Transparency in Coverage: Unlocking Clear, Accessible Pricing for All
Empowering Customers with the Healthcare Data They Deserve
Advancing Smarter Healthcare Choices
What is Transparency in Coverage?
The Transparency in Coverage (TiC) rule, initially passed in 2020 and fully enforced in 2023, requires healthcare plans and issuers to disclose price and cost-sharing information to plan participants, beneficiaries, and enrollees.
Specifically, the ruling demands real-time, personalized access to cost-sharing information through digital, internet-based self-service tools—empowering customers with the data they need to make better-informed decisions about their care. (Since July 2022, this data must also be available in machine-readable files [MRFs]).
In addition, the ruling requires that plans and issuers disclose the following on a public website:
- In-network negotiated rates
- Billed charges and allowed amounts paid for out-of-network (OON) providers
The Transparency in Coverage regulations are part of a larger effort by the U.S. federal government to improve healthcare pricing transparency, an initiative also supported by the No Surprises Act.
The goal: Drive innovation; support informed, price-conscious decision-making; and promote competition in the healthcare industry.
Stay Compliant with Expert Guidance
How Vālenz Health® Ensures TiC Compliance
As the leading platform to simplify healthcare, Vālenz Health® provides full transparency into the healthcare process, using America’s largest cost, quality, and utilization dataset to improve provider selection and decision-making—and to ensure Transparency in Coverage compliance for all of our clients.
From member engagement and transparency to out-of-network claims processing and payment, we enable full compliance through every step of the healthcare journey.
In compliance with TiC regulations, Valenz Bluebook provides transparent cost comparisons for healthcare procedures, providers, and facilities. Members can review a substantial database of information to find providers who charge a Fair Price™ and deliver high-value care.
Our Fair Price estimates are based on real claims data from thousands of shoppable procedures and are risk- and volume-adjusted for accuracy.
Members can also search the database by procedure to view Fair Price estimates (as well as other cost and quality information) for specific facilities and doctors who perform that procedure. In addition, they can search by facility to see estimated procedure charges, a list of contracted providers, and other cost and quality information.
Finally, as outlined by TiC rules, we also deliver the necessary MRFs to health plans or their data aggregator partners to support development of additional price comparison tools.
As a long-time champion of transparency, Valenz has always prioritized giving members the data they need to make informed decisions—a focus that informs every aspect of our fully integrated suite of healthcare solutions.
Valenz Bluebook allows members to easily find and compare in-network providers and Valenz-friendly providers. Our “green-yellow-red" quality rankings system gives members a clear view of their options, highlighting those procedures, providers, and facilities that provide high-value care at an affordable price.
We also deliver the required MRFs (augmented with GIS information, if available) to health plans and/or their data aggregator partners.
Your Solution to TiC Requirements
Valenz Bluebook Comply:
An All-in-One Tool for TiC Compliance
Staying compliant with the Transparency in Coverage rule is an ever-evolving, high-stakes challenge for health plans, third-party administrators, and self-insured employers.
Why not let our experts take on the responsibility for you?
Valenz Bluebook Comply is a comprehensive compliance solution that addresses critical mandates of the Transparency in Coverage rule and No Surprises Act, including price comparison tools and MRFs.
Built by industry experts who are actively involved with federal legislators and policy makers, Bluebook Comply is more than just a checklist; it's a strategic addition to your benefits strategy that delivers enhanced value beyond simple compliance.
Delivering Smarter, Better, Faster Healthcare
Improve Transparency and Care Outcomes with Vālenz Health®
Stay compliant with Transparency in Coverage regulations—and optimize the entire healthcare journey for patient, payer, provider, and plan—with our fully integrated solutions suite.
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