Effective July 1, 2022
Transparency in Coverage: Machine Readable Files
As of July 1, 2022, health plans will be posting links to pricing information for all items and services covered under the health plans. This information, available above as Machine Readable Files, includes:
- In-network negotiated payment rates, and
- Historical out-of-network allowed amounts
Data in these files will be in the JSON file format and will be updated monthly.
Initial Reporting Due December 27, 2022
Transparency in Coverage: Drug Cost Reporting
The Consolidated Appropriations Act (CAA) and the No Surprises Act (NSA) promote greater transparency in health care spending. To comply with the Drug Cost Reporting requirements of the NSA, plans and issuers must submit certain information related to prescription drug and other health care spending to Centers for Medicare & Medicaid Services (CMS). Reporting for the 2020 and 2021 calendar years are due December 27th, 2022. Reporting for the 2022 calendar year is due June 1, 2023 and annually thereafter.