Transparency In Coverage

Work Group

Project Lead(s)

Project Status


Project Deliverables

Data warehouse for insurance cost-sharing data


HMS Department

Health Care Policy

Project Description

In 2020, the Federal Government finalized the “Transparency in Coverage” Rule, which requires health insurers and group health plans, including self-funded clients, to provide cost-sharing data to consumers via monthly uploaded machine-readable files. These files provide pricing data for covered items and services based on in-network negotiated payment rates and historical out-of-network allowed amounts. This rule seeks to grant actionable price and quality transparency to consumers where historically there has been none. The Transparency In Coverage project aims to collect the machine-readable files from 8 commercial insurers using web crawlers and store them in a centralized, structured database, enabling users across HMS to access them as needed for research studies, making terabytes of data more accessible to researchers than ever before.