Transparency in Coverage is coming.

CMS has released rolling requirements for payer price transparency starting July 1st, 2022 through January 1st, 2024. Turquoise Health can not only help meet compliance requirements with our White Label Price Transparency platform, but also drive value-based care decisions for members.

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What’s in the payer regulation

Here is a high level timeline of requirements for payers. The full text of the rule is available here (PDF).

July 1st, 2022: Machine-readable files posted in public

  • In network all service file containing “negotiated rates for all covered items and services between the plan or issuer and in-network providers”
  • Out of network historical file containing “historical payments to, and billed charges from, out-of-network providers”
  • Pharmacy file containing “the in-network negotiated rates and historical net prices for all covered prescription drugs by plan or issuer at the pharmacy location level”

January 1st, 2023: User friendly patient estimate tool for 500 specified services.

January 1st, 2024: User friendly patient estimate tool for all items and services.

Turquoise Health can assist with efficient automation in complying with both the Machine Readable File and Patient Estimate Tool requirements.

There’s no need to build the same thing twice.

Turquoise Health wrote its first line of code for our service search tool in January of 2019. Not only do we already have our White Label tool on the market with provider clients, we use our code for our search engine. On our home page, we provide a market-wide search experience for patients to browse transparent rates already made public by the Hospital Price Transparency Final Rule.

By using our White Label Price Transparency solution, your platform’s capabilities grow as we add features to ours. This includes using machine learning algorithms to power our search and provide the best value search results to our members.

Let us provide the technical infrastructure while you manage your network, create member incentives atop the platform, and help navigate members to the best locations for care.

DIY Direct Contracting Engine

Expand your network of providers and offer more services to your members. Create straightforward rate agreements that eliminate underpayments, and do it all without PhD analysts, lawyers, and expensive consultants.

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Hospital Rates Data Platform

Discover how your rates match up to the market. Empower your team with one of the largest data sets of clean, structured hospital rate data.

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All the compliance, without the hassle.

We know the Transparency in Coverage rule looks burdensome. What if we took away the compliance burden and let you focus on using the regulation to drive value for your members?

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Price transparency resources for payers.

Regulation Fact Sheet

Here is a link to CMS’s fact sheet on the Transparency in Coverage regulation.

CMS’s Github for Transparency in Coverage

Unlike the provider rule, CMS has provided guidance for programmers via Github. View the repository here.

List of 500 Required Services for January 1st, 2023

Here is a list of 500 required outpatient, inpatient and pharmacy services required for the patient estimate tool starting in 2023.

See how your rates compare to the rest

With our Managed Care Benchmarking Engine, you can already get a glimpse of how you stand in the market.

Get ahead of the game

Though the compliance milestones may feel far away, it’s time to get ahead of the industry with sound strategy and tech. Learn how we make it easy.

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