Transparency in Coverage Rule

The Transparency in Coverage rule is a federal regulation that took effect July 2022 requiring health plans to publish their negotiated rates and out-of-network allowed amounts in Machine-Readable Files (MRFs) on a monthly basis. A second phase, effective January 2023, requires plans to offer members a personalized cost-estimator tool for a growing list of covered items and services.

The MRF portion was the earthquake. Before TiC, negotiated rates were trade secrets — providers and payers alike treated them as commercially sensitive information that no one outside the contract negotiation could see. TiC forced all of that into the open. Every plan and every carrier now posts JSON files (frequently in the tens or hundreds of gigabytes) listing every negotiated rate with every provider for every service code. The data quality is uneven and parsing it requires specialized infrastructure, but the raw information is public. This is the foundational data that price transparency tools — including TruePrice — are built on. The consumer cost-estimator tool requirement is more directly member-facing but has had less immediate impact because most plans built minimalist compliance tools rather than genuinely useful shopping interfaces.

The takeaway: if you're a self-funded employer, your TPA can now access the underlying MRF data for your specific network. Use it at renewal, at plan design, and at member steering — the rates are there, they just have to be pulled and interpreted.