NDBanks Benefit Trust

Transparency in
Coverage Rule

The Departments of Health and Human Services, Labor and the Treasury previously 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 that 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.

The price comparison tool is required to be delivered by January 1, 2023. In addition, the Departments have indefinitely delayed enforcement of the requirement to produce machine-readable files containing negotiated rates for in-network prescription drugs as the Departments are working to issue additional rules governing this requirement.

Machine Readable Files

The intent of this regulation is to provide health care pricing information that supports more informed decisions for receiving care.

BCBSND will provide the following machine-readable files, which are files where data is formatted in a way that can be processed by a computer, online:

• In-network provider rates for covered services.
• Out-of-network allowed amounts and billed changes for covered services.

BCBSND will provide public access to machine readable files that provide in-network provider rates for covered services. This information will be available effective July 1st by visiting the Transparency in Coverage website.