Dive Brief:

• National insurers are generally good at making accurate negotiated rate data available in compliance with federal price transparency rules, although there’s still room for improvement, according to a new analysis from transparent pricing company Turquoise Health.
• That’s likely due to large payers having more resources to issue and monitor machine-readable files of rates. Small and regional payers tend to be less successful, Turquoise found.
• Still, the company cautioned the results should not be taken as a true measure of compliance, given only states or the HHS can determine that. Instead, Turquoise said its goal with the report is to prevent payer transparency from stagnating or worsening by creating more accountability.

Dive Insight:

Hospitals and health insurers are required to post machine-readable files of pricing information for healthcare items and services under rules finalized by the first Trump administration. The goal of the rules is to make it easier for patients to compare options, hopefully leading to patients trafficking lower-cost facilities and incentivizing more expensive providers to lower prices.

The regulations have had measurable effects — but only for patients looking for specific services, instead of tamping down on healthcare costs more broadly, according to Brookings research published this fall.

This mixed success is complicated by the fact that price transparency compliance is low and continues to drop, at least among hospitals. It’s trickier to track insurer’s compliance with the rules, in part because it’s more difficult for insurers to follow them, price transparency experts say.

Insurers have to disclose hospital and non-hospital rates for “all items and services,” meaning there’s a whopping amount of information they need to publish and maintain. Payers also have national, regional and statewide networks, yet their industry-specific rule, called “Transparency in Coverage,” doesn’t include any explicit requirements that they need to identify which posted files correspond to which networks.

As a result, insurers often dump as much information as possible, a strategy Carol Skenes, Turquoise’s chief of staff, called “when in doubt, post as many rates as you can” during a media briefing on the company’s new data.

Turquoise tracks URLs that house machine-readable files, or MRFs, for 219 payers that it says represent the majority of covered lives and rates in the U.S. The company has now assigned transparency scores to 97 payers, focusing primarily on the largest insurers, with ratings ranging from “excellent” — meaning their files are complete, high-quality and usable — to “missing,” where no data is reported at all.

Turquoise found three common areas for improvement.

For one, 28% of the payers included in its analysis had more than 50% conflicting rates, meaning there were multiple dollar values associated with a single line item, making it impossible to tell which is the proper rate. Conflicting rates was the biggest common problem across the data files, Turquoise found.

Outlier rates, or rates that appear too high or too low to be accurate — like reporting $0.01 for a high-acuity service like an organ transplant — were also an issue.

Though not as frequently seen as conflicting rates, outlier rates still popped up in virtually every file, Turquoise found. Specifically, 10% of payers reported more than 10% outlier rates, while 4% of payers reported more than 25%. 

Finally, Turquoise tracked parsability, which measures whether files could be pulled automatically and if they worked as expected. Parsability, which can stand in for whether insurers are making a good-faith effort to comply with price transparency efforts, is fairly high: 94% of payers were highly parsable, the company found.

Overall, national payers tended to perform better than payers at the state or regional level. For example, Cigna’s MRFs are 100% parsable, while UnitedHealthcare’s and Aetna’s are at 99%.

UnitedHealthcare, Cigna and Elevance all have outlier rates under 5%. CVS-owned Aetna, however, struggles with conflicting rates, reporting almost 60%, Turquoise found.

“This is an area that they really need to make some improvements on” so that people are “able to distinguish what the truth is,” said Leland Robbins, Turquoise’s senior director of data products, during the briefing.

Turquoise has gotten positive feedback from insurers on its compliance tracking data, representatives said, noting that the mixed compliance evident in the data is likely more an indictment of how complex U.S. reimbursement is.

”Payers, by and large, they want to comply here,” Robbins said.

Policymakers could help. According to Turquoise, issues like conflicting rates could be ameliorated by making changes to the reporting schema, like creating a designated field to identify the specific location of rate. Regulators could also close gaps in reporting requirements, by adding stop-loss reimbursement and non-rate data, the company said.

Prior to the government shutdown, there has been momentum this year to improve compliance. Following an executive order from President Donald Trump in February, HHS and other departments updated guidance for Transparency in Coverage compliance and schema for payer’s MRFs, along with other changes for hospitals. The CMS also proposed a rule in July that would clarify expectations for MRFs, but it has yet to be finalized.

Additional near-term action is unlikely given the government shutdown, now in its fifth week.

Skenes said that if July’s rule is finalized or if regulators post additional guidance around MRF schema, that could indicate momentum heading into next year on price transparency.

“I do think we could see some 2026 movement on the requirements,” Skenes said. “But, yes. Not ideal timing, that’s for sure.”