If the new health plan price transparency requirements proposed by the Centers for Medicare & Medicaid Services are finalized later this year and implemented a year later, as anticipated, they will usher in significant changes in available data for use by consumers, providers, and businesses that collect, analyze, package, and sell such data.

The anticipated changes in transparency requirements could include:

• Specific identification of rate changes from the most recently published rate.
• Reduced file sizes that eliminate some currently required data and a requirement that health plans post a single in-network file for each provider network instead of a file for each plan they offer.
• The elimination of so-called ghost rates – rates that plans list but never actually pay because the provider associated with a rate does not provide the service the rate covers.
• Additional data elements, such as enrollment data for each in-network plan.
• A list of all services for which providers were actually paid over the previous year.
• The posting of more recent out-of-network reimbursement data.
• A reduction in the frequency with which such data must be posted, from monthly to quarterly.

Learn more about how new anticipated regulations could change how health plans fulfill their price transparency posting obligations from the Health Affairs Forefront article “Taking Stock Of Proposed Updates To Health Plan Price Transparency Rules.”