At the heart of our discussion is the Transparency in Coverage Rule (TiC Rule), a groundbreaking policy aimed at enhancing healthcare pricing transparency. This initiative empowers consumers to make informed decisions by mandating that health insurers and group health plans disclose detailed price and cost-sharing information. It requires access to personalized out-of-pocket cost estimates and negotiated rates for all healthcare services and items via online platforms.

The TiC Rule requires the publication of two types of public, machine-readable files (MRFs). The first file provides comprehensive details on negotiated rates for covered services and items between insurers or plans and in-network providers. The second file offers insights into historical payments and billed charges from out-of-network providers. The significance of these Payer MRFs should not be understated, as they serve several critical purposes in the realm of healthcare pricing:

1. Consumer benefits via online shopping tools

2. Clarity on contracted rates promotes competition

3. Driving analysis and comparison by healthcare stakeholders

Deerhold is at the forefront of leveraging these Payer MRFs to promote pricing transparency within the healthcare industry with our PRIZM Shopping and PRIZM Rates Products.  PRIZM Shopping offers self-funded employer groups easy access to essential healthcare cost information, including employee cost shares and deductible tracking. Meanwhile, PRIZM Rates serves as a comprehensive resource for contracted rates between providers and payers that can be used by providers, brokers, and payers, analyzing and presenting payer MRFs in an accessible format, thus eliminating confusion ghost rates and facilitating informed decision-making. Engage Pete Titas to learn more!

We look forward to tackling transparency again with you next Tuesday!