Transparency in Coverage Final Rule (85 FR 72158-01)

On 11/12/2020, the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury published the Transparency in Coverage Final Rule (85 FR 72158-01). The Transparency in Coverage Rule requires that group health plans and health insurance issuers provide in-network provider negotiated rates and historical out-of-network allowed amounts as machine-readable files to members and to the public in order to help members make informed decisions about their healthcare.

 

Enforceable beginning 7/1/2022, the first phase of the Transparency in Coverage Rule requires group health plans and health insurance issuers to:

  • Publicly disclose negotiated rates for in-network providers and allowed amounts for out-of-network providers
  • Provide the information in machine-readable files posted on a publicly available internet site for viewing

 

For examples of the in-network pricing machine-readable files that will be available beginning on or after 7/1/2022, click here.

 

The group-specific in-network and out-of-network pricing machine-readable files will be made available effective on a group’s renewal date beginning on and after 7/1/2022; therefore, groups with renewal dates from 1/1/2022 – 7/1/2022 will be included in the files that are available beginning 7/1/2022.

 

For additional information related to the Transparency in Coverage Rule including how to better understand and read the machine-readable files, visit https://github.com/CMSgov/price-transparency-guide.

 

Please note the machine-readable files could potentially change based on additional issued guidelines. Blue Cross will make any necessary updates as needed.