HMSA Transparency in Coverage

In 2020, the federal government issued the Transparency in Coverage Rule (85 FR 72158), which requires health plans and insurance issuers to disclose certain pricing information for items and services that aren’t benefits under non-grandfathered plans in the individual and group markets. The rule is effective for plan years starting on or after Jan. 1, 2022.

Under the regulation, providers’ rates must be disclosed to the public each month. This includes negotiated rates with in-network providers, as well as provider charges and amounts previously paid to out-of-network providers. Amounts paid to out-of-network providers will reflect historical billed charges and allowed amounts paid three to six months before the publication date.

The data must be reported in the machine-readable (computer-readable) format specified in the final ruling’s technical implementation guide. As required, this data is published on a publicly accessible website, available to any person free of charge, and updated monthly.

To link to the machine-readable files, please click on the URL provided: