Transparency in Coverage

Machine Readable Files

The Departments of Health and Human Services, Labor, and the Treasury have finalized a Transparency in Coverage rule that requires health plans to create a patient-facing price comparison tool and post publicly available machine-readable files which include negotiated rates for covered services for in-network providers, historical payments to and charges from out-of-network providers for covered items and services, and negotiated rates for in-network prescription drugs.

Delivery of the price comparison tool is required by January 1, 2023. The requirement to produce machine-readable files containing negotiated rates for in-network prescription drugs has been delayed while the Departments work to issue additional rules governing this requirement.

Our claims administrator, BCBSND, provides public access to machine-readable files that provide in-network provider rates for covered services. The information is available from the BCBSND website on the Transparency in Coverage page here.

Price Comparison Tool

The Departments of Health and Human Services, Labor and Treasury previously finalized a Transparency in Coverage rule that requires health plans to create a patient facing price comparison tool. The intent of this regulation is to provide health care pricing information for individuals to make more informed decisions about their care.

BCBSND will provide a self-service price comparison tool that will be available online through the member portal. Individuals call also request pricing by calling the contact center. As of January 1,2023, your employees will be able to compare pricing for the 500 most common shoppable services.