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Related Concept Videos

Health Information Technology and Healthcare Information System01:30

Health Information Technology and Healthcare Information System

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Nurses bear specific legal responsibilities under several federal statutes, including:
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Issues And Trends In Healthcare Delivery System01:29

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Reporting and recording are crucial in data documentation. The timely, thorough, and accurate documentation of facts is essential when recording patient data. Failure to record findings during an assessment or interpretation of a problem will result in loss of information and make the patient document unreliable. The reader is left with general impressions if the information is not specific. A recording is documenting data of the individual's health information in a traceable, secure, and...
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  1. Home
  3. Research Domains
  5. Commerce, Management, Tourism And Services
  7. Accounting, Auditing And Accountability
  9. Accounting Theory And Standards
  11. Price Transparency With Gaps: Assessing The Completeness Of Payer Transparency In Coverage Data.
  1. Home
  3. Research Domains
  5. Commerce, Management, Tourism And Services
  7. Accounting, Auditing And Accountability
  9. Accounting Theory And Standards
  11. Price Transparency With Gaps: Assessing The Completeness Of Payer Transparency In Coverage Data.

Related Experiment Video

Inverse Probability of Treatment Weighting Propensity Score using the Military Health System Data Repository and National Death Index
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Inverse Probability of Treatment Weighting Propensity Score using the Military Health System Data Repository and National Death Index

Published on: January 8, 2020

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Price transparency with gaps: assessing the completeness of payer Transparency in Coverage data.

David B Muhlestein1, Yuvraj Pathak

  • 1Simple Healthcare, 465 N Carolina Run, Sanford, FL 32773.

The American Journal of Managed Care
|January 9, 2026

View abstract on PubMed

Summary
This summary is machine-generated.

The 2025 Transparency in Coverage (TIC) negotiated-rate files offer usable data for physician and hospital outpatient services but lack sufficient detail for inpatient care. Payers like Aetna and Cigna performed better than UnitedHealthcare in data completeness.

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Related Experiment Videos

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The Participant-Reported Implementation Update and Score PRIUS: A Novel Method for Capturing Implementation-Related Data Over Time
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Area of Science:

  • Health economics
  • Healthcare policy
  • Health informatics

Background:

  • The Transparency in Coverage (TIC) rule mandates payers to disclose negotiated rates.
  • Accurate and complete data is crucial for market analysis and patient cost estimation.
  • Previous assessments highlighted variability in data quality and completeness.

Purpose of the Study:

  • To evaluate the completeness of 2025 Transparency in Coverage (TIC) negotiated-rate files.
  • To assess data quality for physician, hospital outpatient, and hospital inpatient service lines across major national payers.

Main Methods:

  • A cross-sectional descriptive review of 2025 TIC data releases from Aetna, Cigna, and UnitedHealthcare.
  • Data cleaning, parsing, and deduplication were performed.
  • Network size and negotiated rate completeness for common billing codes were calculated and compared to marketing materials.

    • Main Results:

    • Aetna and Cigna generally met or exceeded network size claims, while UnitedHealthcare listed fewer providers.
    • Negotiated-rate completeness was highest for physician services and lowest for inpatient services.
    • Physician and hospital outpatient data were mostly usable, but inpatient data was insufficient for benchmarking.

    Conclusions:

    • 2025 TIC files are suitable for analyzing physician and hospital outpatient pricing but not for inpatient benchmarking.
    • The Centers for Medicare & Medicaid Services (CMS) should audit TIC file completeness and enforce penalties for non-compliance.