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The Departments of Health and Human Services, Labor, and Treasury have released newly finalized amendments to the Transparency in Coverage regulations, designed to improve the accessibility and standardization of healthcare pricing transparency.
In a fact sheet released on Oct. 5, the Centers for Medicare & Medicaid Services detailed the enhancements to the regulations originally set in 2020. Changes include amendments to how in-network and out-of-network rates are disclosed and accessed, aimed at reducing the persistent confusion Americans experience when shopping for healthcare.
As a longtime provider of compliance solutions, Vālenz Health® has been closely monitoring the changing regulations, including what they mean for our clients and their health plan members.
To that end, we've detailed some of the biggest takeaways from the finalized rules below — and how our team can support clients as they evaluate and implement the updated requirements.
Background: Transparency in Coverage Rules
As part of an executive order in 2019, the Trump administration set new standards for healthcare pricing transparency, which evolved into the Transparency in Coverage (TiC) rules and No Suprises Act (NSA).
These regulations require non-grandfathered group health plans and health insurance issuers to disclose certain in-network negotiated rates, out-of-network allowed amounts, and other pricing information. Separate federal Hospital Price Transparency requirements apply to hospitals. The TiC rules also require plans and issuers to provide consumers with access to personalized cost-sharing information.
In many cases, these requirements ended up easier said than done. The industry was slow to adopt the changes, prompting the administration to release a follow-up executive order in February 2025 urging the implementation and enforcement of the previously announced rules.
What the 2026 Finalized Rules Mean for Healthcare Insurers and their Partners
The newly finalized rules specifically address the existing implementation gap, based on three obstacles identified through internal assessment and external stakeholder feedback:
- Inaccessibility due to the large size of machine-readable files (MRFs)
- Data ambiguity due to lack of contextual information alongside raw data
- Areas of misalignment with the Hospital Transparency rule that hinder accurate data comparison
As a result, the finalized rules focus on accessibility and transparency of available pricing data, providing additional guidance for health plans and issuers to follow:
- Making Pricing Data Smaller, More Relevant, and Easier to Use: The new guidance rules require plans and issuers to exclude certain unlikely provider-service combinations and reduce duplicative reporting through network-level reporting. New Taxonomy and Utilization Files will provide additional context for pricing data.
- Expanding and Improving Out-of-Network Pricing Data: By lowering the existing 20-claims threshold for reporting to 11 claims, the new rules aim to boost the amount of out-of-network data available to plan members. Additional data elements are now required to provide additional context to allow for easier comparison by users.
- Improving Accessibility of MRFs and Pricing Data: Plans and issuers are now required to publish plain text files identifying the location of their MRFs and footer links on their websites to guide users to MRF locations and other TiC-required data.
- Reducing Publishing Frequency: In contrast to the monthly cadence set in the original TiC regulations, plans and issuers are now permitted to update in-network and out-of-network pricing data quarterly, allowing for more analysis time and a reduction in administrative burden.
- Standardizing Pricing Data: The final rules establish a single MRF format, with the Departments indicating that JSON will be specified through technical implementation guidance.
- Strengthening Accountability: The new rules require plans and issuers to certify that their MRFs are complete, accurate, and current, while also identifying the senior executive responsible for integrity.
A full listing of the final rules can be found in the Federal Register
The onus for most of these changes falls to group health plans or health insurance issuers, although third-party partners such as TPAs, claim adjudicators, and other vendors may be required to support gathering, analysis, and reporting of pricing data.
The finalized rules include rolling implementation deadlines as determined by amendment, with the first set for Jan. 1, 2027.
How Vālenz Health® Ensures TiC Compliance for Our Clients
Valenz has long been committed to supporting compliance efforts for our health plan clients and partners. With this latest ruling, we reaffirm that commitment and are evaluating the final rules across our applicable solutions and operations.
Our healthcare transparency and compliance capabilities — including Valenz Bluebook Comply — help clients navigate healthcare pricing and regulatory requirements. As the new TiC requirements are implemented, we will work with clients and partners to identify appropriate changes and support their compliance efforts where our services and data can help.
To learn more about these solutions and how Valenz can help you meet your compliance needs, contact one of our team members today.
