Transparency in Coverage

On November 12, 2020, the U.S. Departments of Health and Human Services (HHS), Labor and Treasury issued a Final Rule entitled Transparency in Coverage (the Rule). The Rule is intended to increase the availability and transparency of health care price information to consumers to enhance market competition and lower health care prices. The Rule follows the Hospital Price Transparency final rule, which went into effect on January 1, 2021, and requires hospitals to make public a variety of pricing information. 

The Rule requires affected entities to: 

  • Make certain rate and pricing information available through machine-readable files 
  • Provide consumers with personalized cost sharing information, including estimates of their out-of-pocket (OOP) costs by service. 

Machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.

Link to Machine Readable Files