Transparency in Coverage Rule Information

Eliassen Group is sharing this information regarding rate transparency and negotiated rates for medical services.

The Transparency in Coverage Rule issued by the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury gives consumers the tools needed to access pricing information through their health plans. As of July 1, 2022, most non-grandfathered group health plans or health insurance issuers offering non-grandfathered health insurance coverage in the individual and group markets will be required to make available to the public, including stakeholders such as consumers, researchers, employers, and third-party developers, three separate machine-readable files that include detailed pricing information.

The first file will show negotiated rates for all covered items and services between the plan or issuer and in-network providers. The second file will show both the historical payments to, and billed charges from, out-of-network providers. Historical payments must have a minimum of twenty entries in order to protect consumer privacy. And, finally, the third file will detail the in-network negotiated rates and historical net prices for all covered prescription drugs by plan or issuer at the pharmacy location level. Plans and issuers must display these data files in a standardized format and will provide monthly updates. These files are required to be made public for plan years that begin on or after January 1, 2022.

Through UnitedHealthcare, UMR and HealthSCOPE Benefits creates and publishes the Machine-Readable Files on behalf of Eliassen Group.

To link to the Machine-Readable Files, please click on the following URL: transparency-in-coverage.uhc.com

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