Healthcare guide
Price transparency rules explained
Federal rules now require hospitals and most health plans to publish pricing information.
Key federal rules
| Rule | Who it applies to | What it requires |
|---|---|---|
| Hospital Price Transparency (in effect since Jan 1, 2021) | Hospitals | A machine-readable file of standard charges, including negotiated rates and discounted cash prices, plus a consumer-friendly list of shoppable services (or a price estimator tool). |
| Transparency in Coverage (files since July 1, 2022) | Most group health plans and health insurers | Public machine-readable files of in-network negotiated rates and out-of-network allowed amounts, plus an online cost-estimate tool for members, phased in from 2023. |
| No Surprises Act (in effect since Jan 1, 2022) | Providers, facilities and plans | Protection from many surprise bills, and Good Faith Estimates for uninsured and self-pay patients. |
Summary only. See CMS.gov for full requirements.
Why it mattered to BrightPay
BrightPay’s eligibility and transparency tool drew on new rules and regulations around data interoperability to bring pricing and insurance data into the app. Read more.
General information only, not medical, legal or financial advice. Rules change; check official sources such as CMS.gov and HealthCare.gov, or ask a professional.
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