cigna | Commercial | 2374 |
|---|---|---|---|
| 2484 | Cigna | Commercial | 532 |
Test 6: No Match in Hospital Rates
| Status | Count | Notes |
|---|---|---|
| FAILED | 1606 | Found 1606 line items with no match in hospital_rates |
Test 7: Multiple Matches in Hospital Rates
| Status | Count | Notes |
|---|---|---|
| FAILED | 4767 | Found 4767 line items with multiple matches in hospital_rates |
Resolution:
- Reviewed and saw 96% of total have duplicates. Flag to @Evelyn Ting.
Test 11: Pricing Flags
| Flag Type | Count | Notes |
|---|---|---|
| ZERO_PRICE | 4230 | All flagged items are $0 pricing |
| UNDER_5_PCT | 0 | |
| UNDER_10_PCT | 0 | |
| OVER_200_PCT | 0 |
Resolution:
- May be related to Test 1 errors or Test 6/7 hospital_rates matching issues. Flag to @Evelyn Ting.
Post-Processing Test Results
Will fill in after above are completed.
Test 8: Zero Prices in Final Table
| Status | Count | Notes |
|---|---|---|
Resolution:
- [ ]
Test 9: Benchmark vs Production SSPs
| Status | Count | Max Variance | Notes |
|---|---|---|---|
SSPs with >25% variance
| SSP ID | SSP Name | Output Avg | Prod Avg | Variance % |
|---|---|---|---|---|
Resolution:
- [ ]
Test 10: Benchmark vs Cash Prices
| Status | Count | Max Variance | Notes |
|---|---|---|---|
SSPs with >25% variance
| SSP ID | SSP Name | Output Avg | Prod Avg | Variance % |
|---|---|---|---|---|
Resolution:
- [ ]