Transparency In Coverage – What You Need To Know
The TRANSPARENCY IN COVERAGE RULE was issued in 2020 by the US Department of Health and in force beginning 7/1/22. While the effective date is near, clarifications are still being made.
In short, the rule requires is that all companies with employer sponsored health plans must include a link on their website that has health plan pricing information.
This link leads to machine-readable files that include negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The files are formatted to allow researchers, regulators and application developers to more easily access and analyze data.
The purpose is so these researchers and app developers can help consumers better understand the costs associated with their healthcare. For now, the files aren’t meant for members to access but eventually there will be additional file links that are user friendly.
The good news is that once an employer establishes the link on their website, it is the carrier or TPA (third party administrator’s) responsibility to maintain the files and keep them updated with current information.
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