Main Library
Following July 1, 2022, most group health plans and issuers of group or individual health insurance across the country are required to disclose pricing information of negotiated rates for healthcare services between insurer and provider under the new Federal Price Transparency Rule (The Rule). The stated purpose of The Rule is “empowering consumers with the necessary information to make informed health care decisions.”
However, provider organizations, especially those that currently have value-based care arrangements or those looking to engage in value-based care arrangements, can also benefit from price transparency data.
Machine-Readable Files derived from the payers under The Rule reveal the costs for items and services related to in-network rates and allowed amounts. Provider organizations can understand the rates for each specialist in the geographic area, by payer. Insights derived from this data helps to understand how peer organizations are being reimbursed within a provider network; this information will be helpful as provider organizations look to complete fee-for-service contract negotiations. Pricing information can be combined with quality information to identify high-value providers. This information will be instrumental in helping to negotiate fair-market value rates.