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).
January 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.